What's the matter with 40-something MD/DO cohort??

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http://www.forbes.com/sites/bruceja...s-ok-with-obamacare-while-older-docs-bristle/

Young Physicians OK With Obamacare While Older Doctors Bristle
Though U.S. physicians continue to have issues with the Affordable Care Act, it appears to be a generational taste developing of the law making sweeping changes to their profession.

More than half, or 50.8 percent, of doctors 46 years of age and older give the health law a “D” or “F” while just 37 percent of doctors 45 and younger give the legislation such poor grades, a new survey released last week of physicians commissioned by The Physicians Foundation.

Meanwhile, nearly 30 percent of the younger doctors gave the health law an “A” or “B” when asked: “What overall grade would you give the Affordable Care Act as a vehicle for healthcare reform?” One-third, or 33.1 percent of doctors 45 and younger gave the law a “C.”
By comparison, just 22.9 percent of the older doctors gave the law an “A” or “B” with 26 percent giving it a “C,” the survey shows.

The survey comes as the ACA and other forces are moving doctors away from fee-for-service medicine that allows doctors to order procedures and tests liberally as opposed to more value-based care that encourages evidence-based approaches to treatment and reimbursement for keeping patients healthy.
A reason for the generational differences could be that younger doctors aren’t as close to the bureaucracy of insurance and changes in reimbursement since more physicians are leaving private practice to become employed.

“Physicians are younger, more are working in employed practice settings and more are leaving private practice,” said Dr. Walker Ray, vice president of The Physicians Foundation and chair of its research committee
.
No matter the age of the doctor, they are feeling the impact of the health law and the more than 8 million Americans who signed up for subsidized private coverage for this year. In addition, millions more Americans are getting coverage via the expanded Medicaid insurance program for the poor.
These newly insured patients are contributing to a stress on the physician workforce with “81 percent of physicians” describing themselves as “either over-extended or at full capacity,” the foundation said.
Here are some other highlights of the survey, conducted online of 20,000 physicians from March 2014 through June 2014 for the foundation by physician staffing firm MerrittHawkins.
  • 56 percent of physicians describe their morale as very negative to somewhat negative
  • 17 percent of doctors are in solo practices compared to 25 percent in 2012
  • 39 percent of physicians say they will “accelerate their retirement plans” due to changes in health care
  • 71 percent of doctors say they would still become a physician if they had to do it all over again

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Oh, I get it..I'm just surprised that "Gen X" doctors turned out to be such sheeple. We were the generation that rebuked authority, learned to be independent by virture of being latch-key kids, etc.

http://en.wikipedia.org/wiki/Sheeple
Turned into a bunch of rule following, administrator-fellating yuppies.
 
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I think I'll start my OWN practice. .. if for no other reason than the benefit of autofellatio.

doesnt work. no matter how hard you try. starting your own practice? that has a slightly better chance....
 
Yep, total sheeple and Comrade freaking marxist Obama worshipers. These new docs have no spines.
i would not be so harsh.

they are brought up in an era where setting up your own practice is not the norm. their forefathers cornered the market, and the market forces along with the political forces have aligned in a way that it is increasingly more difficult to open up private practices.

as it is now, posters here have stated they find it hard as a solo practitioner competing against the multiphysician groups and the hospital groups. imagine having no viable income, mounds of debt much more than when you were a resident/fellow, having to garner even more debt to get the rudiments of a practice started. that doesnt even include changes in how difficult it is to obtain loans in the first place.

what would you do? what i suspect most reasonable and financially responsible individuals would do. join a practice or hospital setting.
 
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i would not be so harsh.

they are brought up in an era where setting up your own practice is not the norm. their forefathers cornered the market, and the market forces along with the political forces have aligned in a way that it is increasingly more difficult to open up private practices.

as it is now, posters here have stated they find it hard as a solo practitioner competing against the multiphysician groups and the hospital groups. imagine having no viable income, mounds of debt much more than when you were a resident/fellow, having to garner even more debt to get the rudiments of a practice started. that doesnt even include changes in how difficult it is to obtain loans in the first place.

what would you do? what i suspect most reasonable and financially responsible individuals would do. join a practice or hospital setting.
Exactly!

I'm FM, but this all still applies. If you finish training with 200k+ in loans, you can't really afford to start a practice where it might take you a few months to get a decent income going.
 
Exactly!

