Why Make 150k When 450k Is Out There?

[jetproppilot]

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

Sorry Dude, I'm not trying to tell someone how much money it should take them.

I'm talking from a pragmatic standpoint.

I've started a discussion about the reality of what happens when you finish your residency monetarily.....speaking to the (ever increasing) percentage of med students who beg, borrow, and steal to get through med school.....accruing 200K + in debt.....

..who then, on the July 1st after their residency-completion-date, assume responsibility of that pricetag they've been deferring forever...

....and oh yeah....I've been living like a pauper for the last decade...and I've kissed my twenties goodbye to med school and residency....

I think anyone who endures this career path deserves a comfortable life.

Or at least, after years and years of sacrifice/sleepless nights/stress, to be able to comfortably pay your bills. And enjoy being able to buy a house/car/pay for your kids tuition.

Whats the note on a 300K home with 10% down? Whats the note on a 30K car? Times two for your wife? How much is tuition to a Catholic school (episcopal, etc) for your 2 kids?

I don't think these are extravagant by any stretch of the imagination.

You're saying thats not an issue with primary care docs. So I assume you're also lumping into your argument young, emerging-from-residency docs. Many of which are in the I owe two hundred grand to Sallie Mae club.

Really?

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[ioh]

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

While we're on happiness, I thought this might be of interest:

http://www.webmd.com/sex-relationships/guide/20061101/sex-better-than-money-for-happiness

 

[ioh]

My take on the article: choose a specialty that gives you free time for extracurricular activities.

 

[Pilot Doc]

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 think you are conflating two books
1) M next door - about millionaires, who fit the description you give
2) The M mind - sequel to #1 about decamillionaires. Though I don't recall specifically, I would be very surprised if these people typically earned under 90K.

Your basic point is well taken: save, don't spend, and you'll become wealthy. But to say a $10 million net worth is within the reach of anyone isn't true.

 

[Coastie]

I'm speaking from experience, as I presume you are.

This thread is great.

 

[indo]

In my med school experience, I've come to believe that most med students won't have that much debt. There are too many new lexuses and range rovers in the parking lot for me to believe all the people in my school complaining about debt. The people around here complaining to me about debt A) didn't pay for their undergrad B) live in a condo their parents bought and C) are borrowing money from their parents that they outwardly intend to never pay back.

Med students, in general, are spoiled and most have not had a real job where they have to make X number of dollars in order to pay their rent. These are typically the people who bust my balls when I talk about how I wouldn't practice medicine if reimbursment wasn't high enough.

 

[sophiejane]

I'm too lazy to do a search. Anyone know what the AVERAGE loan debt for 4 years of medical school is these days?

I know we hear from the folks in the $200-300K range, but I'd venture to guess that's nowhere near the average. I owe about $140. My loan payments are going to be ~$1400/month on a 10 year plan.

My husband also works, and we are going to live in a rural area by choice (we can't WAIT!). Paying back my loans is not going to be an issue.

I know you guys would like to say it's one way for everyone, but there are as many different ways to skin this cat as there are people who choose FM.

Having said that, from what I have seen of my colleagues, we don't drive junker cars and live in cracker boxes and eat Ramen. We have nice lives, our kids go to college, we have a great work/life balance, a satisfying job and money in the bank.

See, the thing is, I don't think there is this grand sense of entitlement among many who choose primary care. Yes, we work hard. But everyone works hard. I came to medicine late and had a blast in my 20s, so I can't really sympathize with those of you who are mourning the loss of that decade. I don't care to spend a lot of money on a Hummer or a Lexus with surround sound, I'm happy with a hybrid and NPR.

I think the reason you don't understand us is because I think a lot of us felt "called" to FM and don't think we'd be happy in anything else. I do believe there are way more of us who are here for the job than in any other specialty.

Who is really "called" to anesthesia? I mean, if it payed $180K and FM payed $300K, which would you have chosen?

 

[Coastie]

Huh?

In my med school experience, I've come to believe that most med students won't have that much debt. There are too many new lexuses and range rovers in the parking lot for me to believe all the people in my school complaining about debt. The people around here complaining to me about debt A) didn't pay for their undergrad B) live in a condo their parents bought and C) are borrowing money from their parents that they outwardly intend to never pay back.

