The Problem With Everything

[BLADEMDA]

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January 22, 2016, 11:00 am
Shortage of residency slots may have chilling effect on next generation of physicians


By Bruce Koeppen, M.D.


http://thehill.com/blogs/congress-b...idency-slots-may-have-chilling-effect-on-next

 

[criticalelement]

You people can bitch all you want to about this job but the fact remains we are paid in the top 1% of the nation in terms of income. Sure, the hospital CEO earns 2 x most MD salaries but for every one hospital CEO there are thousands of Physicians.

If you want to roll the dice go get your MBA and hope you land that coveted .1% management job or go to Medical School where even the bottom 5% of the class can still earn $200K plus for the rest of his/her career.

MBA= roll of the dice (odds aren't even that good) your salary exceeds a Physician

MD= upper middle class lifestyle 99% of the time

I think you are under estimating what people make dude because people who make a lot of money dont blab.

Just in my little world.... A recruiter I know.. 36 years old... Not even that good... showed me his tax return... 245k.. thats with just a bachelors degree.. The guy who took my car in and fixed it.. The service advisor.. Not the guy who fixes the car . Makes 95-100k the guy who gave me my loaner car and signed me up.. makes 90k.. the mechanic who has been there 5 plus years.. all making 140k plus... so i dont think you are the only one doing well. Plus they didnt have to go to school until the age of 35.. Sure being a mechanic is a physical job but 140 is damn good.. The avg salesman makes probably close to 100k

 

[deleted87051]

I think you are under estimating what people make dude because people who make a lot of money dont blab.

Just in my little world.... A recruiter I know.. 36 years old... Not even that good... showed me his tax return... 245k.. thats with just a bachelors degree.. The guy who took my car in and fixed it.. The service advisor.. Not the guy who fixes the car . Makes 95-100k the guy who gave me my loaner car and signed me up.. makes 90k.. the mechanic who has been there 5 plus years.. all making 140k plus... so i dont think you are the only one doing well. Plus they didnt have to go to school until the age of 35.. Sure being a mechanic is a physical job but 140 is damn good.. The avg salesman makes probably close to 100k

I don't understand your point. 90k? Seriously? A 75th percentile anesthesiologist makes that in 2 months. You could spend the rest of the year in Thailand.

In many parts of the US, 150k is a bare middle class existence. Not upscale in any way.

It may have been "a lot of money" in 1988 but not anymore. In 1988, a Mercedes S class was around 50k, tuition at my private med school was 16k, and an upscale home in La Jolla was 400k. The median published income for an anesthesiologist was around 160k. Now the equivalent Mercedes is 150k, tuition is 50k and the house is 2mil+. And an average anesthesiologist makes around 400k.

Americans need to get rid of the notion that 100k income is "a lot of money". That's how they get into trouble. 100k is the new 40k and 400k is the new 160k. And it's all middle class.

 

[Random Anesthesiologist]

I think you are under estimating what people make dude because people who make a lot of money dont blab.

Just in my little world.... A recruiter I know.. 36 years old... Not even that good... showed me his tax return... 245k.. thats with just a bachelors degree.. The guy who took my car in and fixed it.. The service advisor.. Not the guy who fixes the car . Makes 95-100k the guy who gave me my loaner car and signed me up.. makes 90k.. the mechanic who has been there 5 plus years.. all making 140k plus... so i dont think you are the only one doing well. Plus they didnt have to go to school until the age of 35.. Sure being a mechanic is a physical job but 140 is damn good.. The avg salesman makes probably close to 100k

My husband was a mechanic for 25 years, both auto and heavy equipment. They do not make 6 figures, unless in management for MANY years or own the business. Those people were flat out lying to you, or you live in an area with an unrealistic cost of living where all salaries are inflated.

 

[Mman]

I think you are under estimating what people make dude because people who make a lot of money dont blab.

Just in my little world.... A recruiter I know.. 36 years old... Not even that good... showed me his tax return... 245k.. thats with just a bachelors degree.. The guy who took my car in and fixed it.. The service advisor.. Not the guy who fixes the car . Makes 95-100k the guy who gave me my loaner car and signed me up.. makes 90k.. the mechanic who has been there 5 plus years.. all making 140k plus... so i dont think you are the only one doing well. Plus they didnt have to go to school until the age of 35.. Sure being a mechanic is a physical job but 140 is damn good.. The avg salesman makes probably close to 100k

I think you underestimate how much some physicians are making b/c they don't blab about it either. And no, the average sales job isn't making 6 figures.