I'm FM, but this all still applies. If you finish training with 200k+ in loans, you can't really afford to start a practice where it might take you a few months to get a decent income going.

200K, what about 500K?
 
average medical school tuition has more than doubled since 1996-7. some much more. average at private institutions is $50,078 per year, and median debt for graduates in 2012 was 170K.

Florida, for example, instate went from $8700 to $28000. out of state $22,000 to $48,000.

in addition, resident salaries have been stagnant when adjusted for inflation for the past 40 years.

over a third of residents owe more than $200K when they finish residency.
 
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average medical school tuition has more than doubled since 1996-7. some much more. average at private institutions is $50,078 per year, and median debt for graduates in 2012 was 170K.

Florida, for example, instate went from $8700 to $28000. out of state $22,000 to $48,000.

in addition, resident salaries have been stagnant when adjusted for inflation for the past 40 years.

over a third of residents owe more than $200K when they finish residency.


Try 500K:

https://georgetown.app.box.com/s/hbdpvin1ewimsvze14s5
 
if you borrow 250, you will be paying back 600 over 25 years....
 
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All of my friends from residency/fellowship (PM&R, sports, pain) who fall under the "Millennial" generation/mindset took jobs at the largest or most prestigious system they could out of training and then within 2 years realized how much they were underpaid and underappreciated. Now want to move to private practice or smaller system to get appropriate pay/freedom.

I think it is still rare to have the guts/money to open a private practice right out training as a specialist, but wouldn't be surprised that younger physicians are opening their eyes to the benefits of the small to medium multi-specialty practice - especially in the pain/MSK world.
 
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All of my friends from residency/fellowship (PM&R, sports, pain) who fall under the "Millennial" generation/mindset took jobs at the largest or most prestigious system they could out of training and then within 2 years realized how much they were underpaid and underappreciated. Now want to move to private practice or smaller system to get appropriate pay/freedom.

I think it is still rare to have the guts/money to open a private practice right out training as a specialist, but wouldn't be surprised that younger physicians are opening their eyes to the benefits of the small to medium multi-specialty practice - especially in the pain/MSK world.

Bottom line

Millelials supported ACA - they had no real stake in the system and it all sounded great. The don’t understand. Plus liberals run the college university system so that also probably played a role.

Now they are working in the system and the consequences that followed from supporting it and now they realize they are being exploited.

I was definitely in this cohort but never liked Ob or the ACA. Kept my mouth shut though no point in having people hate the loner kid who studies hard and wants to get ahead.
 
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Some people might support the ACA for helping a lot of people get health care, even if it doesn’t directly benefit subspecialists.

Personally, I feel like things have been getting worse for docs since the Clinton administration and nobody’s done anything to turn it around.
 
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All of my friends from residency/fellowship (PM&R, sports, pain) who fall under the "Millennial" generation/mindset took jobs at the largest or most prestigious system they could out of training and then within 2 years realized how much they were underpaid and underappreciated. Now want to move to private practice or smaller system to get appropriate pay/freedom.

I think it is still rare to have the guts/money to open a private practice right out training as a specialist, but wouldn't be surprised that younger physicians are opening their eyes to the benefits of the small to medium multi-specialty practice - especially in the pain/MSK world.

Let's all say it together, "They will never love you back..."
 
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I’ve seen friends get screwed by administrators, and other friends get screwed by senior partners in a partnership who decided to boot them out before they could get a stake in the practice. It’s tough everywhere.
 
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Bottom line

Millelials supported ACA - they had no real stake in the system and it all sounded great. The don’t understand. Plus liberals run the college university system so that also probably played a role.

Now they are working in the system and the consequences that followed from supporting it and now they realize they are being exploited.

I was definitely in this cohort but never liked Ob or the ACA. Kept my mouth shut though no point in having people hate the loner kid who studies hard and wants to get ahead.
Our entire education system is rotten and needs reform. But talk like that can get a person labeled an "existential threat to our democracy"...
 
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I’ve seen friends get screwed by administrators, and other friends get screwed by senior partners in a partnership who decided to boot them out before they could get a stake in the practice. It’s tough everywhere.

This. No one will love you back. Not a senior partner, not an administrator, frankly not 90% of your patients.
 
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Our entire education system is rotten and needs reform. But talk like that can get a person labeled an "existential threat to our democracy"...
Just out of curiosity, have you ever read any of Robert Kiyosaki's books? I think he would agree with you. He talks a lot about the education system and how it's designed to just churn out employees. I actually owe quite a lot to that guy.
 
