The Truth About Physician Salaries

[spenguin]

I live in a suburb of a big city in the Northeast, in an area with lots of doctors. Many FM docs I know make sub 200k.

If you live in an area with lots of doctors or a city in general or Northeast/cali, the pay is less

To me personally, in a normal job getting 100k+ is great. (That being said, my brother just got a entry level software engineer position for 140k with perks)

But when you add in the debt and the fact that you have to put your life on hold during med school/residency and dont get income in your 20s, the pay should be more.

My aunt is a FM doc in semi rural California working for Kaiser I belive. She is working all the time. They have her answering patient emails and calls constantly on top of normal visits. As in before she can sleep she has to finish responding to everyone. That to me is what scares me about FM.

---

Members don't see this ad.

 

[PathoTurnUp1865]

I live in a suburb of a big city in the Northeast, in an area with lots of doctors. Many FM docs I know make sub 200k.

If you live in an area with lots of doctors or a city in general or Northeast/cali, the pay is less

To me personally, in a normal job getting 100k+ is great. (That being said, my brother just got a entry level software engineer position for 140k with perks)

But when you add in the debt and the fact that you have to put your life on hold during med school/residency and dont get income in your 20s, the pay should be more.

My aunt is a FM doc in semi rural California working for Kaiser I belive. She is working all the time. They have her answering patient emails and calls constantly on top of normal visits. As in before she can sleep she has to finish responding to everyone. That to me is what scares me about FM.

I gave a presentation over the ACA and physician reimbursements for an MBA class last week. One of the slides had the average salaries for all specialties, the business students lost their s***. The lowest amount on there was FM, it was 160K I believe. They couldn't believe that we were griping about it, while they barely make half of what the lowest paid specialty makes. However, they didn't realize that we are sacrificing our potential income in our twenties (they didn't consider the time value of money in this case), and didn't realize how much medical school cost. For my MBA I will have 20k in debt whereas my medical school cost will be in the ballpark of 160k.

 

[yanks26dmb]

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.

I've wondered about 401k and/or the right amount to save each month. If OP cut his 3k allotted to savings each month in half, due to employer contribution (which I believe is up to 18k this year), he would be putting 36k a year into a 401k. I used a quick calculator, and at 30 years of that, he'd have almost 3.5M in the bank. Is 3.5M considered enough to live a comfortable retired life? It looks like interest is about 180k a year on that...and assuming you'd have no house payments and fewer expenses at that point in life...seems doable.

 

[group_theory]

I gave a presentation over the ACA and physician reimbursements for an MBA class last week. One of the slides had the average salaries for all specialties, the business students lost their s***. The lowest amount on there was FM, it was 160K I believe. They couldn't believe that we were griping about it, while they barely make half of what the lowest paid specialty makes. However, they didn't realize that we are sacrificing our potential income in our twenties (they didn't consider the time value of money in this case), and didn't realize how much medical school cost. For my MBA I will have 20k in debt whereas my medical school cost will be in the ballpark of 160k.

If you look at academia, for those who pursued the PhD route, then postbac then happen to get that coveted rare tenure-track assistant professorship - the starting salary isn't much higher than a medical resident. Even if they were granted tenure or made full professor, the average salary of a full professor pales in comparison to family medicine. Now granted, most should not have outstanding debt from graduate school but the time-cost is still there (if not longer since there are no guarantee that you can finish a PhD in 4 years). @Goro is a non-clinical faculty so may have more input in this (since I believed he went the PhD/postbac/TT route)

Harvard has the highest average salary for faculty and only at Full professor will they compete with family medicine in terms of salary (and still lower than most starting salary for an internal medicine hospitalist)

http://www.cupahr.org/surveys/fhe4-tenure-surveydata-2015.aspx
http://www.thecrimson.com/article/2013/4/10/harvard_salaries_numbers/

 

[IslandStyle808]

If you look at academia, for those who pursued the PhD route, then postbac then happen to get that coveted rare tenure-track assistant professorship - the starting salary isn't much higher than a medical resident. Even if they were granted tenure or made full professor, the average salary of a full professor pales in comparison to family medicine. Now granted, most should not have outstanding debt from graduate school but the time-cost is still there (if not longer since there are no guarantee that you can finish a PhD in 4 years). @Goro is a non-clinical faculty so may have more input in this (since I believed he went the PhD/postbac/TT route)

Harvard has the highest average salary for faculty and only at Full professor will they compete with family medicine in terms of salary (and still lower than most starting salary for an internal medicine hospitalist)

http://www.cupahr.org/surveys/fhe4-tenure-surveydata-2015.aspx
http://www.thecrimson.com/article/2013/4/10/harvard_salaries_numbers/

Concur strongly with group-theory's post.

