The Truth About Physician Salaries

[surfguy84]

I've been hearing so much chatter from my classmates lately about how little primary care physicians make....and how NONE of them want to go into those fields. I get the same feeling around these boards a lot too....so many people seem to think primary care is such a raw deal.

I thought it might be kind of useful to see what the salary of a primary care doctor really amounts to, in real-life terms. I used a salary calculator which accounts for the appropriate taxes. I also maxed out 401k contributions for the purposes of these calculations (18k).

This all assumes you are SINGLE or have a spouse that doesn't work. Considering a working spouse, I've added a very conservative $40k year.

225k a year salary = 154k take home (172 pre-401k contribution).
This amounts to $12,800 a month.

265k a year salary = 181k take home (199 pre-401k contribution)
This amounts to $15,000 a month.

Let's take the first figure and see what that really gets us.

12.8 - 3 (loans) - 1.5 (savings *this is on top of the 18k already in the 401k) - 3.5 (mortgage/rent) - 1.2 (food) - 1 (monthly bills) - (.5 college savings) - 1 (car payments) = 1.1 leftover.

----------------
$3,500 a month mortgage is gonna put you in something really nice, and right on the beach in Florida...or living in a mansion in Texas.
$1,000 a month is going to have you driving around in a Porsche.
$1,200 a month in food means you're buying organic and eating out at decent places on a weekly basis
You're putting $36,000 a year into savings (assuming ZERO employer match)...more than adequate.
You STILL have over a grand left over to spend on whatever else. How is this not enough?

This isn't to say you need a Porsche or a $3,500/month rent...just that your salary allows for such things.

So, I guess the point of all of this, is to say that yes, even the lowly primary care physicians out there can do quite well for themselves and live a very comfortable and dare I say, luxurious, life.

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[Mehd School]

Just wanted to throw this out there.

I'll graduate from DCOM with $300,000 @6.8% in medical school debt. AAFP states average family practice gross is $195k. If you paid only $3452 a month (lowest number the calculator would give me) it would take over 10 years to repay your loans and you'd end up paying $414,289.

So, for the average family practice MD/DO, you're assuming they make above average and are alright getting boned with an extra ~$115,000 in interest (not counting undergrad). Realistically for many they will have less take home income than you stated and a higher monthly loan burden. So unfortunately it's not as sunny as you're stating. Now we're entering monthly effective salary (take home - loan burden) that is entering the level of NP/PA and is lower than many CRNA's I know. This is why primary care isn't looked upon favorably. Salary.com says peds make $175k a year, so this is even worse for them.

I came into medical school wanting family med, and now I want nothing to do with it for a variety of reasons (income definitely included).

 

[surfguy84]

Just wanted to throw this out there.

I'll graduate from DCOM with $300,000 @6.8% in medical school debt. AAFP states average family practice gross is $195k. If you paid only $3452 a month (lowest number the calculator would give me) it would take over 10 years to repay your loans and you'd end up paying $414,289.

So, for the average family practice MD/DO, you're assuming they make above average and are alright getting boned with an extra ~$115,000 in interest (not counting undergrad). Realistically for many they will have less take home income than you stated and a higher monthly loan burden. So unfortunately it's not as sunny as you're stating. Now we're entering monthly effective salary (take home - loan burden) that is entering the level of NP/PA and is lower than many CRNA's I know. This is why primary care isn't looked upon favorably. Salary.com says peds make $175k a year, so this is even worse for them.

I came into medical school wanting family med, and now I want nothing to do with it for a variety of reasons (income definitely included).

Based on what I've seen around these forums, talking to primary care docs at school, what I've seen in the MGMA report, and have encountered out there in the real world, pulling 225k as a primary care doc isn't unreasonably difficult...especially if you are willing to work 50-55 hours a week. I can't say with certainty, but I don't believe salary.com is a great resource for physician salaries, in regards to the peds reference.


Nonetheless, you could still put 4K a month towards loans with the numbers I used above. Don't have kids yet? Save that 500 for something else. I think we can all agree we don't NEED a thousand dollar car payment each month either. There's a lot of wiggle room in the numbers I used.

But yes, you are correct in that I assumed no undergrad loans. I also didn't get into the various loan repayment options out there because frankly, I don't know enough about them.

I do appreciate your opinion on the matter though.

 

[67552931811]

Just wanted to throw this out there.

I'll graduate from DCOM with $300,000 @6.8% in medical school debt. AAFP states average family practice gross is $195k. If you paid only $3452 a month (lowest number the calculator would give me) it would take over 10 years to repay your loans and you'd end up paying $414,289.

So, for the average family practice MD/DO, you're assuming they make above average and are alright getting boned with an extra ~$115,000 in interest (not counting undergrad). Realistically for many they will have less take home income than you stated and a higher monthly loan burden. So unfortunately it's not as sunny as you're stating. Now we're entering monthly effective salary (take home - loan burden) that is entering the level of NP/PA and is lower than many CRNA's I know. This is why primary care isn't looked upon favorably. Salary.com says peds make $175k a year, so this is even worse for them.

I came into medical school wanting family med, and now I want nothing to do with it for a variety of reasons (income definitely included).

The average FM doc works, what, 45 hours a week?

Also, if you live like a resident for 3-4 years as an attending you can completely destroy that debt. I'll have higher debt, am assuming a 200K salary for said time period, and I'll be debt free in 3 years post res/fellowship

 

[67552931811]

Based on what I've seen around these forums, talking to primary care docs at school, what I've seen in the MGMA report, and have encountered out there in the real world, pulling 225k as a primary care doc isn't unreasonably difficult...especially if you are willing to work 50-55 hours a week. I can't say with certainty, but I don't believe salary.com is a great resource for physician salaries, in regards to the peds reference.


Nonetheless, you could still put 4K a month towards loans with the numbers I used above. Don't have kids yet? Save that 500 for something else. I think we can all agree we don't NEED a thousand dollar car payment each month either. There's a lot of wiggle room in the numbers I used.

But yes, you are correct in that I assumed no undergrad loans. I also didn't get into the various loan repayment options out there because frankly, I don't know enough about them.

I do appreciate your opinion on the matter though.

Where I am, a major market, FM docs make 200+ working 40-45 hours a week.

Also, recruiters use MGMA data in negotiating. I know for a fact where I am all the peds docs I know make more than that. Throw in the higher paying sub specialities (neo, picu, cards, etc.) and they are making substantially more.

 

[surfguy84]

Where I am, a major market, FM docs make 200+ working 40-45 hours a week.

Also, recruiters use MGMA data in negotiating. I know for a fact where I am all the peds docs I know make more than that. Throw in the higher paying sub specialities (neo, picu, cards, etc.) and they are making substantially more.

This is the vibe I got from faculty I've spoken to, and why I used the number I did. It's my understanding that it's relatively easy for a FM doctor to find the work to add another 10-15 hours a week, to bump their salary by 25-40k a year. Is this consistent with what you've seen/heard?

 

[HotLunch96]

a FM doc I talked to who uses OMM was trying to sell the practice to me as a good way to raise that low-salary serum level by ~$30K/year

 

[yanks26dmb]

Good thread...I think seeing things in a practical, what will my money get me, way, helps elucidate things.

As others have mentioned though... is 225 really reasonable to obtain by working 50ish hours? I have no idea, but would love to hear from others.

On the flip side...is this salary specific to FM or would the numbers be similar to IM and Psych for instance...?

