Why Make 150k When 450k Is Out There?

[jetproppilot]

I owed nearly 200K in student loans when I graduated from med school.

After deferring said loans in residency, that amount was a solid 200K.

Yep, like alotta you out there, I had to personally pay for my education.

As a fourth year med student, I thought pragmatically....

hmmm.....

I owe X amount.

Debt is an anchor.

I wanna pay off my debt, but still be happy.

BOOM!!!

A light goes off in my head. I'm gonna specialize.

Now 11 years into private practice.....student loans paid off years ago....money no longer an issue...

I wanna hear from the med students going into primary care with 200K in student loans.

What motivates a dude/dudette to go into a specialty where monetary reimbursement is less than some nurses?

Are there really philanthropic people left out there, concerned about societal issues in medicine?

If you are a med student reading this, do you think you'll think the same way after your residency is over?

Can one be comfortable with the fact that after 4 years of college, 4 years of med school, then residency, you've selected primary care as your profession which puts you behind the eight ball financially?

BTW....one of the most conflicting issues in marriages is....MONEY.

So, again, why would a med student select primary care?

(rich family prodigies out there, you dont count)

Five years outta residency your focuses will be different.....family.....hobbies....

I read a post in this FM section about personal finance.....went something like...."its OK to rent..."

WTF?

You're gonna endure pre-med/med school....business major colleagues are sittin' out by the pool while you're in the study lounge cramming for an organic chem final...or 1st year med school biochem....2nd year pathophys... endure 3rd year clinicals......then select a career where the reimbursement suks to the point where you haffta rent?

Cummon....

This post is not for the FP people who have already selected their fate.

This post is for med students reading this who are trying to figure out what they want to do with the rest of their lives....

I'm 11 years out of residency. Specialist. Love my job. Plenty of time off. Money not an issue anymore.

My student loans are long gone.

I didnt make the rules.....

....the rules are.....

...specialists make more than twice that of primary care docs.

And pick your specialty wisely, you'll make twice-bank with 9-12 weeks vacation.

So I'm wondering why med students would want to go into primary care.

Yep, an inflammatory thread.

But I wanna know, and YOU DESERVE TO KNOW WHAT YOUR MED SCHOOL ACADEMIC "ADVISORS"

aren't telling you, which is being saddled with 200k student loans and selecting primary care is FINANCIAL SUICIDE.

P.S. : If your dad has paid for college/med school/condo during residency, your opinion doesnt count.

---

Members don't see this ad.

 

[Mayhem]

But it's about fit too. I'm sure you didn't pick anaesthesia just for the money (it is anesthesia right?). Some people are just attracted to FM and if they're good at it then why not? Somebody has to do it, at least let it be someone who wants to do it.

 

[alphaholic06]

How long did it take you pay off 200K in loans, Jet?

 

[AwesomO]

I am one of those students with 200K+ loans and chose FM.

Why did I? A variety of reasons. If we're looking at solely at monetary reasons.

One was financial independence. Yes you heard right.
As a FM doc I have the flexibility of taking medicare and private insurance or just taking cash payments. In fact cash or "direct practices" or becoming more and more popular. What does this mean for me? It means I can set my own prices (based on what the market will tolerate). It means I don't have to worry about the next round of medicare cuts. It means I am in control of my life and not the govt or insurance companies.

While some see financial independence as having low debt and oodles of cash I see it as knowing that I am in charge of my own financial destiny.

Finally I don't fear debt. Especially good debt from school loans. Half of my loans are consolidated and locked in at rates that are around inflation. In fact I intend to sit on those and drag out the payments to 30 years since they are pretty much no interest loans when you factor in inflation. As for the higher rated loans well those will be paid off faster but I certainly don't fear them. School debt is not the monster people make it out to be. Pretty much every entrepreneur spends a good amount of time in debt. Most go into serious debt before they make profit. Some then go into debt AGAIN in hopes of generating more profit.

 

[Disciple]

I am one of those students with 200K+ loans and chose FM.

Why did I? A variety of reasons. If we're looking at solely at monetary reasons.

One was financial independence. Yes you heard right.
As a FM doc I have the flexibility of taking medicare and private insurance or just taking cash payments. In fact cash or "direct practices" or becoming more and more popular. What does this mean for me? It means I can set my own prices (based on what the market will tolerate). It means I don't have to worry about the next round of medicare cuts. It means I am in control of my life and not the govt or insurance companies.

Are you talking about concierge practices?

How do you plan to obtain the appropriate patient base for this particular practice model right out of residency?

 

[jocg27]

P.S. : If your dad has paid for college/med school/condo during residency, your opinion doesnt count.

How about the people whose dads fix cars for a living, and who know that 150K really is still a ton of money to the the great majority of people in this country where the median personal income is 32K, and earning more than 100K puts you in the top 5% of the population? Do we count?

(going into peds)

 

[burlypie]

WHy go into primary care, family medicine in particular?

Because I like it. I didn't go to college for 4 years, do a post-bacc, and complete 4 years of med school to get up and do something every morning that I wasn't passionate about.

And in terms of the money...I grew up in a family of six, my dad was a miner. Money was tight so I learned how to manage it and not live above my means. So despite my 200K in debt I know I'll be fine. It also helps that my sig-o makes a decent living in a non-medical field, but even if I were on my own, financial concerns wouldn't be great enough to push me into a specialty I didn't want to go into.

 

[jetproppilot]

How long did it take you pay off 200K in loans, Jet?

A little under seven years.

 

[dilated]

So I'm wondering why med students would want to go into primary care.