Also, I seriously question a recruiter showing you their tax return. That's one of the oddest things I've ever heard.

 

[BLADEMDA]

I think you underestimate how much some physicians are making b/c they don't blab about it either. And no, the average sales job isn't making 6 figures.

Also, I seriously question a recruiter showing you their tax return. That's one of the oddest things I've ever heard.

High six figures is actually fairly common in my area for many specialties.

 

[Mman]

High six figures is actually fairly common in my area for many specialties.

The majority of our PP subspecialty surgeons are making 7 figures.

 

[PainDrain]

Americans need to get rid of the notion that 100k income is "a lot of money". That's how they get into trouble. 100k is the new 40k and 400k is the new 160k. And it's all middle class.

America is quickly becoming France circa 1789. We have a massive problem with economic inequality in this country and no one seems to actually be paying attention, or they don't like the potential fixes. Those like Blade who have been in practice for 20 years have it made because they went through training when med school and college were relatively cheap and the salaries were still high compared to cost-of-living. My generation and those below graduate with an average of 170K worth of debt and then consider current housing prices and salaries and we are no longer living like the top earners. We are middle class and likely stuck. France was stable when the Bourgeoisie were content with what they had; France burned when the Bourgeoisie realized they were getting screwed.

Hell, I know people who make probably 75K a year but their lifestyle and assets far exceeds mine. They have 6-7 rental properi and more toys then I could imagine. The difference between us is that they don't piss away 35K-40k a year paying back student loans. They graduated from college with little debt and have ten years of earning behind them.

 

[Mman]

America is quickly becoming France circa 1789. We have a massive problem with economic inequality in this country and no one seems to actually be paying attention, or they don't like the potential fixes. Those like Blade who have been in practice for 20 years have it made because they went through training when med school and college were relatively cheap and the salaries were still high compared to cost-of-living. My generation and those below graduate with an average of 170K worth of debt and then consider current housing prices and salaries and we are no longer living like the top earners. We are middle class and likely stuck. France was stable when the Bourgeoisie were content with what they had; France burned when the Bourgeoisie realized they were getting screwed.

Hell, I know people who make probably 75K a year but their lifestyle and assets far exceeds mine. They have 6-7 rental properi and more toys then I could imagine. The difference between us is that they don't piss away 35K-40k a year paying back student loans. They graduated from college with little debt and have ten years of earning behind them.

you strike me as someone who doesn't understand finance. Rental properties are income generators, not sunk costs. So when you say they earn 75K, you mean their real job. They probably earn another 50K from their rental properties.

You'd probably also be surprised at what middle class actually is. As a physician I can assure you your income is greater than the 50th percentile nationally. It's probably at least 90th percentile.

 

[Carbocation1]

There is currently a PP posting on GASWORK offering 600K for solo GAS in the heart of downtown Manhattan, Q15 call, 100% solo cases. Is there a catch? Will these kinds of job opportunities exist in 5-10 years? Many thanks.

http://gaswork.com/post/188311

 

[PainDrain]

you strike me as someone who doesn't understand finance. Rental properties are income generators, not sunk costs. So when you say they earn 75K, you mean their real job. They probably earn another 50K from their rental properties.

You'd probably also be surprised at what middle class actually is. As a physician I can assure you your income is greater than the 50th percentile nationally. It's probably at least 90th percentile.

No, those properties break even, trust me on that. So that 75K income is about right. The person I reference is a perfect example of someone who timed things correctly. He bought all these places just before the market uptick in 1999 and then again after things crashed in 2007. He never would have been able to do this in today's market in this area. I don't know if you have any experience with rental properties but unless it's a new, well built home, it is a PITA. You constantly have to fix things (typically 10-15% of home value per year) and unless you hire a management company (sucking up an additional 5-10%); you are left doing the maintenance. Sure you can rent it yourself and then let the home degrade over time but that doesn't make sense long term.

 

[Mman]

No, those properties break even, trust me on that. So that 75K income is about right. The person I reference is a perfect example of someone who timed things correctly. He bought all these places just before the market uptick in 1999 and then again after things crashed in 2007. He never would have been able to do this in today's market in this area. I don't know if you have any experience with rental properties but unless it's a new, well built home, it is a PITA. You constantly have to fix things (typically 10-15% of home value per year) and unless you hire a management company (sucking up an additional 5-10%); you are left doing the maintenance. Sure you can rent it yourself and then let the home degrade over time but that doesn't make sense long term.