The 4 years PhD and 3 years post-doc is the bare minimum before having an assistant professorship. There is also no guarantee that one will finish the post-doc in 3 years and even make it to a non-tenure position. From the point of view of such degrees, medicine seem like a far better deal.

 

[Goro]

Very true. A rule of thumb I use is that clinician salaries, even in Primary Care, will be 2x that of my own, and I'm at full Professor, with tenure!

Nowadays, more PhDs go into Industry rather than Academia (a reversal since I got my PhD), so I surmise that their salaries are higher, but may come with more anxiety.

https://www.higheredjobs.com/salary/salaryDisplay.cfm?SurveyID=24


However, really good PIs with R01s (no mean feat these days in times of grant difficulties) can get over $200K in salary, especially in larger cities.

If you look at academia, for those who pursued the PhD route, then postbac then happen to get that coveted rare tenure-track assistant professorship - the starting salary isn't much higher than a medical resident. Even if they were granted tenure or made full professor, the average salary of a full professor pales in comparison to family medicine. Now granted, most should not have outstanding debt from graduate school but the time-cost is still there (if not longer since there are no guarantee that you can finish a PhD in 4 years). @Goro is a non-clinical faculty so may have more input in this (since I believed he went the PhD/postbac/TT route)

Harvard has the highest average salary for faculty and only at Full professor will they compete with family medicine in terms of salary (and still lower than most starting salary for an internal medicine hospitalist)

http://www.cupahr.org/surveys/fhe4-tenure-surveydata-2015.aspx
http://www.thecrimson.com/article/2013/4/10/harvard_salaries_numbers/

 

[IslandStyle808]

Very true. A rule of thumb I use is that clinician salaries, even in Primary Care, will be 2x that of my own, and I'm at full Professor, with tenure!

Nowadays, more PhDs go into Industry rather than Academia (a reversal since I got my PhD), so I surmise that their salaries are higher, but may come with more anxiety.

https://www.higheredjobs.com/salary/salaryDisplay.cfm?SurveyID=24


However, really good PIs with R01s (no mean feat these days in times of grant difficulties) can get over $200K in salary, especially in larger cities.

Very true.

A professor of mine in my research ethics class actually had this discussion about PhDs going into industry. The vast majority of post-docs still want to pursue academia, because of being able to do the research they want and job stability. Those that enter industry do get higher salaries at the cost of doing a narrower scope of research and decreased job stability (if they don't produce the result or if the company flounders, they are out of a job).

 

[spenguin]

Concur strongly with group-theory's post.

The 4 years PhD and 3 years post-doc is the bare minimum before having an assistant professorship. There is also no guarantee that one will finish the post-doc in 3 years and even make it to a non-tenure position. From the point of view of such degrees, medicine seem like a far better deal.

Yes but post doc is much more easy than residency. And you literally get paid during your phd (tuition plus living stipend)

Very true.

A professor of mine in my research ethics class actually had this discussion about PhDs going into industry. The vast majority of post-docs still want to pursue academia, because of being able to do the research they want and job stability. Those that enter industry do get higher salaries at the cost of doing a narrower scope of research and decreased job stability (if they don't produce the result or if the company flounders, they are out of a job).

There are also a very limited number of people who get into academia. At my UG, one of my TAs was competing with 6/7 other people for an assistant professor post and that was just getting his foot in the door

 

[IslandStyle808]

Yes but post doc is much more easy than residency. And you literally get paid during your phd (tuition plus living stipend)

I'm not sure what you mean by easy. If you are referring to the amount of hour put in, then yes post-doc is easier than residency. If you are referring to what it takes to make yourself competitive and land a job, then this is an apples and oranges argument. Post-doc is a time of trying to get as many high yield results and publications as possible. It is up to the individual post-doc how much effort they want to put in to get the result. There are PhDs who willing extend their post-doc years in order to help boost their publications and CV. It is like a pre-med trying to do post-bacc to make themselves more competitive for medical school. With residency, as long as one works hard and doesn't screw up royally, then they are able to land a job somewhere (YMMV for certain specialities).