For one thing, anybody who thinks anesthesiologists will still be making 450k 10 years from now (when it would actually matter to med students making this decision) is smoking crack. Anesthesiologists making double what surgeons do is kind of a fluke that has started only recently in the US and nowhere else in the world, so I don't see any reason that CMS won't go after them with a hatchet eventually. You've got a good deal going, but the next generation will probably arrive just in time for the game of musical chairs to stop.

It's hard to predict long term salaries but you could argue FM is undervalued (like gas was 15 years ago) and is due for an upswing. But I think mostly the people in my class who want to do FM just don't care about the difference between 150k and 300k, at least not until they're actually getting the 150k paycheck.

 

[iatrosB]

4th year, 200K+ in loans, going into primary care.

It's all about fit...nothing against your specialty, but I'd rather be a Walmart greeter than a gas passer (much like you feel about clinic I'm sure). I don't care about MORE money, it doesn't FIT with my interest. I will make plenty in FM, between loan repayment offers and smart money decisions...my debt will be gone in 10 years. Another poster made a good point that money may not be there in gas when I'm done...same for cards, GI, ortho, etc...

Don't get me wrong...if I enjoyed the work, I'd be all over gas...but I don't.

 

[NewmansOwn]

For one thing, anybody who thinks anesthesiologists will still be making 450k 10 years from now (when it would actually matter to med students making this decision) is smoking crack. Anesthesiologists making double what surgeons do is kind of a fluke that has started only recently in the US and nowhere else in the world, so I don't see any reason that CMS won't go after them with a hatchet eventually. You've got a good deal going, but the next generation will probably arrive just in time for the game of musical chairs to stop.

It's hard to predict long term salaries but you could argue FM is undervalued (like gas was 15 years ago) and is due for an upswing. But I think mostly the people in my class who want to do FM just don't care about the difference between 150k and 300k, at least not until they're actually getting the 150k paycheck.

Well Jet? Do you agree with this? I'm not entirely sure I do -- there's a nationwide shortage of anesthesiologists predicted to extend well into the next decade.

I think FM is wonderful, especially if practiced in a rural area -- I was sure I wanted to do that for a long time. However, unless the climate changes, I'm not sure it's worthwhile.

The low 100s is borderline insulting as starting income for someone with so many years of schooling and training, especially given the giant loan burden. Miss America stories regarding spartan upbringings aside, that kind of salary with that kind of loan burden makes the comforts of life less easy to achieve, especially with a family to support.

I (and presumably Jet, as well) work to live, not the other way around. As such, any job that gets you 10+ weeks of vacation and that much money is going to feel pretty good after the novelty of practicing medicine wears off. I need time to ski, fish and mountain bike -- lots of time.

FM docs are absolutely necessary and I think it would be a rewarding career. But the movers and shakers of our country need to appeal to the bottom line of these young doctors if they want to funnel decent students into primary care. Raising reimbursements and increasing the prevalence of loan repayment options would be a good start. Protecting livlihood by keeping independently practicing PAs and NPs at bay would be an excellent next step.

 

[OtisRSB]

this blog is truly sad to me. i chose family medicine because i love patient care, because i want to help people in a way that is meaningful and to become a part of a community and love my work so that i am not just dreading getting up to go to work to make money to get to retirement as soon as possible. i'd slit my wrists if my patients were all unconscious and i had to do crosswords all day while others actually performed patient care.

i am $250k in debt would NEVER let my debt control my choice for what i do for the rest of my life. regardless of residency choice, we will all have a roof over our heads and cars and food on the table. i see the opportunity to have been able to go to medical school and to be a doctor as an amazing privilege, NOT a reason to think i "deserve" a certain paycheck. medschool is a pain in the *** and a long expensive road, but what about teachers who work their asses off, get no recognition and make 30K/yr. or how about not having the opportunity for education and being a garbage collector or whatever that works their *** off for less respect and even less money but still provides a necessary service.

the pride and egotism in medicine is astonishing.

for those of you who "work to live" i feel sad for you that you chose a profession that you don't actually love.

as for the practical part of paying off loans, i plan on working in the underserved community and becoming involved in loan repayment programs. i'm not worried about it.

 

[NewmansOwn]

this blog is truly sad to me. i chose family medicine because i love patient care, because i want to help people in a way that is meaningful and to become a part of a community and love my work so that i am not just dreading getting up to go to work to make money to get to retirement as soon as possible. i'd slit my wrists if my patients were all unconscious and i had to do crosswords all day while others actually performed patient care.

i am $250k in debt would NEVER let my debt control my choice for what i do for the rest of my life. regardless of residency choice, we will all have a roof over our heads and cars and food on the table. i see the opportunity to have been able to go to medical school and to be a doctor as an amazing privilege, NOT a reason to think i "deserve" a certain paycheck. medschool is a pain in the *** and a long expensive road, but what about teachers who work their asses off, get no recognition and make 30K/yr. or how about not having the opportunity for education and being a garbage collector or whatever that works their *** off for less respect and even less money but still provides a necessary service.

the pride and egotism in medicine is astonishing.

for those of you who "work to live" i feel sad for you that you chose a profession that you don't actually love.

as for the practical part of paying off loans, i plan on working in the underserved community and becoming involved in loan repayment programs. i'm not worried about it.

I don't understand your post.