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Just out of curiosity, have you ever read any of Robert Kiyosaki's books? I think he would agree with you. He talks a lot about the education system and how it's designed to just churn out employees. I actually owe quite a lot to that guy.
Rich Dad Poor Dad is a decent intro to personal finance and his way of thinking about assets vs liabilities is very good IMO.

However, his social media posts are wildly speculative and all about market timing which is counter to most of his writing (and good long term investing).
 
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Rich Dad Poor Dad is a decent intro to personal finance and his way of thinking about assets vs liabilities is very good IMO.

However, his social media posts are wildly speculative and all about market timing which is counter to most of his writing (and good long term investing).
I'm one of those people in the 46 and under crowd but still in my 40s so I'm not on twitter. I did read about his prediction of a market crash which is what I think you're referring to. I think it's impossible to time the market but I must say I agree with him that a significant correction has to be impending. Other than high-risk speculative stocks I consider myself to be completely out of the market and am happy to be on the sidelines for now. I jumped ship a few months ago.
 
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Just out of curiosity, have you ever read any of Robert Kiyosaki's books? I think he would agree with you. He talks a lot about the education system and how it's designed to just churn out employees. I actually owe quite a lot to that guy.
The only thing I read is SDN. And it shows lol
 
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Just out of curiosity, have you ever read any of Robert Kiyosaki's books? I think he would agree with you. He talks a lot about the education system and how it's designed to just churn out employees. I actually owe quite a lot to that guy.
I've read most of his purple/black books (and there's a lot), but not his social media stuff. I have even played his Cash-flow board game. I think his basic premise about assets/liabilities is spot-on, as is his don't-do-business-in-something-you-don't-know philosophy. I'm sure all his later stock stuff is more reflective of his disposable income, not proper get-wealthy investing advice.
 
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I've read most of his purple/black books (and there's a lot), but not his social media stuff. I have even played his Cash-flow board game. I think his basic premise about assets/liabilities is spot-on, as is his don't-do-business-in-something-you-don't-know philosophy. I'm sure all his later stock stuff is more reflective of his disposable income, not proper get-wealthy investing advice.
 
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I'm one of those people in the 46 and under crowd but still in my 40s so I'm not on twitter. I did read about his prediction of a market crash which is what I think you're referring to. I think it's impossible to time the market but I must say I agree with him that a significant correction has to be impending. Other than high-risk speculative stocks I consider myself to be completely out of the market and am happy to be on the sidelines for now. I jumped ship a few months ago.

From my perspective, predicting a market crash is the same as timing the market.
 
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From my perspective, predicting a market crash is the same as timing the market.
I agree but I'm happy to be out. Too risky for me right now and I generally love risk. I prefer to buy stocks and houses when they go on sale and there are definitely no sales going on right now.

For documentation, I'm still going to keep the same prediction I've said for years: next housing peak 2025/2026 with resultant housing crash in 2027, give or take a year or so. I'm preparing for it. It's my ticket home.
 
Kiyosaki's "Rich Dad Poor Dad" is a great book for behavioral finance purposes, but I think he has discredited himself over the years.

I think all you can really do is pick an asset allocation that works for you and keep DCAing into the market. Who knows how high it will go before we have a real correction?
 
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Kiyosaki's "Rich Dad Poor Dad" is a great book for behavioral finance purposes, but I think he has discredited himself over the years.

I think all you can really do is pick an asset allocation that works for you and keep DCAing into the market. Who knows how high it will go before we have a real correction?
I think you're right. I try to take people for what they're worth. His books are really easy reads but do provoke thought. I read many of his books and others that are similar. After a while, they all pretty much say the same thing and most of the pages are filled with fluff. With that said, If I had to credit anyone with planting the seed for me in real estate, I would have to say it was him.
 
I think you're right. I try to take people for what they're worth. His books are really easy reads but do provoke thought. I read many of his books and others that are similar. After a while, they all pretty much say the same thing and most of the pages are filled with fluff. With that said, If I had to credit anyone with planting the seed for me in real estate, I would have to say it was him.

I haven't made the jump to RE yet. I am reading more in depth about syndications, but I don't think I ever want to be a landlord.
 
