Why I will not be going into FM/Gen Peds/Gen IM

[punkedoutriffs]

---

Members do not see this ad.

...before I've even rotated in them:

Full time jobs in gen peds earns ~150,000. A little more in fam med and General IM.

Enter that amount into paycheckcity.com, select your state as, oh say, California.

Take home pay is $92,744 after taxes. I'll be graduating residency with around $250,000 in loans. According to the loan repayment calculator at finaid.org, a 10-year repayment plan will allow $95,240.90 of interest to be added to the principle balance. In the end, I'll have paid $345,240.90 to Uncle Sam. Divide that number out by 10 yrs, and I'll be paying ~$34,524/yr in loans.

Therefore, my take home pay of $92,744 has decreased to ~$58,220. Someone without this kind of loan burden can take this amount home with a gross salary of just ~90,000. And also, I would be 32, so I HAVE to start saving for retirement, since I will be a latecomer to the game with an opportunity cost of 10 years of time in terms of compound interest. Conventional wisdom says I should save ~20% of my gross salary JUST FOR RETIREMENT. This takes another $30,000 out of my take home pay.

Now we're down to ~$28,220.

That's what I have to work with to pay:

Rent/mortgage
Utilities
Car
Food
Insurance
Educational costs for the kids
Etc.
Etc.

A mother-effing waiter can take home as much as that. I hate to say it, but I just can't stomach that.

 

[BANGO]

.

 

[guitarguy23]

True story man - no free lunches. We all just take a risk on what we think will pan out best for us, make the choices as they come, and hope our decisions put us in a nice spot later on. Though, all those things you listed can vary wildly depending on where you live, your spending habits, spouses habits, if you have kids, etc. That's why I laugh when people view a high salary as being equal to a high quality of life - the 120K single pediatrician in Arkansas may be living like a king while the 350K ortho in CA with 4 kids and a wife who likes to buy TP at the Pottery Barn is living paycheck to paycheck. But on the positive side...the waiter also isn't going to be stuffing 30K into retirement accounts each year (probably more like $30 into the sock under his bed every week) and won't have "an extra 35K" after 10 years of working either?

Job security is huge as well.

 

[dap]

3/10, not punk rock.


Edit: I agree though, people that go into gen peds are saints.

 

[deleted500612]

Unless you are earning more in interest in your RRSP then they are charging interest on your loan, in my opinion it would make more sense to pay off the loan as quickly as possible before putting money away for retirement. In the end you will have the same amount saved after 10 years but will pay less interest on the loan for paying it off sooner.

 

[bulldogmed]

No income tax states + lower COL areas = at least 20k more take home pay than being in CA.

FM and General IM can probably be 200k or more depending on where you work.

 

[mcloaf]

Preach.

 

[e30ftw]

yeah, not ****ing worth it.

run the numbers at ~325k/yr in a state w/o income tax and it looks much better.

 

[Arkangeloid]

I'm now convinced that med school isn't worth it for anyone not going into a competitive specialty.

 

[DocVapor]

I'm now convinced that med school isn't worth it for anyone not going into a competitive specialty.

Unless, of course, you happen to love the specialty and couldn't see yourself doing anything else. There are those people out there.

 

[Brain Bucket]

Unless, of course, you happen to love the specialty and couldn't see yourself doing anything else. There are those people out there.

You don't HAVE to be physician to be actively involved in patient care.

 

[Arkangeloid]

Unless, of course, you happen to love the specialty and couldn't see yourself doing anything else. There are those people out there.

SDN knows what I think of idealists, haha.

 

[sazerac]

With the income-based repayment plan PAYE you would contribute around $10K per year towards you loans, not $35K.

Very few doctors in any specialty pay 23% of their income towards student loans. Very few doctors in any specialty stay on the 10 year standard repayment plan.

Don't get me wrong, things would be a little tight as a primary care provider if you have big dreams for a big family in an expensive state. But your argument loses credibility when you paint this worst-possible debt repayment scenario that few people follow.

 

[DocVapor]

You don't HAVE to be physician to be actively involved in patient care.

Of course, but there is a difference between being involved in patient care, and being the final say in directing patient care (before the patient/parents). All the peds faculty at my school that I have asked, say they wouldn't have been happy going the mid-level route.

SDN knows what I think of idealists, haha.