First of all, saying an anesthesiologist sits around and does crossword puzzles and does not care for patients is astonishingly ignorant -- I mean, really quite flooring. The procedural, pharmacological and pathological knowledge an anesthesiologist must master (and I mean master, because they need to react lightning-fast if somethone goes south) is staggering. That doesn't even scratch the surface of pain management and other perioperative responsibilities. That you'll graduate medical school without realizing this is nothing short of abhorrant. Alas, I am not the expert -- but the OP will take you to task.

I disagree that medical school is a privilege; it is a choice. You and I and everyone else made the choice to go to medical school and we ought to have a sense of entitlement. The reward for going to medical school is not simply 'being a doctor;' this is a long road and a really tough job; we deserve lots for that.

What's your point about teachers? I agree that they're underpaid -- we should absolutely pay them more because education is an integral part of a successful and healthy society. But so is medical care. And doctors are in school longer and in debt deeper than teachers -- exponentially so. We do "deserve" a high paycheck -- we worked for it.

I don't need your sympathy. You are foolish if you think that 'working to live' means you don't love your job. You can easily love your job, but love your free time, family and self a hell of a lot more.

 

[AwesomO]

Are you talking about concierge practices?

How do you plan to obtain the appropriate patient base for this particular practice model right out of residency?

In a way but I also include urgent care and and the similar fee for service clinics.

As for concierge or as they are now known direct practices, patient panels for those have been traditionally very small. Ranging anywhere from 400-600 patients total. Although that number can be anything really depending on what you offer and your business model. So getting raw numbers is actually easier than that of a traditional practice. Additionally people have always envisioned patients participating in direct practices as the very wealthy. This was the case until about 8 years ago when various physicians were able to design practices that catered to the middle and lower middle class that provided many of the services of the traditional direct practice services in addition to affordable rates (roughly a persons cell phone bill). I believe the Gov of Washington recently presented such a physician with an award for providing care to the underserved through his practice model. Also I believe that they stated they he was actually saving the medical community in that area money. So really it just comes down to marketing and referrals.

It can be even easier than that though. Some direct practice physicians actually just serve as retainers for companies. They (the company) pay them a flat fee for the year and the physician or group of physicians agree to see all the employees. As a ballpark you could charge anywhere from 500-1000 per patient and the company would save money by combining you with a high deductable plan over traditional insurance. From there you decide if you want to go on a year by year plan or if you want to sign with them for a period of years.

Even easier is you could just join a franchise. Theres one in particular that is located in 8 or 9 states and serves middle to lower class patients. You agree to join their franchise and they come evaluate your market, set up you office, do all your marketing establishing your patient panel. Since you are now in their referral network you automatically have a potential patient base. You just show up and go to work. The catch is that once your patient panel is established and you are practicing you pay the required franchise fees. However physicians still do very well after paying fees. To say they do better than the traditional FM docs is an understatement. Plus you get to run your practice how you want to not how Uncle Sam wants you to.

In the end one can do very well in FM if you don't play by specialists rules. But to me it's not about the dollar bottom line but about knowing that I will be financially independent and that my financial future is dependent on me rather than Uncle Sam and insurance companies.

Those are just the financial reasons. From an actual career aspect FM beat out every other specialty I tried. I made the decision to do FM long before I knew the financial freedom it would provide for me.

 

[ioh]

Finally I don't fear debt. Especially good debt from school loans. Half of my loans are consolidated and locked in at rates that are around inflation. In fact I intend to sit on those and drag out the payments to 30 years since they are pretty much no interest loans when you factor in inflation. As for the higher rated loans well those will be paid off faster but I certainly don't fear them. School debt is not the monster people make it out to be. Pretty much every entrepreneur spends a good amount of time in debt. Most go into serious debt before they make profit. Some then go into debt AGAIN in hopes of generating more profit.

Thank you, it's great to see another physician with good business sense. If your interest rate is less than 3 percent on loans (as mine are), and you get a 1.25 percent discount for having the payments made automatically you should definitely prolong the payment period. Even if I could pay off my loans right now, I'd utilize my money and earn higher rates on investments.

As far as the "it's OK to rent" advice, owning a home is a personal choice and is usually sound advice since it's a low-risk investment over a long term. Nonetheless, you are tying up a large sum of money that could be earning returns elsewhere. A savvy investor should at least go through the exercise of calculating potential returns based on your portfolio's performance and compare it with expected appreciation of the home.

With regard to salary, I was aware of it because that's part of what a career is about. I'll be open about the fact that I scrambled into a Family Medicine residency for this year (after applying for Psychiatry, which I don't consider a high salary specialty either). I have loans and want to rid myself of that anchor, and don't shun the idea of a higher standard of living as shallow materialism. However, I think that anyone making six figures should be able to live comfortably and enjoy life, and if you can't do it with 150K and good money managing skills then in all likelihood money isn't the obstacle to your happiness.

That said, I'm not relegating myself to 150K based on my specialty. There are plumbers out there making bank right now while a cardiologist somewhere is filing for bankruptcy. Medicine is also a business, and the sky's the limit in business.

 

[AwesomO]

As far as the "it's OK to rent" advice, owning a home is a personal choice and is usually sound advice since it's a low-risk investment over a long term. Nonetheless, you are tying up a large sum of money that could be earning returns elsewhere. A savvy investor should at least go through the exercise of calculating potential returns based on your portfolio's performance and compare it with expected appreciation of the home.

I've never really liked the idea as a home for an investment unless you know for sure the property will go sky high in value. Too much work via upkeep and such imo. I've always been more of a lazy man's investor in that I prefer to just stick my cash somewhere and let it grow. Although med school years have not yielded any cash to stick anywhere

Now I'm certainly a fan of owning a home for pride of ownership and for the freedom that entails. The added benefits of home appreciation and tax deductions are just icing on the cake.