As for being paid during your PhD, this is school dependent. In my university, you are not directly paid simply by being in a PhD program. You can get paid if you have an RAship (which not every professor offers) and TAship. During my masters, I did TAships and had worked with several PhD students who paid for their education with TAships (throughout their entire degree). There are those lucky dogs who are in programs where they only have to do 1-2 years of TAships and their entire tuition and stipend for 4-5 years is given. Again school dependent.

There are also a very limited number of people who get into academia. At my UG, one of my TAs was competing with 6/7 other people for an assistant professor post and that was just getting his foot in the door

Correct. Pretty much the point I was getting at with my statement. It has become so competitive that PhDs are now looking at going into industry to get a job doing research. They would much rather be in academia because there is much more freedom in doing the research they want (they are willing to take a salary hit for it too).

 

[Goro]

Both points are true. I like to tell young post-docs that there are jobs out there, but you have to be in the right place at the right time.

Yes but post doc is much more easy than residency. And you literally get paid during your phd (tuition plus living stipend)


There are also a very limited number of people who get into academia. At my UG, one of my TAs was competing with 6/7 other people for an assistant professor post and that was just getting his foot in the door

 

[kalat]

Calculate lost income from the training time, the debt, the interest, and the emotional and social sacrifice that goes along with practicing medicine and it isn't anything special other than it is a consistent path to comfortable income as long as you can graduate and finish residency. I think medicine is desirable more for the job security rather than the income. Unless you end up doing subspecialty procedure based work in your own clinic, your lifestyle will probably not be very much more extravagant than other individuals with similar education or work ethic. You must also keep in mind everything seems to get more difficult (and/or competitive) over time. If you see an older physician soaking up money and not doing much of anything it is wrong to assume the future physicians training today will share the same fortune. As far as comparisons to graduate school: it's an awful time to be in academia right now. That has nothing to do with medicine.

 

[cbrons]

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.

Living in 0 state income tax states can really help

 

[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.

 

[Seth Joo]

Someone did a graph of a UPS Driver vs a Primary Care doctor a few years back and it was interesting, it turns out in the long run, given the time it takes to become a doctor, four years of college plus four years of medical school, educational debt, and then the amount of time it takes to pay it all back the Primary Care doctor is no better off than a UPS Driver.

Medical school costs have nearly doubled since that post, I have to find it because I believe it was made nearly 8 years ago, and I think today the UPS Driver would actually come out ahead.

 

[costales]

I'm afraid many UPS employees will soon be working for the Amazon guy.
http://seekingalpha.com/article/3767216-amazon-is-squeezing-ups-out

 

[Mjolner]

Someone did a graph of a UPS Driver vs a Primary Care doctor a few years back and it was interesting, it turns out in the long run, given the time it takes to become a doctor, four years of college plus four years of medical school, educational debt, and then the amount of time it takes to pay it all back the Primary Care doctor is no better off than a UPS Driver.

Medical school costs have nearly doubled since that post, I have to find it because I believe it was made nearly 8 years ago, and I think today the UPS Driver would actually come out ahead.

I guess this is why the UPS drivers all live in big houses and the doctors drive used civics.

Seriously. People worried about being broke because you're a doctor need to quit school and get a job in ANY OTHER FIELD for a few years and learn that while we all know that guy who's making $500k in finance, there are 50 others making $50k
Being a doctor and complaining about money to the average joe will get you punched. You do realize that the median household income is $50k, right? Tack on 50k for loans and figure $35k for seven years lost income at the national average of $50k and even from day one (if you spread that debt and lost income over ten years) you're making over DOUBLE the average joe even if you do FM.
People here need perspective.

 

[scoKraz4]

I guess this is why the UPS drivers all live in big houses and the doctors drive used civics.

Seriously. People worried about being broke because you're a doctor need to quit school and get a job in ANY OTHER FIELD for a few years and learn that while we all know that guy who's making $500k in finance, there are 50 others making $50k
Being a doctor and complaining about money to the average joe will get you punched. You do realize that the median household income is $50k, right? Tack on 50k for loans and figure $35k for seven years lost income at the national average of $50k and even from day one (if you spread that debt and lost income over ten years) you're making over DOUBLE the average joe even if you do FM.
People here need perspective.

Many people who are worried probably came from upper/upper-middle class families to begin with and worried about the possibility of not continuing that life.

 

[Mjolner]

Many people who are worried probably came from upper/upper-middle class families to begin with and worried about the possibility of not continuing that life.

That doesn't change anything. Medicine is still the best bet for a high salary.

 

[Seth Joo]

I guess this is why the UPS drivers all live in big houses and the doctors drive used civics.