I certainly understand the sentiment. I wouldn't consider a specialty without looking at the money aspect either. I just wanted to point out that some individuals do draw enough satisfaction to be happy with their choices in spite of the low pay. It's fairly presumptuous for you or I (or anyone) to say what specialties aren't worth it for someone else.

 

[sazerac]

Pediatricians (and dermatologists) consistently rank the happiest and most satisfied of the medical specialties.

Life is good at the extremes, apparently.

 

[Arkangeloid]

Pediatricians (and dermatologists) consistently rank the happiest and most satisfied of the medical specialties.

Life is good at the extremes, apparently.

It's worth noting that most pediatricians are women, who don't need to worry about money because they can just marry a wealthy man. Us men don't have that option.

 

[DocVapor]

It's worth noting that most pediatricians are women, who don't need to worry about money because they can just marry a wealthy man. Us men don't have that option.

😵

That's a thought that you should have kept to yourself.

 

[deleted500612]

It's worth noting that most pediatricians are women, who don't need to worry about money because they can just marry a wealthy man. Us men don't have that option.

 

[mcloaf]

It's worth noting that most pediatricians are women, who don't need to worry about money because they can just marry a wealthy man. Us men don't have that option.

That SPI thread is making a lot more sense now.

 

[Doctor Strange]

It's worth noting that most pediatricians are women, who don't need to worry about money because they can just marry a wealthy man. Us men don't have that option.

Wooooooooooooooow

 

[Arkangeloid]

That SPI thread is making a lot more sense now.

I don't understand, did I say something wrong? My parents always told me that women could do any career they wanted, because they could rely on a man to provide for them. However, a man's choices are more limited, because he needs to provide for his family.

 

[deleted500612]

I don't understand, did I say something wrong? My parents always told me that women could do any career they wanted, because they could rely on a man to provide for them. However, a man's choices are more limited, because he needs to provide for his family.

 

[mcloaf]

I don't understand, did I say something wrong? My parents always told me that women could do any career they wanted, because they could rely on a man to provide for them. However, a man's choices are more limited, because he needs to provide for his family.

Can I use your time machine?

 

[DermViser]

I'm now convinced that med school isn't worth it for anyone not going into a competitive specialty.

DING! DING! DING! We have a winner.

The competitive ones, however, can also be competitive due to lifestyle, not just gross pay. PM&R for example, which med students have now caught on.

 

[KinasePro]

Most pediatricians in my neck of the woods are in two-physician households, so arkangeloid isn't entirely off the mark. Maybe a tad tone deaf, though.

 

[Wordead]

I don't understand, did I say something wrong? My parents always told me that women could do any career they wanted, because they could rely on a man to provide for them. However, a man's choices are more limited, because he needs to provide for his family.

Here is a fix for all your problems: Everything your parents have told you and molded you into is wildly useless and incorrect for living in the modern world.

At the very least, keep it to yourself.

 

[MerickManual]

It's worth noting that most pediatricians are women, who don't need to worry about money because they can just marry a wealthy man. Us men don't have that option.

http://pediatrics.aappublications.org/content/116/1/e156.full

It's about 60 female/40 men doing general peds. Sooo, almost 50/50.

And your statement about all females need to do is marry a rich guy is grossly sexist.

 

[DocVapor]

Here is a fix for all your problems: Everything your parents have told you and molded you into is wildly useless and incorrect for living in the modern world.

At the very least, keep it to yourself.

Quoted for posterity.

 

[KinasePro]

 

[Brain Bucket]

Of course, but there is a difference between being involved in patient care, and being the final say in directing patient care (before the patient/parents). All the peds faculty at my school that I have asked, say they wouldn't have been happy going the mid-level route.

You already don't have final say, and neither does the patient. The insurance companies / hospital boards do.

Sent from my SM-N9005 using Tapatalk

 

[Winged Scapula]

I don't understand, did I say something wrong? My parents always told me that women could do any career they wanted, because they could rely on a man to provide for them. However, a man's choices are more limited, because he needs to provide for his family.

Whenever I hear things like this it makes me grateful that my parents valued education for all their children, not just the boys, because they recognized that freedom, self-assuredness, competency and power are valuable attributes for both genders.

