Specialty Selection and Financial Considerations

[RunKid11]

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Just some background: I'm a third year student and for most of this year, have been debating between PM&R and IM. I'd like to do sports medicine, but also have an interest in allergy. I'm on my IM clerkship now and have not enjoyed the experience, so I'm a bit panicked. I wasn't able to rotate on PM&R this year and have it scheduled as my first rotation in August.

Pediatrics was one of my favorite rotations of third year, and probably the only one where seeing patients was something I looked forward too. I considered it briefly, but quickly realized that the finances of choosing to be a pediatrician really don't work. I'm going to graduate next year with approximately 220-225k in debt. From speaking with pediatric residents at my home institution (mid-size Midwest city), starting salaries for general peds range from 80-100k. The bump in pay with a fellowship seems to be minimal. The numbers, I'm assuming, are comparable if not worse in larger cities and on the coasts. I understand that in most contexts 80-100k would be plenty to live on, but with such a large debt load, paying down loans and saving money would be very difficult. PM&R, while not a hugely lucrative field, certainly offers better compensation.

Can anyone comment on the feasibility of choosing a low paying field and paying off sizable student loans? I'm not naive, and I understand that certain fields simply may not be realistic given the amount of debt I've accrued. A career in medicine is nothing close to the romantic picture that's painted on med school interview days, and I recognize the importance of making a pragmatic decision. Still, I don't want to close doors unnecessarily. Any input would be very helpful.

 

[BenzylAcetate]

220k is slightly low-average debt for students financing their entire educations through loans. Not to say that it is an insignificant amount of debt, but you aren't in a horrible place. Live off of 40k post tax income and it could be paid off in 3-4 years on 200k gross income. 80k seems incredibly low, is there some significant benefits package that adds a large hidden value to these positions? Is this just the reality of academic peds? If so, look into working outside of academics for a few years. My understanding was a starting peds salary was closer to 125-150k.

I'm not familiar with the specifics, but there are loan repayment programs for those going into primary care fields.

 

[RunKid11]

80k seems incredibly low, is there some significant benefits package that adds a large hidden value to these positions? Is this just the reality of academic peds? If so, look into working outside of academics for a few years. My understanding was a starting peds salary was closer to 125-150k.

I'm actually curious about these numbers too. Prior to rotating on pediatrics, I would have pegged a starting salary for general peds at 125-150k. I'm not sure if my current city is uniquely saturated, if the people that I've spoken with are limiting their job searches to academic institutions, or possibly that they're quoting salaries for part-time job offers. I suppose any of those are possible, but it makes me uneasy to assume that's the case without asking around on a place like sdn.

 

[TexasPhysician]

My friend just took a low paying pediatric academic position starting at 140k. He had higher offers elsewhere. Paying off the debt over time should be fine.

 

[The White Coat Investor]

Just some background: I'm a third year student and for most of this year, have been debating between PM&R and IM. I'd like to do sports medicine, but also have an interest in allergy. I'm on my IM clerkship now and have not enjoyed the experience, so I'm a bit panicked. I wasn't able to rotate on PM&R this year and have it scheduled as my first rotation in August.

Pediatrics was one of my favorite rotations of third year, and probably the only one where seeing patients was something I looked forward too. I considered it briefly, but quickly realized that the finances of choosing to be a pediatrician really don't work. I'm going to graduate next year with approximately 220-225k in debt. From speaking with pediatric residents at my home institution (mid-size Midwest city), starting salaries for general peds range from 80-100k. The bump in pay with a fellowship seems to be minimal. The numbers, I'm assuming, are comparable if not worse in larger cities and on the coasts. I understand that in most contexts 80-100k would be plenty to live on, but with such a large debt load, paying down loans and saving money would be very difficult. PM&R, while not a hugely lucrative field, certainly offers better compensation.

Can anyone comment on the feasibility of choosing a low paying field and paying off sizable student loans? I'm not naive, and I understand that certain fields simply may not be realistic given the amount of debt I've accrued. A career in medicine is nothing close to the romantic picture that's painted on med school interview days, and I recognize the importance of making a pragmatic decision. Still, I don't want to close doors unnecessarily. Any input would be very helpful.

My general rule is that your upper limit of the student loans to salary ratio should be 2. If you're really looking at $80-100K in salary and $200-225K in debt (probably more after residency BTW) you're beyond that. I'm not sure you can afford to take a job for $80K a year. Perhaps if you go down the PAYE/PSLF route (and PSLF doesn't change.)

I don't think it's that hard to make $200K in either IM or PM&R. Heck, I bet you can figure out a way to make $200K in peds.

Good luck with your choice. Remember it's important to consider salary and lifestyle, but it's also important to choose something you want to do the rest of your life. All else being equal, a longer career makes more money.

 

[sazerac]

How exactly does one make only $80K in pediatrics? That is so far below the median (100K is 14th percentile last time I checked) that there must be some significant extenuating circumstances.

Are we talking post tax, post 401k, post health insurance take home pay?
Are we talking the first year as an attending, when you spent 6 months at a resident salary?
Is this working only part time, like Friday afternoon plus all day Saturday?
Does this include 4 months unpaid paternity / maternity leave?