Seriously. People worried about being broke because you're a doctor need to quit school and get a job in ANY OTHER FIELD for a few years and learn that while we all know that guy who's making $500k in finance, there are 50 others making $50k
Being a doctor and complaining about money to the average joe will get you punched. You do realize that the median household income is $50k, right? Tack on 50k for loans and figure $35k for seven years lost income at the national average of $50k and even from day one (if you spread that debt and lost income over ten years) you're making over DOUBLE the average joe even if you do FM.
People here need perspective.

The average Joe usually does not have 400k in student loan debt, many new doctors have that kind of loan debt, then you got to pay taxes, then you need a roof over your head, then you need to eat, and other stuff. It does not take much education to become a UPS Driver, and they make more thank 50k per year, more like around 70k and also get a retirement account and other perks.

Also that 400k does not take into account other student loans that most people have before entering medical school. And if you live in an expensive city its even harder for you to have a good lifestyle as a primary care physician.

 

[Mjolner]

The average Joe usually does not have 400k in student loan debt, many new doctors have that kind of loan debt, then you got to pay taxes, then you need a roof over your head, then you need to eat, and other stuff. It does not take much education to become a UPS Driver, and they make more thank 50k per year, more like around 70k and also get a retirement account and other perks.

Also that 400k does not take into account other student loans that most people have before entering medical school. And if you live in an expensive city its even harder for you to have a good lifestyle as a primary care physician.

I figured 500k in student loans in my figures. Which covers both undergrad and medschool loans for most. Also ups drivers pay taxes and put a roof over their head and eat etc so those balance out for both professions. Doctors get 401k and other perks as well. So they come out 30k ahead from day one.

Actually I DID make a mistake. I forgot to mention after ten years they have no more loans if they followed my described plan and they have no more loss of money due to time spent in school. So then it is 115k more than the ups driver. That seems significant. Plus I ignored all residency income.

In total, it's almost 1.5 million extra income as a doctor over 20 years. Which seems like a significant amount to me.

 

[Seth Joo]

I figured 500k in student loans in my figures. Which covers both undergrad and medschool loans for most. Also ups drivers pay taxes and put a roof over their head and eat etc so those balance out for both professions. Doctors get 401k and other perks as well. So they come out 30k ahead from day one.

Actually I DID make a mistake. I forgot to mention after ten years they have no more loans if they followed my described plan and they have no more loss of money due to time spent in school. So then it is 115k more than the ups driver. That seems significant. Plus I ignored all residency income.

In total, it's almost 1.5 million extra income as a doctor over 20 years. Which seems like a significant amount to me.

There was a time when a doctor earned an income that was 5 or 6 times that of an average working person, but now that advantage has worn away due to rising costs of education lower reimbursements.

401K?? There are many doctors on 1099s out there.

 

[Mjolner]

There was a time when a doctor earned an income that was 5 or 6 times that of an average working person, but now that advantage has worn away due to rising costs of education lower reimbursements.

401K?? There are many doctors on 1099s out there.

There was a time when if you were a landowner you could conscript those who lived on that land to fight the neighboring lord too.

Times change buddy, but it's still more economical advantageous to be a doctor than pretty much any other field out there. And if the average household income is $50k and most FM docs out there making 4 times that and most specialists making 6-8 times that or more, I think the average is probably still 5-6 times that of an AVERAGE WORKING HOUSEHOLD. Which is higher than the average working person.

Stop fear mongering dude.

 

[Seth Joo]

There was a time when if you were a landowner you could conscript those who lived on that land to fight the neighboring lord too.

Times change buddy, but it's still more economical advantageous to be a doctor than pretty much any other field out there. And if the average household income is $50k and most FM docs out there making 4 times that and most specialists making 6-8 times that or more, I think the average is probably still 5-6 times that of an AVERAGE WORKING HOUSEHOLD. Which is higher than the average working person.

Stop fear mongering dude.

I agree that you can make a very good living, its just that you are not going to live in a house in the hills, have a country club membership, be in the 1 percent, the kind of things many premeds think they are going to get from a career in Medicine, so they days are gone.

 

[Mad Jack]

I guess this is why the UPS drivers all live in big houses and the doctors drive used civics.