I hope you don't have any sisters that have been fed this **** from your parents. Have you ever questioned what happens to an uneducated woman if/when her male provider leaves/dies/treats her like ****? There's a reason why women have the ability to make healthy and liberated choices for themselves and any children they may have and it's education. An uneducated woman often feels she has no choice but to stay in a bad, even dangerous relationship.

This just sickens me because it's evidence that some people really undervalue women and their contribution to society. Education is good for everyone. PLEASE BE A FORCE FOR CHANGE AND DO NOT ADOPT THESE ANTIQUATED IDEAS THAT YOUR PARENTS ARE PROPAGATING. ASK YOURSELF IF YOU HAD A DAUGHTER WOULD YOU BE HAPPY FOR HER TO STAY IN A DANGEROUS OR EVEN JUST UNHAPPY RELATIONSHIP BECAUSE SHE FELT SHE HAD NO OTHER OPTIONS BECAUSE SHE COULD NOT PROVIDE FOR HERSELF IF SHE NEEDED TO?

 

[punkedoutriffs]

Whenever I hear things like this it makes me grateful that my parents valued education for all their children, not just the boys, because they recognized that freedom, self-assuredness, competency and power are valuable attributes for both genders.

I hope you don't have any sisters that have been fed this **** from your parents. Have you ever questioned what happens to an uneducated woman if/when her male provider leaves/dies/treats her like ****? There's a reason why women have the ability to make healthy and liberated choices for themselves and any children they may have and it's education. An uneducated woman often feels she has no choice but to stay in a bad, even dangerous relationship.

This just sickens me because it's evidence that some people really undervalue women and their contribution to society. Education is good for everyone. PLEASE BE A FORCE FOR CHANGE AND DO NOT ADOPT THESE SEXIST AND ANTIQUATED IDEAS THAT YOUR PARENTS ARE PROPAGATING. ASK YOURSELF IF YOU HAD A DAUGHTER WOULD YOU BE HAPPY FOR HER TO STAY IN A DANGEROUS OR EVEN JUST UNHAPPY RELATIONSHIP BECAUSE SHE FELT SHE HAD NO OTHER OPTIONS BECAUSE SHE COULD NOT PROVIDE FOR HERSELF IF SHE NEEDED TO?

Holy... you must've had some experiences, Dr. Cox... I've never seen you this agitated.

 

[Brain Bucket]

http://pediatrics.aappublications.org/content/116/1/e156.full

It's about 60 female/40 men doing general peds. Sooo, almost 50/50.

And your statement about all females need to do is marry a rich guy is grossly sexist.

It is. At the same time, most of the female peds at our hospitals are married to considerably (5-10 years, 20 in one case) older males in relatively more competitive fields.

Holy... you must've had some experiences, Dr. Cox... I've never seen you this agitated.

You don't actually need to experience this first-hand. As a physician you'll see plenty of uneducated women make poor life choices.

I can see why WS feels so strongly about this, and I completely agree with her post, especially the dire need for education of women, but it doesn't negate the horrible reality of Ark's post.

 

[Arkangeloid]

Whenever I hear things like this it makes me grateful that my parents valued education for all their children, not just the boys, because they recognized that freedom, self-assuredness, competency and power are valuable attributes for both genders.

I hope you don't have any sisters that have been fed this **** from your parents. Have you ever questioned what happens to an uneducated woman if/when her male provider leaves/dies/treats her like ****? There's a reason why women have the ability to make healthy and liberated choices for themselves and any children they may have and it's education. An uneducated woman often feels she has no choice but to stay in a bad, even dangerous relationship.

This just sickens me because it's evidence that some people really undervalue women and their contribution to society. Education is good for everyone. PLEASE BE A FORCE FOR CHANGE AND DO NOT ADOPT THESE SEXIST AND ANTIQUATED IDEAS THAT YOUR PARENTS ARE PROPAGATING. ASK YOURSELF IF YOU HAD A DAUGHTER WOULD YOU BE HAPPY FOR HER TO STAY IN A DANGEROUS OR EVEN JUST UNHAPPY RELATIONSHIP BECAUSE SHE FELT SHE HAD NO OTHER OPTIONS BECAUSE SHE COULD NOT PROVIDE FOR HERSELF IF SHE NEEDED TO?