 

[2021Doctor]

I've been hearing so much chatter from my classmates lately about how little primary care physicians make....and how NONE of them want to go into those fields. I get the same feeling around these boards a lot too....so many people seem to think primary care is such a raw deal.

I thought it might be kind of useful to see what the salary of a primary care doctor really amounts to, in real-life terms. I used a salary calculator which accounts for the appropriate taxes. I also maxed out 401k contributions for the purposes of these calculations (18k).

This all assumes you are SINGLE or have a spouse that doesn't work. Considering a working spouse, I've added a very conservative $40k year.

225k a year salary = 154k take home (172 pre-401k contribution).
This amounts to $12,800 a month.

265k a year salary = 181k take home (199 pre-401k contribution)
This amounts to $15,000 a month.

Let's take the first figure and see what that really gets us.

12.8 - 3 (loans) - 1.5 (savings *this is on top of the 18k already in the 401k) - 3.5 (mortgage/rent) - 1.2 (food) - 1 (monthly bills) - (.5 college savings) - 1 (car payments) = 1.1 leftover.

----------------
$3,500 a month mortgage is gonna put you in something really nice, and right on the beach in Florida...or living in a mansion in Texas.
$1,000 a month is going to have you driving around in a Porsche.
$1,200 a month in food means you're buying organic and eating out at decent places on a weekly basis
You're putting $36,000 a year into savings (assuming ZERO employer match)...more than adequate.
You STILL have over a grand left over to spend on whatever else. How is this not enough?

This isn't to say you need a Porsche or a $3,500/month rent...just that your salary allows for such things.

So, I guess the point of all of this, is to say that yes, even the lowly primary care physicians out there can do quite well for themselves and live a very comfortable and dare I say, luxurious, life.

Many wrong assumptions here.
At least 42 states have a state income tax and a substantial number of cities do as well.
Malpractice insurance is at least $10K per year in most places.
You have to pay licensure fees in each state as well.
You need to buy health insurance.

 

[W19]

The numbers are similar for IM/Psych. But psych docs work less hours based on AAMC Career in Medicine website.. But I think it would be more reasonable to put the number at 200k... 225k is a little bit on the higher end right out of residency IMO.

Edit.... Here are the numbers...

FM: 211k.......53 hrs/wk
IM: 229k......55 hrs/wk
Psych: 227k......47 hrs/wk

 

[surfguy84]

Many wrong assumptions here.
At least 42 states have a state income tax and a substantial number of cities do as well.
Malpractice insurance is at least $10K per year in most places.
You have to pay licensure fees in each state as well.
You need to buy health insurance.

I did calculate this based on living/practicing in Florida, so yes..you are correct about the state income taxes.

Isn't malpractice covered by most employers these days? Same goes for health insurance?

I did leave out licensure fees as I have no idea what they are - can you give a ballpark?

But again, I assumed zero employer contribution to the 401k which isn't realistic..it'd be easy to pull a bit away from savings to spend elsewhere. This also doesn't assume you spend your first 4 years living incredibly frugally and knocking those loans out, as many do. You do that, and you instantly have an extra 3k a month in year 5.

 

[yanks26dmb]

The numbers are similar for IM/Psych. But psych docs work less hours based on AAMC Career in Medicine website.. But I think it would be more reasonable to put the number at 200k... 225k is a little bit on the higher end right out of residency IMO.

Edit.... Here are the numbers...

FM: 211k.......53 hrs/wk
IM: 229k......55 hrs/wk
Psych: 227k......47 hrs/wk

Thanks for looking that up. I guess my follow up question is how easy is it to add extra hours in those fields? Can a hard-working doctor find work to add?

AND, assuming you do add extra hours can you assume a comparable % increase in salary?

As in, if I'm a psych doc and I'm making ~225k a year working ~45 hr/week, would working an extra 10 hours a week bring in another 45k a year?

 

[W19]

Thanks for looking that up. I guess my follow up question is how easy is it to add extra hours in those fields? Can a hard-working doctor find work to add?

AND, assuming you do add extra hours can you assume a comparable % increase in salary?

As in, if I'm a psych doc and I'm making ~225k a year working ~45 hr/week, would working an extra 10 hours a week bring in another 45k a year?

Yes you can... If you don't work on weekend, you can basically moonlight 1 weekend per month and that might add another 40k+ to your salary...

 

[Drrrrrr. Celty]

Idk, I think an average take home salary of about 8-9k a month isn't bad at all ( Considering that this is still about the take home money that two engineers combined bring in). Also even with ~240ish I'm graduating with I don't feel deterred from FM at all ( Mostly because if I wanted to make more I'd be able to for sure).

 

[yanks26dmb]

Idk, I think an average take home salary of about 8-9k a month isn't bad at all. Also even with ~240ish I'm graduating with I don't feel deterred from FM at all ( Mostly because if I wanted to make more I'd be able to for sure).

You should definitely expect to bring home more than 8-9k a month. That's like 145k a year pre-tax salary.


EDIT: Even in a tax heavy state like California, I think you should expect 11k a month take home minimum... that assume 200k salary with zero deductions.

 

[Goro]

Yeah, I don't why people seem to think that PC is the 7th circle of hell. All of my PC colleagues on the Faculty are definitely making at least 2x what I at full Professor!

Go look up the wise @Law2Doc's comments in a recent thread on doctor's salaries:

http://forums.studentdoctor.net/threads/academic-medicine-salary.1167666/#post-17092588

I've been hearing so much chatter from my classmates lately about how little primary care physicians make....and how NONE of them want to go into those fields. I get the same feeling around these boards a lot too....so many people seem to think primary care is such a raw deal.

I thought it might be kind of useful to see what the salary of a primary care doctor really amounts to, in real-life terms. I used a salary calculator which accounts for the appropriate taxes. I also maxed out 401k contributions for the purposes of these calculations (18k).

This all assumes you are SINGLE or have a spouse that doesn't work. Considering a working spouse, I've added a very conservative $40k year.

225k a year salary = 154k take home (172 pre-401k contribution).
This amounts to $12,800 a month.

265k a year salary = 181k take home (199 pre-401k contribution)
This amounts to $15,000 a month.

Let's take the first figure and see what that really gets us.

12.8 - 3 (loans) - 1.5 (savings *this is on top of the 18k already in the 401k) - 3.5 (mortgage/rent) - 1.2 (food) - 1 (monthly bills) - (.5 college savings) - 1 (car payments) = 1.1 leftover.

----------------
$3,500 a month mortgage is gonna put you in something really nice, and right on the beach in Florida...or living in a mansion in Texas.
$1,000 a month is going to have you driving around in a Porsche.
$1,200 a month in food means you're buying organic and eating out at decent places on a weekly basis
You're putting $36,000 a year into savings (assuming ZERO employer match)...more than adequate.
You STILL have over a grand left over to spend on whatever else. How is this not enough?

This isn't to say you need a Porsche or a $3,500/month rent...just that your salary allows for such things.

So, I guess the point of all of this, is to say that yes, even the lowly primary care physicians out there can do quite well for themselves and live a very comfortable and dare I say, luxurious, life.

 

[Drrrrrr. Celty]

You should definitely expect to bring home more than 8-9k a month. That's like 145k a year pre-tax salary.


EDIT: Even in a tax heavy state like California, I think you should expect 11k a month take home minimum... that assume 200k salary with zero deductions.