Seriously. People worried about being broke because you're a doctor need to quit school and get a job in ANY OTHER FIELD for a few years and learn that while we all know that guy who's making $500k in finance, there are 50 others making $50k
Being a doctor and complaining about money to the average joe will get you punched. You do realize that the median household income is $50k, right? Tack on 50k for loans and figure $35k for seven years lost income at the national average of $50k and even from day one (if you spread that debt and lost income over ten years) you're making over DOUBLE the average joe even if you do FM.
People here need perspective.

Actually, you're making about four times what the average Joe is as a FM doc, per BLS.gov. The average wage for a full-time worker in the United States is $47,230. A FM doc with a 200k salary will have $128,750 available of income after maxing out their 401k, of which $18,000 (the amount required to meet PAYE monthly payments, though this is actually an exaggeration by a few thousand dollars because I don't care to do all of the deducting and the like to figure out the exact payment) would go to debt service, and 5.5k would be contributed to a Roth IRA. This leaves our FM doctor with $105,500 post-tax, with $23,500 contributed to their retirement (plus whatever match they get), far more than our average wage earner that is pulling $30,976.45 after taxes (assuming 10% 401k contribution and the average $4,995 employee cost of health insurance per year) and only getting $4,723 pitched into their retirement per year. And that's if our average Joe has no student loan debt...

This isn't to say that FM docs are making bank, but that they're still relatively well off compared to the average American, even on a post-tax basis, with $129,000 of income and retirement funding per year, post debt servicing, compared to $35,699.45 per year held by the average American (that has zero student loan debt- if they're also on PAYE, they will have around 8% less than this).

 

[W19]

I agree that you can make a very good living, its just that you are not going to live in a house in the hills, have a country club membership, be in the 1 percent, the kind of things many premeds think they are going to get from a career in Medicine, so they days are gone.

Only the top 0.5% can afford these stuff you are talking about...

 

[Mad Jack]

There was a time when a doctor earned an income that was 5 or 6 times that of an average working person, but now that advantage has worn away due to rising costs of education lower reimbursements.

401K?? There are many doctors on 1099s out there.

1099 is even better, from a tax perspective. Do you even SEP IRA, bro? Better still, if you keep a second job on the side that is W2, you can contribute to both a SEP IRA and a 401k/403b and store more than three times the wealth an average American can for retirement, though be ready to hire a good accountant, as the math gets really ugly in regard to contribution limits in a two job, half 1099/half W2 scenario.

 

[Mad Jack]

I agree that you can make a very good living, its just that you are not going to live in a house in the hills, have a country club membership, be in the 1 percent, the kind of things many premeds think they are going to get from a career in Medicine, so they days are gone.

The 1% generally don't get there by work, they get there via multigenerational wealth and work because they enjoy it, not because they have to. Too many people have this false belief that the top 1% is an income-based goal, which would peg it at around $380,000. However, if we look at wealth instead of income, the barrier is at $8.4 million, a figure few physicians set aside even in the good 'ol days. Which, by the way, were a very short-lived period- prior to the passage of Medicare and Medicaid, physician incomes were barely higher than the average household. With the passage of Medicare, physicians found they could charge the government far more than they could charge individuals back in the day, and thus they raised prices to whatever they felt like. Incomes octupled within a few short years in many fields, and have slowly been reigned in ever since. The "good old days" were a government-induced anomaly, not a long-standing state of the medical profession, and only lasted about 30 years (from the advent of Medicare to the establishment of HMOs).

I feel like many expectations of what people have in regard to medicine are based more on this brief anomaly of medical history that many premeds saw their parents or relatives experience, combined with the excessively glamorous media portrayal of what physician lifestyle is like.

 

[Mad Jack]

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.

1: live in a low tax area
2: pick employers that provide full coverage
3:All employers have to pay for this, it isn't unique to physicians. Because of our larger income to expense ratio, it actually affects us over four times less than it does the average person.
6, 7, 9,10, 13, 14, 15: Again, not issues unique to physicians and actually easier for us to deal with.
5: don't send your kids to private school and have them pay for their own education
4: Licensure fees are expensive, but are a fraction of overall income.
12: That's a personal decision, I guess. My parents didn't pay for my school or help me really, aside from a book here and there paid for by my father's rare child support checks that I obviously don't feel very indebted for given that he was a deadbeat. If you've got cultural things I guess that can be a real barrier though.
11: Spot on.

What it really boils down to is that none of our issues are unique to our field, and that our income allows us to face these barriers far better than anyone in the middle class could.

 

[yanks26dmb]

Some of you need to spend some time working in corporate America to understand what reality is.