Hey, bee nice to my parents. I've always had a rocky relationship with them, and I admit they have some flaws, but I think they are good people in spite of everything that has happened. In this case, they're just teaching me what they knew from their culture (where we are much more communal in our outlook, and a woman's family and extended community protects her interests in a marriage). I guess it's not completely applicable here, where there are no such entities to protect the woman.

To answer your question, I have no sisters. If I have a daughter, I will encourage her to be whatever she wants to be, though I will discourage her from pursuing a career as a physician (because by then, med school will cost well over half a million dollars in today's money, and physician reimbursements will have dropped through the floor).

It is. At the same time, most of the relatively good looking female peds at our hospitals are married to considerably (5-10 years) older males in relatively more competitive fields.



You don't actually need to experience this first-hand. As a physician you'll see plenty of uneducated women make poor life choices.

I can see why WS feels so strongly about this, and I completely agree with her post, especially the dire need for education of women, but it doesn't negate the horrible reality of Ark's post.

Why is it horrible? Am I horrible?

 

[Winged Scapula]

Holy... you must've had some experiences, Dr. Cox... I've never seen you this agitated.

You're right I don't usually get so agitated but this revelation by @Arkangeloid about his parents bothered me. It bothered me because 1) his parents are probably my age but appear to come from a different culture where perhaps those attitudes are commonplace and 2) because @Arkangeloid appeared to believe those comments despite sitting side by side with half a class of female medical students. (NB: Arkangeloid - this was not meant as an attack on you, just on the idea that you would accept your parent's antiquated teachings without question. I challenge you to use your obvious intelligence to not accept what you are being told but to verify, just as any scientist would do).

Full disclosure: I come from an upper middle class educated WASP family and am the product of a socially liberal (but politically moderate) upbringing. I've never been emotionally or physically abused by any boyfriend/family member nor have I ever seen that amongst my friends or family. My parents valued education (my mother with her 4 year Art & Design degree has the least education of us all) however, my father wasn't thrilled about the idea of medical school for me, feeling that a woman's real happiness lied in being married and having a family. As I've stated before, his comment to me at the time of medical school graduation was, "you've educated yourself out of the marriage market". He only has himself to blame as he pushed me toward a scientific career and lauded my graduate studies before medical school. However, he came to realize that for *me* being married and having children was not the key to my happiness and has since recanted his earlier comments and realized that he and my mother were responsible for imparting the most valuable lesson that they could have ever given me: "I can do and be whatever I wish". My father and I never argued about this, it was simply something he believed that I chose not to accept; since I was no longer financially dependent on him I was free to chose to live my life as I saw fit.

As @Brain Bucket noted, you don't have to experience this personally to be affected by the disparity in which women are treated. I see it everyday in my office; women in bad relationships, teenagers coming in with babies and I just can't help but wonder if someone had taught them that the key to happiness is independence, the ability to CHOOSE for themselves what and where they wish their life to head, would things have been different for them? I probably get on my soapbox when I have teenage girls in the office but I ask all of them about their goals and aspirations and I've had at least 1 parent tell me their daughter was thinking of going to medical or vet school because of the conversation she had with me. I don't necessarily encourage them to go to medical school (and as a matter of fact, I tell them, "don't use me as a role model"), but rather just try and impart the idea that education will give them power and freedom for life. Teenagers really like that idea.

There certainly was sexism in surgical training but I felt it better to focus on the job at hand and change people's attitudes about women in surgery than make a big deal about it. Our department chair was adamant about bringing about change and more women in the residency. The female attendings were not role models for me in terms of behavior but they had certainly succeeded at a time when it was more difficult than what I was facing. My "brothers" in residency were the keys to my success and continue to be some of my best friends to this day because of their support.

 

[Winged Scapula]

Hey, bee nice to my parents. I've always had a rocky relationship with them, and I admit they have some flaws, but I think they are good people in spite of everything that has happened. In this case, they're just teaching me what they knew from their culture (where we are much more communal in our outlook, and a woman's family and extended community protects her interests in a marriage). I guess it's not completely applicable here, where there are no such entities to protect the woman.

I'm sorry if my comments were offensive but I'm not sure where I was "not nice" to your parents. People can clearly be good people even if I disagree with them or they act in a way that I find distasteful. Yes, I think those teachings are ****ty but that doesn't mean I think they're bad people or that you are. Believe me, I spend a lot of time reading the newsfeed on my FB account and shaking my head at some of the things my friends post. That doesn't mean that I dislike them or feel the need to unfriend them.