I'm calling it a post-tax 9k.

 

[iwillnevergiveup]

Income-based repayment pegged at 10%. Don't take out private loan even if it means slightly lower interest.

 

[Law2Doc]

...


EDIT: Even in a tax heavy state like California, I think you should expect 11k a month take home minimum... that assume 200k salary with zero deductions.

Um no. A lot of us get pay stubs that beg to differ.

Truth of the matter is your starting salary may be substantially lower than the OP indicated, your taxes, loans and self paid benefits may be higher, your hours right out of the box may be a lot higher. (As I've pointed out on multiple threads, a lot of us see our hours jump, not fall, in the early years out of residency, as we "pay our dues" and suck up the lions share of the call).

You'll still have a "comfortable" life, especially compared to residency, and you'll service your debt and pay your bills, but we really aren't talking Florida beach house, Texas mansion or Porshe kind of money. We are more often talking about a modest townhouse far away from any body of water and a reliable American or Japanese compact car for the initial handful of years of practice.

Money goes a lot further in the abstract before you actually have it to budget with. You never realize what expenses are looming or that you are overlooking with these financial calculators, but believe me, they are out there. From personal experience in two professional careers now, these calculators can be off from reality by 30-50% even if you input the appropriate salary and tax figures (which as mentioned, I don't think you have). So don't count those chickens just yet.

 

[yanks26dmb]

Um no. A lot of us get pay stubs that beg to differ.

Truth of the matter is your starting salary may be substantially lower than the OP indicated, your taxes, loans and self paid benefits may be higher, your hours right out of the box may be a lot higher. (As I've pointed out on multiple threads, a lot of us see our hours jump, not fall, in the early years out of residency, as we "pay our dues" and suck up the lions share of the call).

You'll still have a "comfortable" life, especially compared to residency, and you'll service your debt and pay your bills, but we really aren't talking Florida beach house, Texas mansion or Porshe kind of money. We are more often talking about a modest townhouse far away from any body of water and a reliable American or Japanese compact car for the initial handful of years of practice.

Money goes a lot further in the abstract before you actually have it to budget with. You never realize what expenses are looming or that you are overlooking with these financial calculators, but believe me, they are out there. From personal experience in two professional careers now, these calculators can be off from reality by 30-50% even if you input the appropriate salary and tax figures (which as mentioned, I don't think you have). So don't count those chickens just yet.

I hear you about unforeseen costs, etc. That said, Im from California and spent several years working right after unfergrad. My pay stub was exactly in line with this calculator. With all due respect to you, what am I missing? 200k is 11k take home in California based on this this calculation.

I realize you are a practicing physician and I'm a lowly med student, so I don't mean to imply I know better than you. Based on my own personal life experiences I do think living on 11k a month would be pretty comfortable.

 

[Moose A Moose]

... but the Porsche

 

[Goro]

You can manage with a lexus or a Lincoln, as do many of my clinician colleagues. I think the Dean has an Audi.

... but the Porsche

 

[Moose A Moose]

You can manage with a lexus or a Lincoln, as do many of my clinician colleagues. I think the Dean has an Audi.

There is no substitute.

 

[dyeguy21]

I did calculate this based on living/practicing in Florida, so yes..you are correct about the state income taxes.

Isn't malpractice covered by most employers these days? Same goes for health insurance?

I did leave out licensure fees as I have no idea what they are - can you give a ballpark?

But again, I assumed zero employer contribution to the 401k which isn't realistic..it'd be easy to pull a bit away from savings to spend elsewhere. This also doesn't assume you spend your first 4 years living incredibly frugally and knocking those loans out, as many do. You do that, and you instantly have an extra 3k a month in year 5.

1. States and even some cities have different income taxes and costs of living. For instance, philadelphia imposes a 4% tax on income, pennsylvania state income tax is 3.07% with additional sales tax of 6% with an additional 2% local sales tax on purchases.
2. Some employers offer full (with a limit) of malpractice coverage, others do cost sharing. You may need to purchase tail coverage.
3. Health insurance is somewhat covered by employer, you still generally have a monthly payment, especially if you want dental and vision. Additional money here for prescription drug co-pays.
4. License fees: State medical and DEA (varies), + recert fees and CME courses
5. You assume no children, which a lot of people have been wanting, but have been holding out because of school and residency, which means more than $500 savings for "possibly" private school, then college, then post-bac (i.e. med school). These kids also require food, clothing, child care, toys, health care, and various supplies.
6. Home repair, car repair. When your water heater dies, you'll realize just how expensive this can be.
7. You're gonna need more than 1 car if you have a spouse and kids.
8. Assuming people have the same tolerance for risk and cost loss, as pointed out you will be "wasting" a lot of return by paying down loans so slowly.
9. Disability insurance, you can break and if you do you will want to be able to live.
10. Term life insurance, if you're married with a non working spouse or children, you will want them to not starve.
11. As noted above, relative work to money earned. If you enjoy PC work and only PC work, its no big what you make. But if you enjoy medicine and GI, it only makes economic sense to try for the better ROI job. (i.e. work 55 hrs and make 229k or 60hr and make 349k)
12. Some people's parents sacrificed a lot to get them where they are, they feel indebted or even culturally bound to provide financial assistance to their parents in old age.
13. What about vacations? Trust me, a simple trip to California or Disney World costs a lot more than you'd think.
14. Pets. Vet vists, medications, toys, food.
15. Hobbies, you will find one, it will be expensive.

To be fair, you can obviously live on 225k/year. Families of 4 do it on much less in the USA. However, most feel that they have spent 4 years of college, 4 years of med school, and minimum 3 years of residency (during the prime of their lives) and are coming out the other end with 200k in debt. Meanwhile, PCPs are being forced to do more and more work to get their RVUs up, while doing less and less of what they enjoy and are being paid on the low end of all doctors. Specialists spend the same relative amounts of time on patient care and paperwork, but they have that extra 100-200k per year to make it worth it.

In the end it's a personal choice, you do what you love. The equation isn't as simple as Income - taxes - expenses = $$ for fun.

 

[surfguy84]

1. States and even some cities have different income taxes and costs of living. For instance, philadelphia imposes a 4% tax on income, pennsylvania state income tax is 3.07% with additional sales tax of 6% with an additional 2% local sales tax on purchases.
2. Some employers offer full (with a limit) of malpractice coverage, others do cost sharing. You may need to purchase tail coverage.
3. Health insurance is somewhat covered by employer, you still generally have a monthly payment, especially if you want dental and vision. Additional money here for prescription drug co-pays.
4. License fees: State medical and DEA (varies), + recert fees and CME courses
5. You assume no children, which a lot of people have been wanting, but have been holding out because of school and residency, which means more than $500 savings for "possibly" private school, then college, then post-bac (i.e. med school). These kids also require food, clothing, child care, toys, health care, and various supplies.
6. Home repair, car repair. When your water heater dies, you'll realize just how expensive this can be.
7. You're gonna need more than 1 car if you have a spouse and kids.
8. Assuming people have the same tolerance for risk and cost loss, as pointed out you will be "wasting" a lot of return by paying down loans so slowly.
9. Disability insurance, you can break and if you do you will want to be able to live.
10. Term life insurance, if you're married with a non working spouse or children, you will want them to not starve.
11. As noted above, relative work to money earned. If you enjoy PC work and only PC work, its no big what you make. But if you enjoy medicine and GI, it only makes economic sense to try for the better ROI job. (i.e. work 55 hrs and make 229k or 60hr and make 349k)
12. Some people's parents sacrificed a lot to get them where they are, they feel indebted or even culturally bound to provide financial assistance to their parents in old age.
13. What about vacations? Trust me, a simple trip to California or Disney World costs a lot more than you'd think.
14. Pets. Vet vists, medications, toys, food.
15. Hobbies, you will find one, it will be expensive.