Listen to the non-trads who tell you, for every guy that goes into "business" and is pulling 300k as a VP or working at Goldman-Sachs..theres 200 other guys working as financial analysts, middle managers, and various other support roles who would be ecstatic to make 100k.

Immediately out of undergrad I worked for a well-known and high-profile tech company who hired the best of the best. Even here, the rat race was in full effect and there were a lot of very smart people who would simply never make the big bucks because there were some few of those spots and so many of them. You think getting into med school was hard? Try playing the politics of the rat race and compete against a couple thousand people for four or five spots that open up not every year, but whenever someone retires, moves groups, or a new (rare) opening is created.

 

[surfguy84]

Someone did a graph of a UPS Driver vs a Primary Care doctor a few years back and it was interesting, it turns out in the long run, given the time it takes to become a doctor, four years of college plus four years of medical school, educational debt, and then the amount of time it takes to pay it all back the Primary Care doctor is no better off than a UPS Driver.

Medical school costs have nearly doubled since that post, I have to find it because I believe it was made nearly 8 years ago, and I think today the UPS Driver would actually come out ahead.

And then you step into the real world and the doctor is living in the better neighborhood and driving a nicer car. Either the UPS driver is inherently less materialistic or what happens on paper doesn't play out in reality.

 

[surfguy84]

One big thing I think a lot of people are missing...

In all of the primary care fields, you could typically (from what I've been told by attendings) add to your salary pretty easily by simply working more. Spend a full weekend on call at some rural hospital and you can literally add 40k to your yearly salary.

Just deciding to add more income to your yearly salary by simply working more hours isn't possible in the vast majority of other fields.

 

[68PGunner]

Some of you need to spend some time working in corporate America to understand what reality is.

Listen to the non-trads who tell you, for every guy that goes into "business" and is pulling 300k as a VP or working at Goldman-Sachs..theres 200 other guys working as financial analysts, middle managers, and various other support roles who would be ecstatic to make 100k.

Immediately out of undergrad I worked for a well-known and high-profile tech company who hired the best of the best. Even here, the rat race was in full effect and there were a lot of very smart people who would simply never make the big bucks because there were some few of those spots and so many of them. You think getting into med school was hard? Try playing the politics of the rat race and compete against a couple thousand people for four or five spots that open up not every year, but whenever someone retires, moves groups, or a new (rare) opening is created.

Let's not forget that the financial guy pulling 300K is probably pulling 60-70 hrs/wk on a regular basis. Most docs can pull 200K by just working 40 hrs/wk and 4-6 wks of vacation.

 

[NurWollen]

Let's not forget that the financial guy pulling 300K is probably pulling 60-70 hrs/wk on a regular basis. Most docs can pull 200K by just working 40 hrs/wk and 4-6 wks of vacation.

And then turn around and give up half of that 200k in taxes and loan repayments.

 

[Drrrrrr. Celty]

http://graphaday.blogspot.com/2010/04/doctor-salary-vs-ups-driver.html

Basically you break even with the UPS driver within 10 years of finishing med school. However if the UPS driver is working MD hours ( I guess 50?) then you're going to break even closer to 20 years after finishing school. I guess the moral of the story is don't retire at 50..

Idk about you all, but I expect to have a decent flat in a decent city, have relatively decent hours at work, and have time for my family. I don't need to make millions for that.

 

[Mjolner]

http://graphaday.blogspot.com/2010/04/doctor-salary-vs-ups-driver.html

Basically you break even with the UPS driver within 10 years of finishing med school. However if the UPS driver is working MD hours ( I guess 50?) then you're going to break even closer to 20 years after finishing school. I guess the moral of the story is don't retire at 50..

Idk about you all, but I expect to have a decent flat in a decent city, have relatively decent hours at work, and have time for my family. I don't need to make millions for that.

There are so many problems with that graph

 

[Drrrrrr. Celty]

There are so many problems with that graph

Well no duh. People were mentioning it though, so I felt like posting it for the lols.

 

[68PGunner]

http://graphaday.blogspot.com/2010/04/doctor-salary-vs-ups-driver.html

Basically you break even with the UPS driver within 10 years of finishing med school. However if the UPS driver is working MD hours ( I guess 50?) then you're going to break even closer to 20 years after finishing school. I guess the moral of the story is don't retire at 50..

Idk about you all, but I expect to have a decent flat in a decent city, have relatively decent hours at work, and have time for my family. I don't need to make millions for that.