I understand your culture, that you are a product of that, and your parents teachings reflect that. I may criticize some aspects of that culture because I don't think it fully "protects" a woman's interests but that is not my place to comment on.

To answer your question, I have no sisters. If I have a daughter, I will encourage her to be whatever she wants to be, though I will discourage her from pursuing a career as a physician (because by then, med school will cost well over half a million dollars in today's money, and physician reimbursements will have dropped through the floor).

I don't think any of us know what medicine will be like in 20+ years; it may resemble nothing like what we see today. Encouraging all your children to be educated is a good thing and to help them realize that is important. Frankly, we have more of a problem with boys in the US now, as women outnumber men in higher education.

 

[boogaloo]

I don't understand, did I say something wrong? My parents always told me that women could do any career they wanted, because they could rely on a man to provide for them. However, a man's choices are more limited, because he needs to provide for his family.

If you still have to say "But my parents told me..." in your mid-20s, bro... you're either too far gone or a troll. I thought you were genuinely ignorant up until this point, but my trolley senses are tingling. Your only saving grace is that I actually have a few classmates who are this inept. Not trying to attack you, but maybe I am.

 

[Arkangeloid]

I'm sorry if my comments were offensive but I'm not sure where I was "not nice" to your parents. People can clearly be good people even if I disagree with them or they act in a way that I find distasteful. Yes, I think those teachings are ****** but that doesn't mean I think they're bad people or that you are. Believe me, I spend a lot of time reading the newsfeed on my FB account and shaking my head at some of the things my friends post. That doesn't mean that I dislike them or feel the need to unfriend them.

I understand your culture, that you are a product of that, and your parents teachings reflect that. I may criticize some aspects of that culture because I don't think it fully "protects" a woman's interests but that is not my place to comment on.

I think it's more that I've also never seen you sound so angry, so I interpreted it as an attack on my family. I apologize.

If you still have to say "But my parents told me..." in your mid-20s, bro... you're either too far gone or a troll. I thought you were genuinely ignorant up until this point, but my trolley senses are tingling. Your only saving grace is that I actually have a few classmates who are this inept. Not trying to attack you, but maybe I am.

Someone didn't grow up in a socially liberal, individualistic household, and their comments reflect that? They must be a troll.

 

[Brain Bucket]

Why is it horrible? Am I horrible?

No, you aren't. You do need a filter, though. The reality of what you said is horrible. I have seen first-hand what the reality of a woman's life can be in different cultures around the world.

edited.

 

[Winged Scapula]

I think it's more that I've also never seen you sound so angry, so I interpreted it as an attack on my family.

Apologies are not necessary. As a matter of fact, I was going to send you a private message explaining that wasn't yelling at you but didn't get a chance to before you replied.

It just so happens this is a topic that I feel strongly about; your comment touched a nerve. Maybe I'm still cranky from the scorpion fighting earlier this week. LOL

 

[boogaloo]

Someone didn't grow up in a socially liberal, individualistic household, and their comments reflect that? They must be a troll.

No, it's more like I can't believe someone who is in medical school still relies on their parents to influence their way of thinking instead of, you know, making decisions on your own and thinking for yourself. I had a conservative, religious, "cultural" upbringing, and now I'm the complete opposite of that. Almost the same story as Winged Scap: my parents are great, but if I gave a crap about what they thought I should do or what I should believe, then I'd be married to some pretty girl from church right now, possibly with 3 kids and 1 on the way.

 

[Arkangeloid]

No, it's more like I can't believe someone who is in medical school still relies on their parents to influence their way of thinking instead of, you know, making decisions on your own and thinking for yourself. I had a conservative, religious, "cultural" upbringing, and now I'm the complete opposite of that. Almost the same story as Winged Scap: my parents are great, but if I gave a crap about what they thought I should do or what I should believe, then I'd be married to some pretty girl from church right now, possibly with 3 kids and 1 on the way.

Despite all that they've done, my parents and community still play a big part in my life. One of the main reasons I went to medical school is to advance the honor of my family (medicine is considered the "god profession" in India).

 

[Brain Bucket]

medicine is considered the "god profession" in India.