To be fair, you can obviously live on 225k/year. Families of 4 do it on much less in the USA. However, most feel that they have spent 4 years of college, 4 years of med school, and minimum 3 years of residency (during the prime of their lives) and are coming out the other end with 200k in debt. Meanwhile, PCPs are being forced to do more and more work to get their RVUs up, while doing less and less of what they enjoy and are being paid on the low end of all doctors. Specialists spend the same relative amounts of time on patient care and paperwork, but they have that extra 100-200k per year to make it worth it.

In the end it's a personal choice, you do what you love. The equation isn't as simple as Income - taxes - expenses = $$ for fun.

I hear you on those points. At the end of the day, it's all about how one lives. I live simply. My wife lives simply. There were times we made very little money but still lived better than our friends making double. Then there were times we started making more money and still lived simply and didn't feel compelled to buy more and more as the income grew.

I totally get there are unexpected expenses...but who really need thats 4k rent/mortgage or grand in car payments each month? I still believe this budget has enough room to account for the things in your list and STILL be a luxurious life.


Luckily, I have a free hobby (see user name)

 

[scoKraz4]

The answer is simple, don't go into primary care, don't have kids, and live like a resident for the first few years out.

 

[JustPlainBill]

I've been hearing so much chatter from my classmates lately about how little primary care physicians make....and how NONE of them want to go into those fields. I get the same feeling around these boards a lot too....so many people seem to think primary care is such a raw deal.

I thought it might be kind of useful to see what the salary of a primary care doctor really amounts to, in real-life terms. I used a salary calculator which accounts for the appropriate taxes. I also maxed out 401k contributions for the purposes of these calculations (18k).

This all assumes you are SINGLE or have a spouse that doesn't work. Considering a working spouse, I've added a very conservative $40k year.

225k a year salary = 154k take home (172 pre-401k contribution).
This amounts to $12,800 a month.

265k a year salary = 181k take home (199 pre-401k contribution)
This amounts to $15,000 a month.

Let's take the first figure and see what that really gets us.

12.8 - 3 (loans) - 1.5 (savings *this is on top of the 18k already in the 401k) - 3.5 (mortgage/rent) - 1.2 (food) - 1 (monthly bills) - (.5 college savings) - 1 (car payments) = 1.1 leftover.

----------------
$3,500 a month mortgage is gonna put you in something really nice, and right on the beach in Florida...or living in a mansion in Texas.
$1,000 a month is going to have you driving around in a Porsche.
$1,200 a month in food means you're buying organic and eating out at decent places on a weekly basis
You're putting $36,000 a year into savings (assuming ZERO employer match)...more than adequate.
You STILL have over a grand left over to spend on whatever else. How is this not enough?

This isn't to say you need a Porsche or a $3,500/month rent...just that your salary allows for such things.

So, I guess the point of all of this, is to say that yes, even the lowly primary care physicians out there can do quite well for themselves and live a very comfortable and dare I say, luxurious, life.

Yep, what you've said is somewhat realisitic on paper -- but let's move into the real world ---

That spouse patiently waiting at home, burning the candles in the window, having the nice lit fireplace and warm meal when you walk in the door from slaying dragons, and put down ye olde trusty shield and battleaxe -- yeah, all of a sudden it becomes $100 for nail appointments (speaking from a guys perspective with a spouse), $200 for hair, a clothing budget and whatever vehicle (4 door jeeps to the tune of $700 a month are popular where I'm at) -- get expensive in a hurry -- they've been living the MS/resident life with you and supposedly you love them so it becomes a little difficult to say ,"No" ---

After working the "40-45" (try like 50 to 60 -- to earn that 225K you need to see about 26 patients a day and make good use of your ancillary studies as medically appropriate -- at that rate, you have no time to chart so plan on spending nights and time on the weekends for charting or you get calls from billing telling you to get your stuff done) you get home and are exhausted so you participate in your favorite form of relaxation -- when you're young and newlywed, it's a bottle of wine, candlelight dinners and bumpin' uglies -- if you're older, it's taking the family out for fun with Mommy or Daddy (whoever the PCP is) -- for a family of 4 to eat at Chili's it' around $60 before you walk out the door -- call it Friday PM, Saturday PM and Sunday after church and you can kiss close to $200 goodbye -- per week

during the week? -- well, depends on what your hours are -- I'm the after hours guy so I work 12-7 M-F and 8-1 Saturday -- which means I hit the gym at 9PM (less crowded) and am in bed by 11:30 -- up at 9 to try to finish charts before leaving for work at 11 -- on satudays I usually spend from 1-5 charting and finishing up lab results/patient messages/reading up on patient complaints/doing CME and then after we get home from dinner (around 8-9pm) until 11 doing the same. sunday is our day for grocery shopping, getting ready to do it again for another 7 days ---

While I am making a decent salary -- my student loan repayment is something like this -- either $3k/month for 10 years or $1400/month for 25 or $1800/month for 10 and qualify for forgiveness of remaining;

And don't forget to account for all the extras that go into owning your own place -- yardwork -- fertilizer, weed maintenance, plant maintenance/changout per season, mowers, weedeaters -- or hiring somebody to do that for you -- here it's $25/2 weeks to get it cut/weedeater/ bagged; and then you get actual house maintenance -- washers/dryers/fridge/stove that tend to go out when you desperately need them to say nothing of water heaters/air conditioners ( and new houses aren't immune) -- the expenses add up -- quickly;

Almost forgot -- unless you've got decent furniture, you can also add in the costs of outfitting said new place -- I can tell you from experience, the completely fine single person furniture that you created those great memories of pre-spouse illicit liaisons with copious amounts of alcohol and polaroids to the cinderblock and 1x12 plank bookshelves to the clear glass tabletop dinner table that you picked up at a flea market will need to be replaced with things that "match" -- and now you'll need more than 1 set of sheets that you wash Qweekly and you can forget the Spiderman/Batman motif that was perfectly fine; Yes, your favorite yellow Dickey's BBQ cup will now need to be replaced with actual glasses -- and it all comes with a cost ----

Bottom line: do what you love, try to plan as best you can --start a dedicated "I don't even see it" savings plan now and pay those loans off ASAP -- if you can get away with it, DO NOT buy what you can afford in terms of a house -- buy a nice starter on a 15 year mortgage that you can pay off in 10 --then either sell it or rent it to use for the college fund for the kiddos or whatever -- key here is to generate as many passive streams of income as you can when you're young -- then when you feel like throttling back as you "mature", you can without diminished income -- consider starting your own UC and hiring PAs/NPs to run the joint while you're working at your other clinic but available if SHTF;

You've got one thing I don't -- time -- you're likely young and just starting out -- read the book "The Millionaire Next Door" --

 

[group_theory]

Good post @JustPlainBill

The vast majority of docs aren't paid by the hour. It's either salary + production bonus, or a percentage of what you collect, or percentage of what you bill vs overall group collection, etc