However, I think that anyone making six figures should be able to live comfortably and enjoy life, and if you can't do it with 150K and good money managing skills then in all likelihood money isn't the obstacle to your happiness.

Agreed, I would say that 150K is plenty to build real wealth with, even with med school debt. Now if your in the "Keeping up with the Jone's" mode 150K may not be enough.

 

[Doowai]

There is a book called THE MILLIONAIRE NEXT DOOR - it is a dissection of a large group of deca millionaires. One finding was the majority of them never made over $90K a year. However they were all PAW (prodigious accumulators of wealth). Many of the people making millions a year were UAW (under accumulators of wealth). There is a formula for what sort of wealth accumulator you are. The book definately for people making $80-150,000 dollars a year.

 

[AwesomO]

There is a book called THE MILLIONAIRE NEXT DOOR - it is a dissection of a large group of deca millionaires. One finding was the majority of them never made over $90K a year. However they were all PAW (prodigious accumulators of wealth). Many of the people making millions a year were UAW (under accumulators of wealth). There is a formula for what sort of wealth accumulator you are. The book definately for people making $80-150,000 dollars a year.

I love that book! In fact I'm rereading now that I have all this free time in 4th year.

 

[Coastie]

I always love JPP's posts.

I owed nearly 200K in student loans when I graduated from med school.

After deferring said loans in residency, that amount was a solid 200K.

Yep, like alotta you out there, I had to personally pay for my education.

As a fourth year med student, I thought pragmatically....

hmmm.....

I owe X amount.

Debt is an anchor.

I wanna pay off my debt, but still be happy.

BOOM!!!

A light goes off in my head.

Now 11 years into private practice.....student loans paid off years ago....money no longer an issue...

I wanna hear from the med students going into primary care with 200K in student loans.

What motivates a dude/dudette to go into a specialty where monetary reimbursement is less than some nurses?

Are there really philanthropic people left out there, concerned about societal issues in medicine?

If you are a med student reading this, do you think you'll think the same way after your residency is over?

Can one be comfortable with the fact that after 4 years of college, 4 years of med school, then residency, you've selected primary care as your profession which puts you behind the eight ball financially?

BTW....one of the most conflicting issues in marriages is....MONEY.

So, again, why would a med student select primary care?

(rich family prodigies out there, you dont count)

Five years outta residency your focuses will be different.....family.....hobbies....

I read a post in this FM section about personal finance.....went something like...."its OK to rent..."

WTF?

You're gonna endure pre-med/med school....business major colleagues are sittin' out by the pool while you're in the study lounge cramming for an organic chem final...or 1st year med school biochem....2nd year pathophys... endure 3rd year clinicals......then select a career where the reimbursement suks to the point where you haffta rent?

Cummon....

This post is not for the FP people who have already selected their fate.

This post is for med students reading this who are trying to figure out what they want to do with the rest of their lives....

I'm 11 years out of residency. Specialist. Love my job. Plenty of time off. Money not an issue anymore.

My student loans are long gone.

I didnt make the rules.....

....the rules are.....

...specialists make more than twice that of primary care docs.

And pick your specialty wisely, you'll make twice-bank with 9-12 weeks vacation.

So I'm wondering why med students would want to go into primary care.

Yep, an inflammatory thread.

But I wanna know.

P.S. : If your dad has paid for college/med school/condo during residency, your opinion doesnt count.

 

[Coastie]

A good dose of capitalism and business sense can go a long way.

Stay out of the 'hood. Move to an appropriate area. Advertise. Provide a service people want but aren't getting elsewhere.

Are you talking about concierge practices?

How do you plan to obtain the appropriate patient base for this particular practice model right out of residency?

 

[Coastie]

Check your historical data.
Check your worldwide data.
Check the latest CMS upswings, and remember, we can branch into the ICU's when reimbursement goes up there. CMS noted we are one of the most undervalued specialties, and gave us a 32% raise this year.
We can do pain.
FM isn't undervalued when we have NP's who are destroying docs on the legislative front.
FM can provide MASSIVE value NOW as long as they have appropriate capitalistic training and business sense.

For one thing, anybody who thinks anesthesiologists will still be making 450k 10 years from now (when it would actually matter to med students making this decision) is smoking crack. Anesthesiologists making double what surgeons do is kind of a fluke that has started only recently in the US and nowhere else in the world, so I don't see any reason that CMS won't go after them with a hatchet eventually. You've got a good deal going, but the next generation will probably arrive just in time for the game of musical chairs to stop.

It's hard to predict long term salaries but you could argue FM is undervalued (like gas was 15 years ago) and is due for an upswing. But I think mostly the people in my class who want to do FM just don't care about the difference between 150k and 300k, at least not until they're actually getting the 150k paycheck.

 

[deleted77919]

Even if I could pay off my loans right now, I'd utilize my money and earn higher rates on investments.

I'd be curious as to what all those <relatively safe> investments are. As of last week the 10yr average on the S&P500 was something like 1.6%/yr (before dividends, but the dividends don't make too much difference).

March 16 2008: 1288
March 16 1998: 1099

I'm not trying to give you specifically a hard time, it's just that (other) people talk about how averaging 7% a year is no big deal, when clearly that isn't the case. I guess if your interest rates are low enough you could get T-bills, but that seems like a relatively big hassle for little return.

 

[sophiejane]

Goodness. Somebody got his panties in a wad.