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I haven't made the jump to RE yet. I am reading more in depth about syndications, but I don't think I ever want to be a landlord.
Are you sure? I love it. I have many properties which I manage myself and I prefer landlording to medicine. I like my pts a lot but am kind of bored of being in the office and doing procedures. That's why I try to post on here as much as possible. I find more freedom in real estate than in medicine. I also like the physicality involved.

If you change your mind, the best piece of (unsolicited) advice if you want it I can give you is to screen your tenants. I think that one small factor can make or break a real estate investor.
 
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Are you sure? I love it. I have many properties which I manage myself and I prefer landlording to medicine. I like my pts a lot but am kind of bored of being in the office and doing procedures. That's why I try to post on here as much as possible. I find more freedom in real estate than in medicine. I also like the physicality involved.

If you change your mind, the best piece of (unsolicited) advice if you want it I can give you is to screen your tenants. I think that one small factor can make or break a real estate investor.

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I think you're right. I try to take people for what they're worth. His books are really easy reads but do provoke thought. I read many of his books and others that are similar. After a while, they all pretty much say the same thing and most of the pages are filled with fluff. With that said, If I had to credit anyone with planting the seed for me in real estate, I would have to say it was him.
What are some good resources to look into to get an idea of how to evaluate what's a good real estate opportunity and other resources on how to apporpiately screen tenants without some sort of legal violation?
 
great tenants = easiest money made
terrible tenants = succubus life suck
 
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What are some good resources to look into to get an idea of how to evaluate what's a good real estate opportunity and other resources on how to apporpiately screen tenants without some sort of legal violation?
IMO it's easier than it may seem. Just do the basic math. You already have a real-time market analysis available to you for free. It used to be called craigslist and is now called Zillow. Check apartments.com too. If you can swing it, get your realtor's license so you can have access to your local MLS. Calculate PITI, principal, interest, taxes, and insurance on a real estate calculator. Get an app for this. Contact a lender for ballpark rates. Add in HOA fees and renovation costs and any other fees. Now you have your monthly cost. Return to zillow to see if the rent you can bring in will be worth it. I personally always try to charge less than fair market value as I try to keep everyone happy.

I use transunion smartmove to screen tenants. Tenants pay for this. I also have a questionnaire application I ask them to fill out and do my own screen off of that. It also contains legal forms like Meghan's law. EPA lead form for older properties. Always go back to at least 2 landlords as the current landlord may be lying to you to get the tenant out.

It's a pretty objective process. Obviously, don't discriminate based on anything and you'll be okay. You wouldn't anyway. From my experience, there's no correlation between a bad tenant and anything that you can discriminate against anyway. It's so individual.

Always emotionally connect with the tenant so they don't destroy the place in the event something goes awry. If they lose their job and can't pay rent they still have to get out, sorry. I explain to them why and hope they understand. So far, it's worked for me.

Learn plumbing, electrical, carpentry and HVAC if you can. It will save you lots of headaches and expenses. I have lots of friends in these trades and text them with questions when I need their help. I recommend you make these friends too. Youtube will only get you so far.
 
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What are some good resources to look into to get an idea of how to evaluate what's a good real estate opportunity and other resources on how to apporpiately screen tenants without some sort of legal violation?
a. Follow Pain Applicant1's advice (Except for the learning the trades. If you are so inclined and "handy," his is good advice. If not, it's bad advice and you just need to plan on paying a lot for these services.)

b. Consult @Agast, who knows a lot about both of these. She dropped some great advice on the forum re: how to analyze a real estate deal.
 
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a. Follow Pain Applicant1's advice (Except for the learning the trades. If you are so inclined and "handy," his is good advice. If not, it's bad advice and you just need to plan on paying a lot for these services.)

b. Consult @Agast, who knows a lot about both of these. She dropped some great advice on the forum re: how to analyze a real estate deal.
Painapp always has good advice.

Which thread did Agast drop this knowledge on? I am lazy to scroll through 13 pages of posts.
 
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Painapp always has good advice.

Which thread did Agast drop this knowledge on? I am lazy to scroll through 13 pages of posts.
No clue, probably several. I recall several posts re: an ongoing drama with a tenant. I was also referencing a metric used to evaluate a real estate deal. IIRC, it was similar to 6. Gross Rent Multiplier in the link below. It's a good way to quickly review whether a deal is worth your time. If it looks promising, you can get "in the weeds" as Painapp describes above.

The Top 10 Metrics Every Real Estate Investor Should Know (and...
 