There's also regional variation to the average compensation as well. The mean salary for family medicine in the northeast region was $165k, $166k for southwest, and $198k for North Central region. The nationwide median compensation is around $229k (but that includes those who own their own practice or are partners in their own practices with ancillary income stream). As a young graduate from a residency, you should focus on "average starting salary" because that is what recruiters, hospitals, and potential physician employers will use (you're not going to be part-owner and divide the profit of the practice like the senior partners, you'll likely be the work horse, working more hours and more calls as part of your "contract")

Yes, you can always moonlight and make more money (ie work urgent care during your time off, or cover a rural ER with desperate coverage issues), or offer to do additional shifts/calls of a colleague or senior partner for $$, but at some point as you get older, you'll get tired working a residency schedule. One thing to keep in mind - as you work more, there are more charts to document, more labs/imaging to follow-up (hey, that cxr of the cough turned out to have an opacity - better make sure to follow-up on that), and with more patients, more phone calls (some urgent, some not) and paperwork to do (FMLA, social security disability, etc) as well as prior-auths and peer-to-peer review/appeal. They take a lot more time than you expect/realize. So seeing more/doing more means more stuff to do/follow-up on.

As I mentioned in my other threads, RVUs ultimately will drive your compensaton (whether directly or indirectly). The average RVUs that family medicine billed in 2015 was 4,975.

The wRVU for the most commonly billed code (99213) was 0.97. (to keep the math simple as well as not overwhelm med students/residents, I'm ignoring the Non‐Facility Practice Expense RVUs as well as malpractice RVU and assume that it will go towards practice overhead/expenses). Medicare 2015 conversion factor of $36/RVU,

If you assume the following: 248 working days in a year (includes 7 days off for holidays), 4 weeks of vacation (20 days), 1 week of CME (5 days), Work week 4.5 days ----> 223 days worked

To generate $225k in billing (again ignoring non-facility practice expense RVU), you will need to generate 27.2 RVUs per day worked.

Of course lots of assumption, including all your patients are level 3 outpatient established office visit, and all are medicare. Also assumes your overhead and practice expenses is covered by the non-facility practice RVU (otherwise, it comes out of your income stream). As discussed in my other thread, if you have medicaid patients, that RVU per day minimum to maintain that salary will go up just to generate that income.

Plus the reality is that your employer (the practice partners or hospital) will also want some "profit" as well for your hard work. If you are revenue neutral for too long (from their perspective), they might want to hire someone else who is "more productive"


Now your payor mix is really important - not only how many patients you see, nor the type of insurance you accept/bill (see my other posts on why medicare vs commercial insurance vs medicaid) but also if you are seeing kids for their sports physical, newborn visit, age-appropriate annual visits, sick visits, etc. since seeing kids will affect your overall compensation as well (the average pediatrician generated 5,448 RVU in 2015 but made less in median compensation than family medicine ... hmmm)

 

[JustPlainBill]

Good post @JustPlainBill

... It's either salary + production bonus, or a percentage of what you collect, or percentage of what you bill vs overall group collection, etc

... As a young graduate from a residency, you should focus on "average starting salary" because that is what recruiters, hospitals, and potential physician employers will use (you're not going to be part-owner and divide the profit of the practice like the senior partners, you'll likely be the work horse, working more hours and more calls as part of your "contract")

...
As I mentioned in my other threads, RVUs ultimately will drive your compensaton (whether directly or indirectly). The average RVUs that family medicine billed in 2015 was 4,975.

The wRVU for the most commonly billed code (99213) was 0.97. (to keep the math simple as well as not overwhelm med students/residents, I'm ignoring the Non‐Facility Practice Expense RVUs as well as malpractice RVU and assume that it will go towards practice overhead/expenses). Medicare 2015 conversion factor of $36/RVU,

If you assume the following: 248 working days in a year (includes 7 days off for holidays), 4 weeks of vacation (20 days), 1 week of CME (5 days), Work week 4.5 days ----> 223 days worked

To generate $225k in billing (again ignoring non-facility practice expense RVU), you will need to generate 27.2 RVUs per day worked.

Of course lots of assumption, including all your patients are level 3 outpatient established office visit, and all are medicare. Also assumes your overhead and practice expenses is covered by the non-facility practice RVU (otherwise, it comes out of your income stream). As discussed in my other thread, if you have medicaid patients, that RVU per day minimum to maintain that salary will go up just to generate that income.

Plus the reality is that your employer (the practice partners or hospital) will also want some "profit" as well for your hard work. If you are revenue neutral for too long (from their perspective), they might want to hire someone else who is "more productive"
...

You've raised some important issues ---

1) Starting salary -- here in the DFW metroplex, 2 years ago Baylor was paying new FM grads $150k/yr with a $5k signing bonus and expecting them to see 19 to 25 patient's per day, end of discussion. Given my minimal experience level ( 2 years in practice) I'm above that and have a bonus plan in place that is directly production driven, so I see on average 24 patient's per day with a good payor mix;

2) 27.2 RVUs at .97 for a 99213 (average single or double complaint with no further workups required -- stable DM, recurrent UTI (it's not a new problem)) turns out to be --- 26.384 patient's per day for a starting salary of $150-160K/yr in DFW -- $155k/yr == $12.916/month x .72 for TTL = bring home around $9300.00;

Now, I can tell you that as a former software engineer, I made $80K/yr and we had a nice life -- 1500 sq/ft house, 2 small children, 1 nice car with my daily driver that was 8 years old but serviceable, had weeklong vacations every other year and life was good -- had that continued, I might have never looked into a medical career. There are couples I know of where one is a teacher and one is a fireman/EMT who are on track to become millionaires with 2 children. it's about what's important to you.

Most medical students have never held real jobs/had real careers other than the college student "jobs" which is why your attendings are such jerks about thing like showing up on time, properly dressed, shaved, showered with the use of deodorant and knowing what a toothbrush/paste is for, to say nothing of preparing for "work" by knowing your cases/patients. Nothing against anyone but (as an over generalization) most just don't have the life experience because you've been in the med school pipeline all of your life. Therefore, you have no idea the real value of $9300/month or how far that will go --- I've lived on a lot less and lived quite well.

At one point, I worked 2 part time jobs for $7.50/hr and cleaned an office on weekends for an additional $150/month while my wife worked a full time job for around (bring home) $600/wk and helped with the office cleaning on the weekends -- we supported our house and children and somehow (by God's grace) made it through the transition (with all that requires -- premed classes, studying/taking the MCAT, etc) from engineering (when the bottom fell out in 2002) to medicine -- were things tight? Yes -- $200 unexpected bill? Well, what can we put off so we can scrape it together? our "emergency" fund was around $500 in the bank..... but my mother grew up almost starving to death during the war in Germany so my perspective is a little different -- as long as my family is together, we can handle anything with God's grace -- yes, it may suck now but there's hope for tomorrow.

You need to adjust your thinking -- I can tell you that specialists have a higher salary --- but if the problem is that you don't know how to budget, that just means you'll be in more debt. yes, there are specialists who are broke because they can't handle their money.

I'm thinking of an FM doc right now in suburban north dallas who sees about 50-60 patients in 8 hours, starts his clinic at 7am and is usually done by 3pm (that's 8 minutes per patient of HIS time, not the MA's time), works until 1pm on Wednesdays, owns a farm further north and is making a nice living (iirc he hinted at $250 - $275k)-- he doesn't like being in clinic/working so when he works, he WORKS -- patient's love him because they're in and out quickly and he's a competent physician.