What I said was that I think it's okay to rent for a few years while you save up to be able to buy a house. I don't think that's shameful or a crime. I don't want a crappy house, I want the house I want, and will likely build. It's really okay to rent a house while you are starting out and paying back loans so you can get what you really want.

I'm not saying it's okay to live like a pauper. I am saying that fiscal responsibility is important.

Why don't I want a job that I'd hate just because it pays more? Because it's about more than money, friend.

I am 38 years old. My daddy didn't pay for my medical school. I have lived enough to know that what matters to me is the value of my work, my satisfaction from it, and having the freedom to practice the kind of medicine that is right for me.

It really doesn't bother me when people laugh at me or think I am "philanthropic" because you know what? I am HAPPY. I am having a GREAT time in residency--I know, you can scoff, but I really am. I love this stuff.

I don't need to justify my reasons to you or anyone, because in the end, we all chose what it best for us. I chose this, as implausible as it may seem, because I love it.

 

[thedman888]

i dont get it, if $$$ is really that important, isnt it better to go into business and investment? become the ceo of texaco oil tycoon.. y go thru so many yrs of training to be a joe specialist and make barely 500k or 800k when the rest of the white collar friends are making > 20000k the last time i checked hippocrates oath there was no mention of $$$ in it...

 

[michaelrack]

150,000 a year isn't that much, especially if you are self-employed. In addition to the standard income taxes, social security, and medicare tax that everyone pays, the self-employed physician also has to pay 6.2% on the first 102,000 of income and 1.45% on all income (I believe that this tax is figured BEFORE retirement account deductions). Assuming the 150,000 is after all practice expenses (CME, malpractice, etc), you still have to pay for health insurance (12-$15 k for a family of 4) and retirement (15K) out of that.

So the $150,000 that a self-employed FP can make is equivalent to the $110,000-$120,000 that an employed FP (with generous benefits) can easily make.

You can easily argue with my assumptions of FP potential income. My point is that in any discussion of physician reimbursement (especially when compared to employed bankers/teachers/etc), you have to take into account whether a physician is an employee or is self-employed when discussing physician salary/income, and benefits have to be taken into account.

 

[NewmansOwn]

i dont get it, if $$$ is really that important, isnt it better to go into business and investment? become the ceo of texaco oil tycoon.. y go thru so many yrs of training to be a joe specialist and make barely 500k or 800k when the rest of the white collar friends are making > 20000k the last time i checked hippocrates oath there was no mention of $$$ in it...

The Hippocratic Oath does mention money (in terms of sharing it with your mentor), as well as (according to the Nova translation of the Ancient Greek) "being honored with fame among all men for all time to come." Good luck with that.

Secondly, "20000k" would be $20 million, am I correct? This is a classic "grass is greener" problem. No one in business has a salary of $20 million -- most top executives do not have higher base salaries than those of specialist physicians. What makes a very small percentage of business executives lots of money is their stock options and other investments. The downside of this wealth is that your wealth is tied entirely to the success of your company.

Business is not an easy road -- trust me, I've been there. If you want to work in investment banking, you can make a sizable salary just starting out. You will work upwards of 80 hours a week, year-round, however -- closer to 100 hours a week during times of financial downturn (such as right now). Also, you will more than likely lose your job at such times. Investment bankers are having a hell of a time holding on to jobs on Wall Street right now -- some have abandoned the lease on their apartment in favor of sleeping in the office. Sadly, they are left absolutely no time to enjoy the money everyone assumes they have.

There are far too many "why don't we just go to b-school and get an MBA and come out making 200k/year starting?" This is pure idiocy. The graduates of even the best business schools, if they have no prior executive work experience, are fighting like hopped-up roosters for 60k/year jobs. Then they work their tails off for multiple years before maybe, if they shmooze just right, getting that promotion that will bump them up to a modest 150k.

 

[ioh]

I'd be curious as to what all those <relatively safe> investments are. As of last week the 10yr average on the S&P500 was something like 1.6%/yr (before dividends, but the dividends don't make too much difference).

March 16 2008: 1288
March 16 1998: 1099

I'm not trying to give you specifically a hard time, it's just that (other) people talk about how averaging 7% a year is no big deal, when clearly that isn't the case. I guess if your interest rates are low enough you could get T-bills, but that seems like a relatively big hassle for little return.

You must have excellent bedside manner Dakota, thanks for asking in such a polite way.

If my attachment attempt works, the performance of the S&P 500 index from 1950-present should be up. If you look from 1995-2002, overall there was steady growth over the period but a strong rise and fall in between (largely courtesy of the dot com bubble). This explains why your 1998-2008 figures show low returns: the index was overvalued in 1998. But if you invest over a long period of time, you can see the trend is a relatively steady return.

I appreciate that my analysis offers little consolation to someone who's experienced 1.6% returns over the past decade. A low risk and short term alternative would be a prime money market fund, they return around 4% right now due to the low prime rate. Marginally higher return than my loan interest rate, but when you're fresh out of med school I say take what you can get.

My personal strategy is more aggressive and involves a mix of mutual funds and individual stocks, but I enjoy finance (and higher than 4% returns!). For those who don't, and those who feel an inherent value in being free of debt, it's probably not worth the effort. Still, I'd say an S&P 500 index fund remains an excellent choice for investing for the long run.

 

[2oRadio]

i dont get it, if $$$ is really that important, isnt it better to go into business and investment? become the ceo of texaco oil tycoon.. y go thru so many yrs of training to be a joe specialist and make barely 500k or 800k when the rest of the white collar friends are making > 20000k the last time i checked hippocrates oath there was no mention of $$$ in it...