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Pain applicant speaks gold.

Cash flow is king; but other reasons to gain from real estate rentals is 2) depreciation tax savings, 3) loan equity paydown, 4) hopefully appreciation.

also don't rent to lawyers. (half joking)
 
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a. Follow Pain Applicant1's advice (Except for the learning the trades. If you are so inclined and "handy," his is good advice. If not, it's bad advice and you just need to plan on paying a lot for these services.)

b. Consult @Agast, who knows a lot about both of these. She dropped some great advice on the forum re: how to analyze a real estate deal.
Something to consider regarding handyman stuff. Sometimes, I ask these trade guys if I can spend the day with them helping them. They get free labor from me and I get to learn from them. I've learned a lot this way. I still do this. I'm currently working with a diesel mechanic friend of mine because I want to make sure I can fix my farm and construction equipment myself. It comes in handy. I learned how to rebuild a cylinder on my skid steer and I was also able to fix my snowplow when I blew a hydraulic hose and an o ring on the solenoid after the snowstorm last week. I would have been in trouble if I couldn't fix this because another storm is rolling in this weekend and there aren't too many people who work on plows.

Next, I'm planning on learning how to weld.

Just make sure these guys know that you definitely have zero interest in doing this as a living. You don't want to end up having them feel threatened that you're coming after their job.

I really can't overemphasize how much I've learned from these guys. Sometimes the guys with no teeth and no formal education really know the most, especially when it comes to farming.
 
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Doctors have always been patsies.
Even when we came out in 2000’s, creating a small businesses was stressful and life altering . Most wouldn’t have the courage to take the jump the or now. We deserve everything we earned …

If you have money to invest try Crowd street . Being a landlord is tough , esp when your tenants are other doctors … bunch of drama queens …
 
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IMO it's easier than it may seem. Just do the basic math. You already have a real-time market analysis available to you for free. It used to be called craigslist and is now called Zillow. Check apartments.com too. If you can swing it, get your realtor's license so you can have access to your local MLS. Calculate PITI, principal, interest, taxes, and insurance on a real estate calculator. Get an app for this. Contact a lender for ballpark rates. Add in HOA fees and renovation costs and any other fees. Now you have your monthly cost. Return to zillow to see if the rent you can bring in will be worth it. I personally always try to charge less than fair market value as I try to keep everyone happy.

I use transunion smartmove to screen tenants. Tenants pay for this. I also have a questionnaire application I ask them to fill out and do my own screen off of that. It also contains legal forms like Meghan's law. EPA lead form for older properties. Always go back to at least 2 landlords as the current landlord may be lying to you to get the tenant out.

It's a pretty objective process. Obviously, don't discriminate based on anything and you'll be okay. You wouldn't anyway. From my experience, there's no correlation between a bad tenant and anything that you can discriminate against anyway. It's so individual.

Always emotionally connect with the tenant so they don't destroy the place in the event something goes awry. If they lose their job and can't pay rent they still have to get out, sorry. I explain to them why and hope they understand. So far, it's worked for me.

Learn plumbing, electrical, carpentry and HVAC if you can. It will save you lots of headaches and expenses. I have lots of friends in these trades and text them with questions when I need their help. I recommend you make these friends too. Youtube will only get you so far.
My dad had some duplexes and an apt complex. The tenants did not have much money. He would give them a grocery gift card at Thanksgiving. The tenants were so appreciative. I certainly have rented and like 10x the amount and never got a gift card from my landlord. So little things make a difference
 
My dad had some duplexes and an apt complex. The tenants did not have much money. He would give them a grocery gift card at Thanksgiving. The tenants were so appreciative. I certainly have rented and like 10x the amount and never got a gift card from my landlord. So little things make a difference
Agree. The tenants I rent to tend to live paycheck to paycheck. I try to help them out when I can but it's a tough balance. I don't charge late fees or raise their rent much but paying rent is a redline. They must pay their rent or I threaten to pursue legal action and eventually eviction. I usually wait at least a month before I do this. I wouldn't be able to survive if I wasn't like this.

There's a power imbalance with me being the one with the power. I recognize this and I don't want to bully them but at the same time, I have to keep them feeling appreciation for my late fee waiver, their below fair market value rent, etc and at the same time prevent them from feeling entitled. If I let them slip a month, they get used to it, and it will soon become 2 and then 3 months. I have to draw the line somewhere.
 
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