Let me disabuse you of this notion.

 

[SouthernSurgeon]

I'm marrying a woman who will be an attending several years before me and (barring massive changes in reimbursement patterns - which are certainly possible) will likely always have higher earning potential than me.

So I take offense to the notion that men can't go out there and find themselves a sugar momma 😉

 

[darktooth]

I used to live comfortably on 24k working as a med assistant. 58k is a monster amount for me...in fact, both my parents collectively made less than 50k growing up.

I guess it depends on your perspective...I also went into this for the knowledge and because I really enjoy the whole pt doctor interaction...which is most pronounced in FM. I wouldn't mind it

 

[eject]

I think this idea of gender differences in career choices/goals is interesting. From the AAP:

"Among pediatric residents, 58% of females and 15% of males expressed an interest in arranging a part-time position within 5 years of completing residency."

There is more in the document about a move toward part-time work, including the fact that pediatricians are the most likely to have worked part-time at some point in their careers. There's a clear trend of this being a more common goal for women. So bringing things back to the original topic, I wonder whether compensation figures account for this trend. I can imagine it would be difficult to control for, which might undercut the OP's rationale for not considering peds. It also suggests that Ark may have a good point that was obfuscated by his inflammatory/bone-headed post: for women (or men, but that's just less common) who want to prioritize family or other non-medicine interests, peds sounds like a great option, because that choice is common and supported among pediatricians.

Anyway, interesting stuff.

 

[Winged Scapula]

I don't believe the key to happiness is independence. I believe it's love. Shared experiences with people who love you and whom you love is what makes life worth living. Self-sufficiency (what I believe you're referring to as independence) makes that easier achieve. I do believe you are quite singular.

No time to respond to everything but did want to comment that I don't believe that independence and love are necessarily mutually exclusive.

I believe that education brings you independence and the power to choose whom you love and who is worthy of that. Choices make people happy.

My point is that independence is only the *key* to happiness; it allows you to access love and all the other wonderful things in life worth living for.

I may be singular but I've never found that being unmarried and childless has robbed me of any love or happiness in life. I do quite well thank you . 😉

You're right that women can find someone to take care of them much easier than men; it is unpalatable but true. I objected to the next logical step (in my mind) that women don't need to be educated. I've traveled extensively through many 3 rd world countries and have seen first hand what this attitude wroughts so was bothered by the fact that these attitudes potentially exist in modern day US and that someone as bright as a medical student might agree with them.

I think we can all agree that men and women should be free to pursue our bliss whether that means as a physician, an engineer or a SAHM. As long as it's not a DNP. 😉

 

[boogaloo]

I'm marrying a woman who will be an attending several years before me and (barring massive changes in reimbursement patterns - which are certainly possible) will likely always have higher earning potential than me.

So I take offense to the notion that men can't go out there and find themselves a sugar momma 😉

You're living the dream, my man.

 

[Brain Bucket]

No time to respond to everything but did want to comment that I don't believe that independence and love are necessarily mutually exclusive.

I believe that education brings you independence and the power to choose whom you love and who is worthy of that. Choices make people happy.

My point is that independence is only the *key* to happiness; it allows you to access love and all the other wonderful things in life worth living for.

I may be singular but I've never found that being unmarried and childless has robbed me of any love or happiness in life. I do quite well thank you . 😉

You're right that women can find someone to take care of them much easier than men; it is unpalatable but true. I objected to the next logical step (in my mind) that women don't need to be educated. I've traveled extensively through many 3 rd world countries and have seen first hand what this attitude wroughts so was bothered by the fact that these attitudes potentially exist in modern day US and that someone as bright as a medical student might agree with them.

I think we can all agree that men and women should be free to pursue our bliss whether that means as a physician, an engineer or a SAHM. As long as it's not a DNP. 😉

I think you just paraphrased/elaborated on what I said >.< 😛

We primary differ in that 'so there's no need to educate women' isn't the next logical step in my mind.

 

[Winged Scapula]

I'm marrying a woman who will be an attending several years before me and (barring massive changes in reimbursement patterns - which are certainly possible) will likely always have higher earning potential than me.

So I take offense to the notion that men can't go out there and find themselves a sugar momma 😉

There are plenty of us single high earning women out there who might not mind being a Sugar Momma. Medicare pays me well! 😉