Because not everyone makes it big in business.

You would be hard-pressed to find a doctor who didn't make a 6 digit salary.

The business world is littered with people who don't make that much.

 

[Coastie]

Because not everyone makes it big in business.

You would be hard-pressed to find a doctor who didn't make a 6 digit salary.

The business world is littered with people who don't make that much.

Exactly. Which is why the "anyone who can get into med school is smart enough to make $$$$MILLIONS$$$$" is lame.

 

[blotto geltaco]

I am surprised this thread has generated so many responses. The only point of the OP was to inflate his already grandiose ego.

 

[jetproppilot]

I am surprised this thread has generated so many responses. The only point of the OP was to inflate his already grandiose ego.

Wow.

You guys are pretty sensitive, huh?

Personal insults and all.....

It has generated so many responses because it is an issue important to med students emerging with an unbelievable debt burden.

You guys can downplay it all you want....reimbursement for primary care specialties is the reason more people don't go into it.

I certainly hope it changes.

I've got a buddy who's a pediatrician...when he is on call his beeper is constantly going off.

He deserves more benjamins.

 

[jetproppilot]

Gee...y'think?

Seriously, what's the point of this thread? Do you really think you're telling us something we don't already know?

Hmmmm.....I think the point of the thread was pretty well elucidated in the....uhhh....original post.

Reality is, emerging with 200-300 K in student loans like alotta med students do today is an intimidating sword to swallow.

I'd say most med students have anxiety about paying back this enormous sum.

And life trudges on after residency. Priorities change. Family/kids/house etc. These expenses are common amongst most people.

So like I said in the OP, considering the above, I wanted to hear from said med students.

You've chosen to insult me incessantly.

Thats your choice.

Doesnt eliminate the fact that this is a huge issue that dramatically affects specialty choice selection.

Concerning your post about telling you what you already know, like I said in the OP, I was interested in hearing from med students.

Since you arent a med student, your inquiry is rhetorical.

 

[jetproppilot]

How have I insulted you? Feel free to quote me.

C'mon, Dude.

Gimme a break.

Read post #145 on the closed thread.

That pretty much sums it up.

 

[jetproppilot]

How have I insulted you? Feel free to quote me.

As for why people continue to choose family medicine despite the relatively low reimbursement compared to certain specialties, the answer should be obvious...it's a great job.

You got fired last year, if memory serves, and took a pay cut in your new job.

I don't have to worry about that. IMO, that's priceless.

Wow! You spend some time on the gas forum, huh?

Contracts are a way of life. Geographically limit yourself like I've done because of family issues, and thats the way it is.

Nah, doesnt suck at all. I lived in a smaller town for my first eight years out prior to choosing to move to this competitive area. Living there enabled me to become debt free.

No, actually its better.

And I'm happier at my new gig.

You forgot to post that part.

 

[jetproppilot]

You mean post #143?



What part of that was inaccurate?

Nope. Post 145, where dude pointed out your insulting fashion.

I've yet to find someone who finds Dude offensive. I certainly don't use it with attempt to insult. I say it, and hear it, a hundred times a day. My girlfriend calls me Dude sometimes. So do my colleagues.

Slim was, as you recall, in response to an insulting post towards me.

Gee, since when was boldfacing insulting?

Don't like my posting style?

Thats OK. I like it.

Hit the ignore button.

Your style happens to be "talking in riddles" for whatever reason.

But your underlying objective is crystal clear, even though you won't admit it.

Still am at a loss at your attacks.

I didnt insult you, nor your specialty.

If I remember correctly I said I enjoyed family med as a med student.

I also said how sad it is about the CRNA salaries....which sounds like a supportive statement to me.

Inflammatory subject?

Sure. But its a very real concern.

You're the one that got personal, Dude.

 

[jetproppilot]

Indeed. You have a "gig," I have a "practice." Thanks for clarifying that.

Now you're resorting to semantics.

Sorry I'm not amongst the bow-tie wearing crowd.

 

[sophiejane]

I think several medical students have so far given honest answers to the OP's query.

Money isn't everything, and paying off debts does not seem to be a problem for those who choose primary care.

Of course we would like reimbursements to be higher, everyone would. But ultimately, and this is what it seems that the OP and others have such a hard time understanding, it is about doing something you get satisfaction from doing. The medical students who choose FM do so because they love it.

How many more times do we have to say it?

There is very little that is productive about this thread, which is not surprising given that it was labeled as inflammatory from post #1 by the OP. If it doesn't contribute anything other than the OP getting satisfaction from fanning his own flames, it too will be closed.

Really, lets see something constructive--a novel thought, a few more well-expressed ideas. We aren't going to allow flame-throwing to continue unchecked.

 

[Coastie]

Anesthesiologists are in the ICU.

We are generalists for very very sick people.

So, which specialties aren't "real doctors" and merely technicians? I'd really like to know!

How have I insulted you? Feel free to quote me.

As for why people continue to choose family medicine despite the relatively low reimbursement compared to certain specialties, the answer should be obvious...it's a great job. We're "real doctors", not technicians. Generalists, not specialists. Patients know our names, and we know theirs. We may be "jacks of all trades, masters of none," but (like it or not), that's what most people need. We don't have to work for somebody else unless we choose to do so. Freedom and flexibility makes FM the ultimate "lifestyle specialty." It's one of the best-kept secrets in medical school. As for the whole debt thing, you never answered my question...have you ever known a family physician who couldn't pay off their loans?