Now, you can also go DPC model (slide over to the FM forums and look up AtlasMD -- he's the guy doing it and doing it well) where docs are rolling back to a small, select panel of patients who pay for the service of having a true personal physician by paying a monthly fee -- for that they get unlimited office visits and whatever can be done in the office is free, other things needed are negotiated prices (radiology studies, labs, etc) and they carry catastrophic insurance for hospitalizations, etc. With that model, the stress of volume is off the doc and they can go back to what they enjoy -- practicing medicine and helping people.

sorry for the long rant and hope it helps...

 

[Postictal Raiden]

You've raised some important issues ---

1) Starting salary -- here in the DFW metroplex, 2 years ago Baylor was paying new FM grads $150k/yr with a $5k signing bonus and expecting them to see 19 to 25 patient's per day, end of discussion. Given my minimal experience level ( 2 years in practice) I'm above that and have a bonus plan in place that is directly production driven, so I see on average 24 patient's per day with a good payor mix;

Correct me if I'm wrong but isn't This job considered an academic position? I'm asking because I find 150k to be extremely low, even for a fresh-out-of-residency physician. At he level of debt most of us have, this means your take home salary after taxes and loan repayments is 50k

 

[user3]

Correct me if I'm wrong but isn't This job considered an academic position? I'm asking because I find 150k to be extremely low, even for a fresh-out-of-residency physician. At he level of debt most of us have, this means your take home salary after taxes and loan repayments is 50k

any full time physician job for under 200k seems like a poor ROI nowadays. I have several classmates who have stated they will be disappointed if they end up making any less than 200-250k, which I think is justified given the sheer length and cost of our training.

 

[PathoTurnUp1865]

Encroachment of the midlevels is what is playing a big factor in my decision. They are trying to take over primary care, not to mention they want equal pay to their physician counterparts. In some states they've even gotten that passed. That is they are paid the same reimbursements as a doctor.

 

[GaiusOctavius]

Houses on the Beach in populated areas of Fl start at >$1million. The mortgage on that is probably closer to $5k/month, and then don't forget property taxes. You can find cheaper places on the intercostal, but beachfront houses in populated areas tend to range from $1mil- $139million. And the $1mil properties are pretty simple (think 2-3 bedroom, 1-story, unrenovated since the 1980s)... I'd bet less than 10% or the people who own a beachfront house in Miami or Ft. Lauderdale are Doctors (regardless of specialty). They're finance tycoons, investors, professional athletes, real-estate developers, entrepreneurs, business founders, or inherited money.

For Texas, it depends on what you consider a "mansion." A Porsche on the other hand, you could lease for less than $1k. You could probably get a boxster for half that (~$500/month). $1k/month for food is what I spend now and I don't eat all organic.

I think you're on to something though in that there probably isn't that much of a difference in lifestyle from a PCP physician and other specialities. There isn't that much of change in lifestyle between someone making $200k/yr and someone making $500k/yr. You're looking at a marginally better house, marginally better car, and marginally better extracurricular activities (front-row tickets to two-three lakers games, or 2 week ski vacation in St. Moritz, etc.). And some of the marginally better paying specialities require significantly more effort (more time studying, 70hr work weeks, and longer residencies). Financially, I'm not sure it's worth it. It's not until you're making millions per year that you truly break apart from the pack, and I only know of a handful of doctors who've done that. One of them started an anesthesiology practice like 20 years ago that grew and expanded, and he sold it to some huge group for like $40mil. I doubt many of those opportunities will be available to us. Few physicians even approach $1million per year and the ones that do probably work so much they don't have time to enjoy it. My friend's dad who is a neurosurgeon works ~70hrs/week and only takes home ~$800k/yr. You'll never really ball out as a physician, so just do what you enjoy and be content that you'll always be above average.

I've been hearing so much chatter from my classmates lately about how little primary care physicians make....and how NONE of them want to go into those fields. I get the same feeling around these boards a lot too....so many people seem to think primary care is such a raw deal.

I thought it might be kind of useful to see what the salary of a primary care doctor really amounts to, in real-life terms. I used a salary calculator which accounts for the appropriate taxes. I also maxed out 401k contributions for the purposes of these calculations (18k).

This all assumes you are SINGLE or have a spouse that doesn't work. Considering a working spouse, I've added a very conservative $40k year.

225k a year salary = 154k take home (172 pre-401k contribution).
This amounts to $12,800 a month.

265k a year salary = 181k take home (199 pre-401k contribution)
This amounts to $15,000 a month.

Let's take the first figure and see what that really gets us.

12.8 - 3 (loans) - 1.5 (savings *this is on top of the 18k already in the 401k) - 3.5 (mortgage/rent) - 1.2 (food) - 1 (monthly bills) - (.5 college savings) - 1 (car payments) = 1.1 leftover.

----------------
$3,500 a month mortgage is gonna put you in something really nice, and right on the beach in Florida...or living in a mansion in Texas.
$1,000 a month is going to have you driving around in a Porsche.
$1,200 a month in food means you're buying organic and eating out at decent places on a weekly basis
You're putting $36,000 a year into savings (assuming ZERO employer match)...more than adequate.
You STILL have over a grand left over to spend on whatever else. How is this not enough?

This isn't to say you need a Porsche or a $3,500/month rent...just that your salary allows for such things.

So, I guess the point of all of this, is to say that yes, even the lowly primary care physicians out there can do quite well for themselves and live a very comfortable and dare I say, luxurious, life.

 

[JustPlainBill]

Correct me if I'm wrong but isn't This job considered an academic position? I'm asking because I find 150k to be extremely low, even for a fresh-out-of-residency physician. At he level of debt most of us have, this means your take home salary after taxes and loan repayments is 50k

No, this was to work as an employed physician as a new grad for the Baylor Hospital System in Dallas/Ft. Worth.

 

[Postictal Raiden]

No, this was to work as an employed physician as a new grad for the Baylor Hospital System in Dallas/Ft. Worth.

Oh crap. This is a very low salary though. Many PAs and NPs make close to that.

 

[NurWollen]

No, this was to work as an employed physician as a new grad for the Baylor Hospital System in Dallas/Ft. Worth.

Why so low? Are there too many doctors in the area? Doesn't Texas typically have some of the highest physician salaries?

 

[Launcelot]

Have any of you seen this: https://www.healthtap.com/

It says you can get paid by doing webcam consults, and they'll even take international doctors for this. How does medical liability and pay work in this situation?

 

[kbeitz]

It's about earnings potential AFTER 12-13 years of training from a medical student's perspective. Specialties typically put a 1.5-2 times multiplier on the earnings potential before considering what work entails.

You also have to be careful about the reported income levels because they have a huge variance and depend on a lot of factors. The problem I consistently see on these forums is that reported income levels are not standardized across work loads experienced for each specialty in each region (i.e., how much more work or business risk would a family doc have to take on to reach 200k compared to IM). I would be VERY cautious with the amount of factors. It's almost better just to ignore income altogether, and go by what you like doing.

 

[JustPlainBill]

Oh crap. This is a very low salary though. Many PAs and NPs make close to that.