There is more to this story. Pediatric PA's can make more than that.

 

[RangerBob]

I don't know if it's something you thought about, but you can also do a peds PM&R fellowship. It extends residency by another 2 years (6 years total) and I believe generally pays the same as doing PM&R with now fellowship (I think spine and pain are the only two fellowships that actually increase your salary in PM&R--I'm not sure if sports does).

Personally, I would go with the specialty I really looked forward to everyday. Like the others, I think pediatricians get paid a good amount more--I know they're the lowest paid specialty, but $80,000 seems excessively low to me (especially for the midwest, which tends to pay more than other areas, often even with COL taken into account--everyone wants to work in CA or NYC, so they don't have to offer as competitive of salaries there). I'd investigate that salary further--perhaps talk with practicing private practice pediatricians.

But if that really is the case, it does seem like it'd be very hard to live off $80,000 (probably closer to $60,000 post-tax) and manage to repay $225k. Especially if you have a family and your spouse doesn't work.

 

[nogolfinsnow]

You have to find a field you enjoy. I picked peds because I really couldn't imagine doing another field, even though almost all of them pay more. I'm 10 days from finishing residency, and glad to say I still think I made the right decision. I tried to convince myself I'd enjoy IM or surgery, but it just wasn't happening. That said, my first primary care peds job pays more than double the lower end of your quoted salaries in a somewhat high but not crazy cost of living area, with a big benefits package on top of that. I'm not sure who is ripping off their pediatricians for $80k/year.

Just some background: I'm a third year student and for most of this year, have been debating between PM&R and IM. I'd like to do sports medicine, but also have an interest in allergy. I'm on my IM clerkship now and have not enjoyed the experience, so I'm a bit panicked. I wasn't able to rotate on PM&R this year and have it scheduled as my first rotation in August.

Pediatrics was one of my favorite rotations of third year, and probably the only one where seeing patients was something I looked forward too. I considered it briefly, but quickly realized that the finances of choosing to be a pediatrician really don't work. I'm going to graduate next year with approximately 220-225k in debt. From speaking with pediatric residents at my home institution (mid-size Midwest city), starting salaries for general peds range from 80-100k. The bump in pay with a fellowship seems to be minimal. The numbers, I'm assuming, are comparable if not worse in larger cities and on the coasts. I understand that in most contexts 80-100k would be plenty to live on, but with such a large debt load, paying down loans and saving money would be very difficult. PM&R, while not a hugely lucrative field, certainly offers better compensation.

Can anyone comment on the feasibility of choosing a low paying field and paying off sizable student loans? I'm not naive, and I understand that certain fields simply may not be realistic given the amount of debt I've accrued. A career in medicine is nothing close to the romantic picture that's painted on med school interview days, and I recognize the importance of making a pragmatic decision. Still, I don't want to close doors unnecessarily. Any input would be very helpful.

 

[mvenus929]

I looked up statistics on general pediatrics jobs: http://www.bls.gov/oes/current/oes291065.htm

75% of pediatricians make $125K or more. I suspect those who make less work part time or have other sources of income other than salary (grants, etc).

You are right that fellowships tend not to increase the salary much, but I suspect that a good part of that is because a lot of specialists, particularly in certain fields, end up working in academics and take a pay cut due to that.

 

[NICUfello]

I love being in Peds. After I finished my residence at Brown, I was offered Peds job 135-150K (LA/NYC/Boston)

I decided to to a fellowship.

Post fellowship first year salarys are 195-245+ bonus (LA/NYC/BOSTON).

My dad is a pediatrician in a Southern State, and makes more than post fellow Peds...in private practice....

 

[rkmoto121]

I love being in Peds. After I finished my residence at Brown, I was offered Peds job 135-150K (LA/NYC/Boston)

I decided to to a fellowship.

Post fellowship first year salarys are 195-245+ bonus (LA/NYC/BOSTON).

My dad is a pediatrician in a Southern State, and makes more than post fellow Peds...in private practice....

Might be a stupid question but what kind of fellowship do you do for peds? And does this change the way you practice or do you still practice as a primary care pediatrician?

 

[mvenus929]

Might be a stupid question but what kind of fellowship do you do for peds? And does this change the way you practice or do you still practice as a primary care pediatrician?

Any fellowship that you can do for IM you can also do for Peds. Except Geriatrics (obviously). Plus, you have 2 ICU options (NICU, PICU), and EM. I'm guessing @NICUfello did a fellowship in NICU (the critical care of neonates).

And yes, it changes the way you practice. Though some people keep their general peds certification current so they can also practice general peds, usually when they have a relatively low flow specialty (ID, for instance).

And not all general pediatricians practice as primary care pediatricians. There are also hospitalist pediatricians out there, though that's becoming more of a fellowship trained position as well.

 

[NICUfello]

Might be a stupid question but what kind of fellowship do you do for peds? And does this change the way you practice or do you still practice as a primary care pediatrician?

I am not a primary care pediatrician.

Reason I did 3 years of extra slave labor (i.e. fellowship) is so that I don't have to be a primary care pediatrician (not that there is anything wrong with that)....

I do keep my Gen Peds board certs..because you never know..but I am in a Level 3/Level 4 ICU