You got fired last year, if memory serves, and had to take a pay cut in your new job. Sucks, don't it?

I don't have to worry about that. IMO, that's priceless.

 

[Coastie]

My buddies facing DO debt and private MD debt would disagree with you: Primary care guys have huge problems paying off their debt.

Like I said in the other thread, FP's can easily get around this, much better than other specialties, including gas.

1) Capitalism
2) Business models

I wish they taught more of the above in med school and in FP residency.

I think several medical students have so far given honest answers to the OP's query.

Money isn't everything, and paying off debts does not seem to be a problem for those who choose primary care.

Of course we would like reimbursements to be higher, everyone would. But ultimately, and this is what it seems that the OP and others have such a hard time understanding, it is about doing something you get satisfaction from doing. The medical students who choose FM do so because they love it.

How many more times do we have to say it?

There is very little that is productive about this thread, which is not surprising given that it was labeled as inflammatory from post #1 by the OP. If it doesn't contribute anything other than the OP getting satisfaction from fanning his own flames, it too will be closed.

Really, lets see something constructive--a novel thought, a few more well-expressed ideas. We aren't going to allow flame-throwing to continue unchecked.

 

[cchoukal]

I'm an anesthesiology resident who reads the anesthesiology forum, and although I don't always agree with Jet, and he's a little flamboyant at times, he raises a good point. I think we all went to med school with the idea that we'd be in this noble profession, that we'd help people, and that there'd be a certain amount of respect for the field. As you get further along, it's a little harder to see the respect side of it, either from patients or society, and it can be frustrating the see that, although you might TRY to help your patients, many (the majority?) seem intent on self-destruction via sloth and gluttony.

As these realizations are crystalizing, you're getting a little older and watching your friends get promoted, make more money, take nice trips, and enjoy their free time. Even as a resident in a relatively lucrative specialty, it's hard to watch people make more money for less work than we do.

And has anyone actually done the math on a $200K loan? On the 10 year plan, that's about $2200 per month. If you make $150K per year, you're looking at a take-home of barely twice your residency salary after the loan payment. You don't own a home, your car is beat, you don't have $hit for savings, the kids' college, your retirement, etc.

I have this friend that always used to say, "It's just as easy to fall in love with a rich girl as a poor one. Maybe easier." I think the same logic applies to your choice of profession. I mean, if you love it, you love it, but you could probably REALLY LIKE a lot of things that would allow you to have an easier life. Being a doctor does not equal signing on to work away your best years and martyr yourself to your patients/specialty/practice/hospital/whatever.

Anyway, this'll probably get a big old flame, and that's cool. Everyone's priorities are different. I really do think the OP's intent was not to bash FP and say, "what a bunch of suckers working for nothing," but rather to point out to people who might be a little blinded by med school idealism that there are a lot of ways to be a physician, to take care of patients, and to live one's life.

 

[thedman888]

The Hippocratic Oath does mention money (in terms of sharing it with your mentor), as well as (according to the Nova translation of the Ancient Greek) "being honored with fame among all men for all time to come." Good luck with that.

Secondly, "20000k" would be $20 million, am I correct? This is a classic "grass is greener" problem. No one in business has a salary of $20 million -- most top executives do not have higher base salaries than those of specialist physicians. What makes a very small percentage of business executives lots of money is their stock options and other investments. The downside of this wealth is that your wealth is tied entirely to the success of your company.

Business is not an easy road -- trust me, I've been there. If you want to work in investment banking, you can make a sizable salary just starting out. You will work upwards of 80 hours a week, year-round, however -- closer to 100 hours a week during times of financial downturn (such as right now). Also, you will more than likely lose your job at such times. Investment bankers are having a hell of a time holding on to jobs on Wall Street right now -- some have abandoned the lease on their apartment in favor of sleeping in the office. Sadly, they are left absolutely no time to enjoy the money everyone assumes they have.

There are far too many "why don't we just go to b-school and get an MBA and come out making 200k/year starting?" This is pure idiocy. The graduates of even the best business schools, if they have no prior executive work experience, are fighting like hopped-up roosters for 60k/year jobs. Then they work their tails off for multiple years before maybe, if they shmooze just right, getting that promotion that will bump them up to a modest 150k.

dang man, props to reading into my sarcasm with so much detail and analysis

 

[herbalgarden]

I'm an anesthesiology resident who reads the anesthesiology forum, and although I don't always agree with Jet, and he's a little flamboyant at times, he raises a good point. I think we all went to med school with the idea that we'd be in this noble profession, that we'd help people, and that there'd be a certain amount of respect for the field. As you get further along, it's a little harder to see the respect side of it, either from patients or society, and it can be frustrating the see that, although you might TRY to help your patients, many (the majority?) seem intent on self-destruction via sloth and gluttony.

As these realizations are crystalizing, you're getting a little older and watching your friends get promoted, make more money, take nice trips, and enjoy their free time. Even as a resident in a relatively lucrative specialty, it's hard to watch people make more money for less work than we do.

And has anyone actually done the math on a $200K loan? On the 10 year plan, that's about $2200 per month. If you make $150K per year, you're looking at a take-home of barely twice your residency salary after the loan payment. You don't own a home, your car is beat, you don't have $hit for savings, the kids' college, your retirement, etc.

I have this friend that always used to say, "It's just as easy to fall in love with a rich girl as a poor one. Maybe easier." I think the same logic applies to your choice of profession. I mean, if you love it, you love it, but you could probably REALLY LIKE a lot of things that would allow you to have an easier life. Being a doctor does not equal signing on to work away your best years and martyr yourself to your patients/specialty/practice/hospital/whatever.