Well, I know of a PA with some good experience that asked for $120K and was told that the salary for PA's is more in line with $90K;

As with most students, there seems to be an inflated sense of what physicians are paid -- for an urgent care physician, you're looking at $80 - $90/hr which works out to -- between $160 - $180K before taxes at 40/hrs week with 2 weeks off; PA's/NPs are cheaper than that which is why most UC companies are getting rid of physicians for that type of work.

 

[JustPlainBill]

Why so low? Are there too many doctors in the area? Doesn't Texas typically have some of the highest physician salaries?

it's what the market will bear -- a LOT of people want to live/work in DFW so they can offer lower salaries as a whole; Now, you get out in the boonies and you'll get $180K as a new grad but you'll be doing hospital work, icu and running an outpatient clinic;

Again, get the idea out of your head that you're going to be lighting cigars with $20 bills as an attending -- the reality is you're going to be working your tail off and needing to manage your money well -- and then AFTER 8-10 years in the business, when loans are paid off, you can live a little easier....and that's no matter what specialty you go into ---

 

[JustPlainBill]

any full time physician job for under 200k seems like a poor ROI nowadays. I have several classmates who have stated they will be disappointed if they end up making any less than 200-250k, which I think is justified given the sheer length and cost of our training.

There's a paper going around on Facebook that works out the salary vs length of time in training -- the primary care fields -- FM, IM, OB/Gyn, Peds -- wind up making about as much as a beginning elementary school teacher if you equate the amount of time spent training -- the specialists are only marginally more well compensated;

If you went into medicine to make money, you're in the wrong business -- I'm not being altruistic -- it's a secure, decent living -- but the days of making lots of cash as a physician ended in the 80s; If your classmates are in this for the money, tell them to get out now before they've been through the pain that is residency and the massive debt -- go into pharmaceutical sales, be a golf pro or finance a UC clinic or whatever ---

 

[surfguy84]

There's a paper going around on Facebook that works out the salary vs length of time in training -- the primary care fields -- FM, IM, OB/Gyn, Peds -- wind up making about as much as a beginning elementary school teacher if you equate the amount of time spent training -- the specialists are only marginally more well compensated;

If you went into medicine to make money, you're in the wrong business -- I'm not being altruistic -- it's a secure, decent living -- but the days of making lots of cash as a physician ended in the 80s; If your classmates are in this for the money, tell them to get out now before they've been through the pain that is residency and the massive debt -- go into pharmaceutical sales, be a golf pro or finance a UC clinic or whatever ---

I agree with a great deal of what you're saying in this thread. And I know you worked corporate (if I'm not mistaken?) before going back to med school...so you likely know how difficult it is to move up in that world...let alone make anything close to FM money. Hell, I have friends who work for big four consulting agencies making low to mid 100s after 100k MBA loans and 8 years in the biz. As tight as some doctors have to be with their money, think about how tight everyone else is living. Things are relative.

Now, if you want to make MILLIONS, I'd agree medicine is the wrong field for you. But then again what's the "right" field? For every finance guy, entrepreneur, etc...how many are actually making millions and how many actually end up making less than docs because they never made it to the pinnacle position in their field? Every dude going into business or finance isn't working for Goldman Sachs or launching the next Twitter. I don't think there is one specific "right field" to make millions.

But if you want to "make money" relative to the millions of other workers out there, how can you say medicine isn't the right field? Even at the original figure of 225k a year, you're in the 96th percentile of all earners.

 

[yanks26dmb]

Houses on the Beach in populated areas of Fl start at >$1million. The mortgage on that is probably closer to $5k/month, and then don't forget property taxes. You can find cheaper places on the intercostal, but beachfront houses in populated areas tend to range from $1mil- $139million. And the $1mil properties are pretty simple (think 2-3 bedroom, 1-story, unrenovated since the 1980s)... I'd bet less than 10% or the people who own a beachfront house in Miami or Ft. Lauderdale are Doctors (regardless of specialty). They're finance tycoons, investors, professional athletes, real-estate developers, entrepreneurs, business founders, or inherited money.

For Texas, it depends on what you consider a "mansion." A Porsche on the other hand, you could lease for less than $1k. You could probably get a boxster for half that (~$500/month). $1k/month for food is what I spend now and I don't eat all organic.

I think you're on to something though in that there probably isn't that much of a difference in lifestyle from a PCP physician and other specialities. There isn't that much of change in lifestyle between someone making $200k/yr and someone making $500k/yr. You're looking at a marginally better house, marginally better car, and marginally better extracurricular activities (front-row tickets to two-three lakers games, or 2 week ski vacation in St. Moritz, etc.). And some of the marginally better paying specialities require significantly more effort (more time studying, 70hr work weeks, and longer residencies). Financially, I'm not sure it's worth it. It's not until you're making millions per year that you truly break apart from the pack, and I only know of a handful of doctors who've done that. One of them started an anesthesiology practice like 20 years ago that grew and expanded, and he sold it to some huge group for like $40mil. I doubt many of those opportunities will be available to us. Few physicians even approach $1million per year and the ones that do probably work so much they don't have time to enjoy it. My friend's dad who is a neurosurgeon works ~70hrs/week and only takes home ~$800k/yr. You'll never really ball out as a physician, so just do what you enjoy and be content that you'll always be above average.

And this is why I think all things are relative. I know a handful of physicians. Are they "balling out" in a professional athlete sort of way? Well, no, no they're not.

Do they all live in million dollar + homes, drive expensive cars, eat at upscale places, etc? Yeah, they all do. For reference their specialties range from Pysch to EM to Radiology.

I totally understand not EVERY physician is going to be be as successful as they are, but the point is, "balling out" is relative. I consider the lives of all of those docs I know to be pretty "baller".

I would disagree there isn't much difference between 200k and 500k a year. It takes money to make money and the amount of investing power at 500k is going to transform your lifestyle in ways that 200k salary is not.

 

[JustPlainBill]

I agree with a great deal of what you're saying in this thread. And I know you worked corporate (if I'm not mistaken?) before going back to med school...so you likely know how difficult it is to move up in that world...let alone make anything close to FM money. Hell, I have friends who work for big four consulting agencies making low to mid 100s after 100k MBA loans and 8 years in the biz. As tight as some doctors have to be with their money, think about how tight everyone else is living. Things are relative.

Now, if you want to make MILLIONS, I'd agree medicine is the wrong field for you. But then again what's the "right" field? For every finance guy, entrepreneur, etc...how many are actually making millions and how many actually end up making less than docs because they never made it to the pinnacle position in their field? Every dude going into business or finance isn't working for Goldman Sachs or launching the next Twitter. I don't think there is one specific "right field" to make millions.

But if you want to "make money" relative to the millions of other workers out there, how can you say medicine isn't the right field? Even at the original figure of 225k a year, you're in the 96th percentile of all earners.

1) Yes, I worked corporate for 17 years before the bottom fell out -- did everything from R&D to standard telecomm stuff (unlike Al Gore, I actually did work on the systems (and my code may still be in there) that eventually became the internet) -- moving up isn't easy -- requires lots of tact and knowledge -- and I'm a little light on tact unless I really focus on it.