You might break even with the UPS driver if you have a total of 400-500K of debt after your medical school residency. However, there are a lot of med students out there who get paid to go to undergrad and med school for free. For those people, they're already 99% ahead of the curve. At the end of the day, it's about financial planning. There's a system in place to reward certain behaviors and decisions. It's up to you to educate yourself in order to maximize your opportunities.

 

[Postictal Raiden]

The physician vs UPS driver graph is one of the most stupid things I've ever seen.

People don't realize how long it takes for one to become a truck driver. I had a friend who worked in UPS and he told me that to become a driver, one needed to work their way up. He said it took 6+ years to become one. Until then, you are making a little above minimum wage loading and unloading trucks. Once you become a driver, you start off making something like $30 an hour. This is less than third the wage an FM makes at urgent care. Heck, that's like as little as one tenth of the hourly pay of many ER physicians.

Just for the fun of it, let's run some numbers. Let's assume that in either scenario, you retire at age of 60.

UPS driver- Starts off as a truck loader/unloader right after high school and 6 years later, he gets promoted to become a UPS driver. This means that this person will work 36 years as a UPS driver. An average driver makes ~80k, but let's assume that this person is lucky enough to make an average of 100k throughout his 36 years career as a driver. Assuming a family of 4, the take home income after taxes in an income tax free state is 82k/year. This means that the total take home income of the UPS driver is just under 3 million.

FM physician- Finishes medical school at age of 26 and starts off making ~50k during residency, but just like we ignored the income the driver made before becoming a driver, we'll ignore the residency income here. At 29, an FM will start off making an average of 180k for the next 31 years. That's 140k of take home income after taxes. The total take home income over the 31 years would be $4.3M. Now lets deduct the student loans from this amount. For the sake of argument, let's assume that this person finishes med school owing 500k, and this amount balloons to 550k after residency. Paying off this amount over 10 years, while refinancing at a lower rate, would result in a total repayment amount of ~670k. $4.3M minus $700k equals $3.6M of take home income after taxes and loan repayment. That is 20% higher bring home income than that of a UPS driver.

This goes to show that even assuming one of the worst case scenarios (very high debt and very low income potential) a physician still comes out financially ahead of the UPS driver.

Now, aside from finances, there are about a billion reasons why I'd choose to be an FM doc over a UPS driver.

 

[Psai]

The physician vs UPS driver graph is one of the most stupid things I've ever seen.

People don't realize how long it takes for one to become a truck driver. I had a friend who worked in UPS and he told me that to become a driver, one needed to work their way up. He said it took 6+ years to become one. Until then, you are making a little above minimum wage loading and unloading trucks. Once you become a driver, you start off making something like $30 an hour. This is less than third the wage an FM makes at urgent care. Heck, that's like as little as one tenth of the hourly pay of many ER physicians.

Just for the fun of it, let's run some numbers. Let's assume that in either scenario, you retire at age of 60.

UPS driver- Starts off as a truck loader/unloader right after high school and 6 years later, he gets promoted to become a UPS driver. This means that this person will work 36 years as a UPS driver. An average driver makes ~80k, but let's assume that this person is lucky enough to make an average of 100k throughout his 36 years career as a driver. Assuming a family of 4, the take home income after taxes in an income tax free state is 82k/year. This means that the total take home income of the UPS driver is just under 3 million.

FM physician- Finishes medical school at age of 26 and starts off making ~50k during residency, but just like we ignored the income the driver made before becoming a driver, we'll ignore the residency income here. At 29, an FM will start off making an average of 180k for the next 31 years. That's 140k of take home income after taxes. The total take home income over the 31 years would be $4.3M. Now lets deduct the student loans from this amount. For the sake of argument, let's assume that this person finishes med school owing 500k, and this amount balloons to 550k after residency. Paying off this amount over 10 years, while refinancing at a lower rate, would result in a total repayment amount of ~670k. $4.3M minus $700k equals $3.6M of take home income after taxes and loan repayment. That is 20% higher bring home income than that of a UPS driver.

This goes to show that even assuming one of the worst case scenarios (very high debt and very low income potential) a physician still comes out financially ahead of the UPS driver.

Now, aside from finances, there are about a billion reasons why I'd choose to be an FM doc over a UPS driver.

6 years and they still can't deliver my package to me when I'm sitting at home all day?

 

[Jinxapotato]

http://graphaday.blogspot.com/2010/04/doctor-salary-vs-ups-driver.html

Basically you break even with the UPS driver within 10 years of finishing med school. However if the UPS driver is working MD hours ( I guess 50?) then you're going to break even closer to 20 years after finishing school. I guess the moral of the story is don't retire at 50..