Anyway, this'll probably get a big old flame, and that's cool. Everyone's priorities are different. I really do think the OP's intent was not to bash FP and say, "what a bunch of suckers working for nothing," but rather to point out to people who might be a little blinded by med school idealism that there are a lot of ways to be a physician, to take care of patients, and to live one's life.

Preface: I'm still a medical student, and not interested in going to fammed (I did have a good med student rotation though).

I think a lot of the students/residents already answered the questions though. They acknowledged that the debt is great, the salary could be better, but they do what they do because it's something they enjoy. I think that's as fair of a reason as any other. I refuse to believe that a $150K a year salary is inadequate, even with a $200K debt. Of course, this all depends on one's lifestyle - and it may not lend to fast cars or 3 vacation houses on the beach, but I think most people can "survive" on those salary.

 

[iatrosB]

Wow.

You guys are pretty sensitive, huh?

Personal insults and all.....

It has generated so many responses because it is an issue important to med students emerging with an unbelievable debt burden.

You guys can downplay it all you want....reimbursement for primary care specialties is the reason more people don't go into it.

I certainly hope it changes.

I've got a buddy who's a pediatrician...when he is on call his beeper is constantly going off.

He deserves more benjamins.

I feel for you, man, I do. I know what you're trying to say...I just think it's coming out wrong, or we're misinterpreting your message. Thanks for your support about primary care needing to make more...they really do. And you're right, debt is a concern to many students...including me. Would it be easier to choose primary care with no debt, of course. Will debt keep me from it, no.

Bottom line, I think we've stated this a few different ways, is that there is more to a career than money and FM offers much flexibility in practice options. It is a good "fit" for a lot of us including personalities of other FMs, enjoying the outpatient setting, personal relationships with patients...not every med student wants this (most don't actually), but a few of us do and that is why we make the "300K mistake" and choose FM over a 450K specialty.

 

[deleted87716]

Primary care guys have huge problems paying off their debt.

Says who?

There's ample evidence that income and indebtedness influence specialty choice, but that's entirely different than saying that those who choose primary care careers will have problems paying off their loans. Again, I have never heard of a primary care physician who couldn't pay off their loans. Selection bias? Maybe, but the average indebtedness of family medicine residents isn't much different from that of other medical students (See: http://www.aafp.org/online/en/home/aboutus/specialty/facts/27.html and http://www.ama-assn.org/ama/pub/category/5349.html).

 

[Coastie]

Says who?

As I said in the original post (which you truncated), my buddies who are facing DO debt and private MD debt. Not all of them are rockin it out capitalism style. A lot of them are struggling in 120k a year entry jobs. They have 200k + med school debt, with wives, young kids, and realize that after taxes, they have about 80k. Subtract 25k for loans, and they have 55k to live on, place in retirement, get a car with, get a place to live, save for kid's college.

It's not pretty out there, Kent. You've gotta present the good and bad cases, and FM has extremes of each, with the trend more towards the "bad" cases these days. Hopefully, things will change, and per SophieJane, the entrepreneurial spirit which leads to better patient quality care and better paid docs is now becoming more common amongst young FP residents. Let's HOPE so.

 

[Coastie]

While we're being honest, it's worth noting that the average income in anesthesiology isn't $450K/year, either. Less than 10% of locums anesthesiologists earn that much, for example: http://www.locumtenens.com/anesthesiology-careers/2006-LT-Anesthesiologist-Salary-Survey.aspx.

That's one survey, yep. I don't think anyone claimed 450k was the average. I encourage medical students to speak with graduating gas residents regarding the current market, or, attendings like Jet, who has been out there for 11 years.

 

[Tired]

Where are the spine surgeons when you need 'em? Those guys earn, what, a million bucks a year? Makes a gas salary pale in comparison. "Twice the bank," indeed. Plus, no CRNA squabbles! Why didn't all you gas guys go into spine?

USMLE scores.

 

[jetproppilot]

While we're being honest, it's worth noting that the average income in anesthesiology isn't $450K/year, either.

350-400K W2, med mal, retirement, medical insurance, etc packages are plentiful in the southeast, so I respectfully disagree with you. Maybe not the average, but certainly pretty easy to find.

But the OP wasnt intended to single out anesthesia.

It was intended to inquire about medical student selection of primary care verses higher paid specialties considering the ever-higher spiraling student loan debt, and to query whether or not any academic attendings ever had a pragmatic educational talk about these very real issues with them.

Its very easy to forget about monetary issues when in training when all you're doing is signing loan checks and hitting the defer icon on your student loan company's website.

Monetary reality hits with a vengeance when you finish residency whether you want it to or not.

 

[Coastie]

USMLE scores.

Next.

 

[Coastie]

I've honestly never understood how somebody can try to tell somebody else how much money it should take to make them happy.

I absolutely agree, but I don't think Jet is coming from this angle AT ALL. If anything, he is anti-preaching what people should or shouldn't be happy with.

Jet is the guy who tells you the truth about ARM loans ahead of time, not because he doesn't want you to have a house, but because he doesn't want to see you get burned. He's the buddy who will tell you things you don't want to hear. He doesn't do this for kicks or because he feels the need to come off as superior, it's just the opposite! You think a guy in his position posts stuff like this just to kick sand in the face of another specialty? The guy was building UP FP, he said he loved it. He's just giving a word to the wise...Take it or leave it, he'll be flying high either way..