2) I see your point -- the impression I get from some of the other posters is that they're thinking of Gordon Gecko in "Wall Street" type of wealth and that just ain't happening in medicine; Yes, as a PCP vs others, I make a great living -- where my crunchtime comes in is next year -- my loans come due, my first is off to college (pre-med) and my second starts driving and the house needs some repairs -- gonna be interesting; That's why I'm recommending to the younger colleagues to get that debt paid off, set up a good budget and spend for quality things but don't blow money -- the greatest mistake is to look at physicians/people that have 15-20 years in the business and expect that you'll have the same things they do within 2 years

 

[JustPlainBill]

And this is why I think all things are relative. I know a handful of physicians. Are they "balling out" in a professional athlete sort of way? Well, no, no they're not.

Do they all live in million dollar + homes, drive expensive cars, eat at upscale places, etc? Yeah, they all do. For reference their specialties range from Pysch to EM to Radiology.

I totally understand not EVERY physician is going to be be as successful as they are, but the point is, "balling out" is relative. I consider the lives of all of those docs I know to be pretty "baller".

I would disagree there isn't much difference between 200k and 500k a year. It takes money to make money and the amount of investing power at 500k is going to transform your lifestyle in ways that 200k salary is not.

I'd be interested to know if those physicians you mention haven't found ways to multiply themselves vs earning that much working on their own -- by that I mean something like:

An EM doc is great -- but if you can get residents/newly minted attendings/PAs/NPs as employees of your EM group (force multipliers) you can earn a great deal more; Have they opened their own freestanding ERs? and similar questions for the others --

I'm getting my experience now and then likely going to do my own thing in 3 years with some colleagues from residency;

 

[yanks26dmb]

I'd be interested to know if those physicians you mention haven't found ways to multiply themselves vs earning that much working on their own -- by that I mean something like:

An EM doc is great -- but if you can get residents/newly minted attendings/PAs/NPs as employees of your EM group (force multipliers) you can earn a great deal more; Have they opened their own freestanding ERs? and similar questions for the others --

I'm getting my experience now and then likely going to do my own thing in 3 years with some colleagues from residency;

In these cases, only the psych owns her own practice. She also takes a lot of outside work in prisoners, legal cases, which I'm sure adds a nice bit to her total income. The EM is a strict hospital employee (single guy, no family) though he does work about 18-19 shifts a month which seems to be a bit above the norm. The radiologist is relatively recently out of training and also hospital employee. fwiw, none come from family money or have a high earning spouse.

I'm with you though, I came from a business background prior to school and I would love to open up my own clinic/group 15 or so years down the road. Good luck to you.

 

[PathoTurnUp1865]

My plan for the future is to use the money I make as a physician to make me more money (i.e. stocks, businesses, etc.). That is how I plan to make 7 figures per year. Granted I am probably a little more frugal, and have a business plan lined out for the future. The only reason I don't see why other doctors don't do this is 3 things: 1.) doctors are notorious to be bad with their finances 2.) they don't want the "baller" life style or 3.) they don't know enough about business. Bottom line is I think anyone can do it, I know lots who have, it's just up to the person.

 

[Seth Joo]

I've been hearing so much chatter from my classmates lately about how little primary care physicians make....and how NONE of them want to go into those fields. I get the same feeling around these boards a lot too....so many people seem to think primary care is such a raw deal.

I thought it might be kind of useful to see what the salary of a primary care doctor really amounts to, in real-life terms. I used a salary calculator which accounts for the appropriate taxes. I also maxed out 401k contributions for the purposes of these calculations (18k).

This all assumes you are SINGLE or have a spouse that doesn't work. Considering a working spouse, I've added a very conservative $40k year.

225k a year salary = 154k take home (172 pre-401k contribution).
This amounts to $12,800 a month.

265k a year salary = 181k take home (199 pre-401k contribution)
This amounts to $15,000 a month.

Let's take the first figure and see what that really gets us.

12.8 - 3 (loans) - 1.5 (savings *this is on top of the 18k already in the 401k) - 3.5 (mortgage/rent) - 1.2 (food) - 1 (monthly bills) - (.5 college savings) - 1 (car payments) = 1.1 leftover.

----------------
$3,500 a month mortgage is gonna put you in something really nice, and right on the beach in Florida...or living in a mansion in Texas.
$1,000 a month is going to have you driving around in a Porsche.
$1,200 a month in food means you're buying organic and eating out at decent places on a weekly basis
You're putting $36,000 a year into savings (assuming ZERO employer match)...more than adequate.
You STILL have over a grand left over to spend on whatever else. How is this not enough?

This isn't to say you need a Porsche or a $3,500/month rent...just that your salary allows for such things.

So, I guess the point of all of this, is to say that yes, even the lowly primary care physicians out there can do quite well for themselves and live a very comfortable and dare I say, luxurious, life.

You also have to consider student loan debt, your office expenses, malpractice insurance, the amount of time you spent in school. Then you will realize the salary of a doctor is not as great as most people might think.

 

[surfguy84]

You also have to consider student loan debt, your office expenses, malpractice insurance, the amount of time you spent in school. Then you will realize the salary of a doctor is not as great as most people might think.

Well student loan payments were accounted for in those figures. Sure some figures weren't but a) there was a monthly surplus and b) I assumed zero employer 401k matching which isn't realistic for the vast majority. This would free up additional funds.

 

[group_theory]

Well student loan payments were accounted for in those figures. Sure some figures weren't but a) there was a monthly surplus and b) I assumed zero employer 401k matching which isn't realistic for the vast majority. This would free up additional funds.

Please don't reduce your 401k contribution because your employer is contributing - it's a financial move against your future. You're already behind the game when you start with a 401k and have lost years of compounded interest that your non-medical friends have gained. You have to save a lot more/month just to catch up. To reduce your contribution will likely cost you hundreds of thousands of dollars.
http://www.businessinsider.com/amazing-power-of-compound-interest-2014-7

I assume you will be responsible and have car insurance since you allotted $1000/month towards a car (which mean your insurance will be pretty high) .... you also don't want the bare-minimum state required insurance ... you want to protect yourself ... otherwise if you hit another doctor's car, or be found at fault for a multi-vehicle/multiple injuries - if you don't have enough coverage, they can come after your personal assets (like your savings and future wage garnishment). Will also need collision/comprehensive (and if you're smart, underinsure/uninsured coverage). That will add a hefty premium. If you live in a state known for high insurance cost (eg Florida, New York, California) ... watch out!!!

I assume you also want to insure your house as well

Since you will now be perceived as "rich" and have assets worth protecting, you might want to consider an umbrella policy for personal liability protection

Plus you want to insure yourself ... life insurance as well as disability insurance with own-occupation clause.

Those premiums can easily eat away your $2.6k/month free money (after your above budgeted expenses)

Since your figures includes no state income tax, I assume your property tax as well as other local taxes will be high to compensate ...

Also keep in mind that at greater than $200k/year, a lot of tax deductions are no longer available to you, phased out at higher income. That student loan interest deduction --> gone. Think you want to get that MBA? Can't deduct tuition, or use any education tax credit - you make too much. Oh there's an additional Medicare tax as well since you make above $200k (it's part of obamacare to help pay for it)

Life has a funny way of throwing curve balls. Now you won't be scrambling to make ends meat, or worry if you can afford food on the table or a roof over your head, or whether you can afford to pay the electric bill or gas bill or water bill or credit card bills or cell phone bill. You won't have to worry about affording to buy a gift for a friend getting married/baby shower

You won't be a pauper. You'll be living the upper middle class lifestyle. And you will still have fun.

And in the end, if what you are doing is enjoyable, then it's worth it ... whether you're a family med doc, a specialist, a surgeon, etc.