I have experience renting properties. They aren't a break even. If they were you'd sell them. Also not sure what planet you spend 10-15% of the value of a home each year on fixing things. In my experience it's more in the range of 1-3% at most. I mean 15%? You think a $300K house needs $45K of repairs each year????????

 

[PainDrain]

You are right, more like 1-5%.

 

[Consigliere]

So who ends up with a larger cash stash?


*The ER doc completed a 4 year residency, and did not pay anything on loans during residency, letting interest accrue at 6.8%. You are welcome to use this image elsewhere, just make sure you provide a link back to this page

http://debtanatomy.com/is-an-md-worth-it/

This graphic is stupid. How do you go from finishing residency with $286,226 in debt to being debt free in 2 years? Living in a cave? There are probably 0.000001% of newly minted doctors with enough discipline to accomplish this. Your hero Dave Ramsey might be able to pull it off, but mere mortals cannot.

 

[Mman]

This graphic is stupid. How do you go from finishing residency with $286,226 in debt to being debt free in 2 years? Living in a cave? There are probably 0.000001% of newly minted doctors with enough discipline to pull this off. Your hero Dave Ramsey might be able to pull it off, but mere mortals cannot.

the small print at the top mentions both professions living on 50K per year. That's how you'd do it. Choosing to do that is a different question.

 

[Notorious T.E.E.]

This graphic is stupid. How do you go from finishing residency with $286,226 in debt to being debt free in 2 years? Living in a cave? There are probably 0.000001% of newly minted doctors with enough discipline to accomplish this. Your hero Dave Ramsey might be able to pull it off, but mere mortals cannot.

In anesthesiology this is VERY doable if you pick the right job. A few years in Kansas is a small price to pay to be debt free. I have seen several people do it successfully.

 

[deleted87051]

In anesthesiology this is VERY doable if you pick the right job. A few years in Kansas is a small price to pay to be debt free. I have seen several people do it successfully.

I've seen it done in California. You don't have to move to Kansas.

 

[deleted162650]

I've seen it done in California. You don't have to move to Kansas.

Yes, you could do it in CA (remember it's a huge state and a lot of it is BFE and undesirable), but you would be an idiot for doing so. Go someplace without a stupid high state income tax (or better yet no state income tax) and put an extra 30-50k in your pocket every year.

 

[calvnandhobbs68]

Hell, I know people who make probably 75K a year but their lifestyle and assets far exceeds mine. They have 6-7 rental properi and more toys then I could imagine. The difference between us is that they don't piss away 35K-40k a year paying back student loans. They graduated from college with little debt and have ten years of earning behind them.

This makes no sense. You could live on his 75K a year for a couple years on an anesthesia salary and pay your loans off way before standard repayment. You're now making upwards of 300K while he's still making 75K. Even the higher marginal tax rates, if you wanted to give up the money you could probably buy at least one of his properties CASH every year (given that he was able to get mortgages on 6-7 properties on a 75K gross salary, I'm assuming they weren't that expensive unless he has some hidden wealth). In 20 years, you're way ahead given that you own comparable rental properties. Assuming you rent them out at a minimum of 1K/month, you've been making 72-84K/year gross (yes given before repairs, property tax, etc but that's pretty low rent as well for any decent 1-2+ bedroom property). Meanwhile he's been paying off his 20 year mortgage on all the places, probably making a few hundred a month before expenses and maybe breaking even if he had any major repairs to do on any of the properties.

Also, let's keep in mind people's lifestyle doesn't reflect what they can actually afford. In 10 years you should be able to afford wayyyy more "toys" than he could (within your respective means) if that's what you really want to do.

 

[sheeed]

There is currently a PP posting on GASWORK offering 600K for solo GAS in the heart of downtown Manhattan, Q15 call, 100% solo cases. Is there a catch? Will these kinds of job opportunities exist in 5-10 years? Many thanks.

http://gaswork.com/post/188311

Its an actual job and the numbers are correct. I was talking to one of my attendings about the job today. No benefits essentially (which could be worth upwards of 100K at the right place) and you work like a dog at beth israel. But thats how they get you in the door with those nice looking numbers. And its right in the middle of downtown manhattan. An added bonus I guess.