Idk about you all, but I expect to have a decent flat in a decent city, have relatively decent hours at work, and have time for my family. I don't need to make millions for that.

Since when do UPS drivers pull in 100k NET income per year (as in, 1 year after high school, 17 years old)?! This means like he's making something like 150k pre-tax at the age of 17? Screw this Imma dropping out while my leg n arm are still working...

 

[Mjolner]

Since when do UPS drivers pull in 100k NET income per year (as in, 1 year after high school, 17 years old)?! This means like he's making something like 150k at the age of 17? Screw this Imma dropping out while my leg n arm are still working...

They don't.

 

[scoKraz4]

The physician vs UPS driver graph is one of the most stupid things I've ever seen.

People don't realize how long it takes for one to become a truck driver. I had a friend who worked in UPS and he told me that to become a driver, one needed to work their way up. He said it took 6+ years to become one. Until then, you are making a little above minimum wage loading and unloading trucks. Once you become a driver, you start off making something like $30 an hour. This is less than third the wage an FM makes at urgent care. Heck, that's like as little as one tenth of the hourly pay of many ER physicians.

This is an important part that a lot of people overlook when they make these type of comparisons. There is an assumption that people who choose these different career paths automatically start at the top possible position making the highest salary range. These comparisons often use the lowest end of a salary in medicine vs. the high end of a different work field. You should compare the UPS driver to a urologist maybe? or derm?.. and compare if they worked the same amount of hours over time. There is no comparison.

 

[Daiichi]

For all of the people whining about physician salaries.. why don't you just become a UPS driver?

I've never met a doctor that wasn't financially well off. I suspect 99% of the people complaining in this thread about physician salaries have never worked a real job and do not truly understand finances. There is no other explanation for how someone could be so incredibly ill-informed on how financially secure a physician's salary can make you.

 

[Mjolner]

For all of the people whining about physician salaries.. why don't you just become a UPS driver?

I've never met a doctor that wasn't financially well off. I suspect 99% of the people complaining in this thread about physician salaries have never worked a real job and do not truly understand finances. There is no other explanation for how someone could be so incredibly ill-informed on how financially secure a physician's salary can make you.

I've been saying this forever.

 

[cbrons]

There was a time when if you were a landowner you could conscript those who lived on that land to fight the neighboring lord.

The North remembers. kappra

 

[W19]

For all of the people whining about physician salaries.. why don't you just become a UPS driver?

I've never met a doctor that wasn't financially well off. I suspect 99% of the people complaining in this thread about physician salaries have never worked a real job and do not truly understand finances. There is no other explanation for how someone could be so incredibly ill-informed on how financially secure a physician's salary can make you.

They probably are doing medicine because it is arguably more prestigious...

 

[Azete]

The truth is always somewhere in-between.

Those expecting to live a lavish lifestyle with the newest cars and multiple vacation homes will likely be incredibly disappointed -- I suspect this is where the majority of physician compensation complaints come from.

On the other hand, I have never seen a doctor struggle to provide for their family, given they're comfortable living an upper-middle class life.

 

[NurWollen]

My brother-in-law is one of the hardest working men I know. He has a business degree and awful luck when it comes to work. I've seen him get laid off more than once, be unemployed for months at a time with four kids to feed. Only recently has he finally found something he likes, albeit in a field completely unrelated to his degree. If medicine keeps me from having to go through that, I'll be satisfied.

 

[Bea5T]

For all of the people whining about physician salaries.. why don't you just become a UPS driver?

I've never met a doctor that wasn't financially well off. I suspect 99% of the people complaining in this thread about physician salaries have never worked a real job and do not truly understand finances. There is no other explanation for how someone could be so incredibly ill-informed on how financially secure a physician's salary can make you.

How many of these doctors are residents or new attendings? Doctors in their 40s and 50s financial situations are irrelevant to the current situation. They didn't have anywhere near the tuition and had much more flexibility, especially in terms of private practice. By and large, the most people who dealt with highest tuition rates(undergrad included) have yet to become attendings.

 

[NurWollen]

How many of these doctors are residents or new attendings? Doctors in their 40s and 50s financial situations are irrelevant to the current situation. They didn't have anywhere near the tuition and had much more flexibility, especially in terms of private practice. By and large, the most people who dealt with highest tuition rates(undergrad included) have yet to become attendings.

True enough.