Med students, in general, are spoiled and most have not had a real job where they have to make X number of dollars in order to pay their rent. These are typically the people who bust my balls when I talk about how I wouldn't practice medicine if reimbursment wasn't high enough.

 

[Coastie]

I'm happy with a hybrid and NPR.

Res ipsa loquitur.

 

[deleted87716]

I'm too lazy to do a search. Anyone know what the AVERAGE loan debt for 4 years of medical school is these days?

$139,517 for the Class of 2007. I posted the link earlier: http://www.ama-assn.org/ama/pub/category/5349.html

 

[sophiejane]

$139,517 for the Class of 2007. I posted the link earlier: http://www.ama-assn.org/ama/pub/category/5349.html

Thanks. Took a break for dinner and missed some action, I guess.

 

[uppi]

These threads make me sick:

For the person who was complaining about a FM doc ONLY having 55k a year to pay the bills, take care of family, etc: NEWS FLASH, the average person only makes around 35-40k a year, if that. Yes you had to go through 11 years of school to get that 55k a year, but as someone pointed out that is a CHOICE. And you made that choice so you could be doing something you LOVE, the average 35-40k person cant say that. I love how everyone tries to tell premeds that they cant go into medicine for the money, yet thats ALL med students (and doctors) complain about on here - not making enough. Also, the argument that I went to school for "x" amount of years, so I am ENTITLED to all this money, is crap. So what about Phd students? They go to school on average jsut as long if not longer than med students, and struggle to find jobs and make crappy salaries doing boring bench work. Then again, they dont have the debt you do, do they? Thats your other arguement. We accure x amount of debt, so we are ENTITLED to all this money. Again, that is crap. What about Veterinarians then? I read the Veterinarian forums daily, and I cant believe the difference in attitude between the vet forums and here. Veterinarians go to school for just as long (if they do a residency) and even if they dont they still go to school minimum of 8 years. They START OUT at 55k. None of this crybaby 55k after loans, taxes, etc are taken into account. 55k a year period. And Vet school tuition is right up there with Med Scool tuition. (Dont believe me, go look at OOS tuition for the various schools). You would think that Vets would not be able to survive AT ALL if Primary Care docs cant make it off of 150k a year. Heck they must be living on the street. Thats what I thought. But they are all making it just fine. Probably not living anywhere NEAR luxury, but they all LOVE what they do. I think the most astounding thing to me is that they make WAY less and have the same debt load (some more) and yet they never complain like these gold-digging med students do. All they do is say how happy they are to be in vet school, and how much they love what they are doing, and that they dont care about the money ( same with the veterinarians themselves). I actually remember posting in a vet thread similar to this one about how I couldnt believe that some of these kids were taking out 350k in loans to be a vet and though that was fiscally irresponsible. I still think it may be. However, if only we had more selfless kids like these vet students going into Human Medicine, healthcare would probably be a lot better. Instead we get these super smart doctors who dont care about patient care at all, just about getting fat paychecks and respect because they think they are entitled to it, but dont realize they have to be compassionate and GOOD doctors to earn that respect first.

 

[sophiejane]

Who is really "called" to anesthesia? I mean, if it payed $180K and FM payed $300K, which would you have chosen?

How about answering that instead of focusing on my choice of small cars and radio station, hmmm? Neither of which have anything to do with being a doctor, by the way.

Anyone? Anyone? Bueller?

 

[jetproppilot]

These threads make me sick:

For the person who was complaining about a FM doc ONLY having 55k a year to pay the bills, take care of family, etc: NEWS FLASH, the average person only makes around 35-40k a year, if that. Yes you had to go through 11 years of school to get that 55k a year, but as someone pointed out that is a CHOICE. And you made that choice so you could be doing something you LOVE, the average 35-40k person cant say that. I love how everyone tries to tell premeds that they cant go into medicine for the money, yet thats ALL med students (and doctors) complain about on here - not making enough. Also, the argument that I went to school for "x" amount of years, so I am ENTITLED to all this money, is crap. So what about Phd students? They go to school on average jsut as long if not longer than med students, and struggle to find jobs and make crappy salaries doing boring bench work. Then again, they dont have the debt you do, do they? Thats your other arguement. We accure x amount of debt, so we are ENTITLED to all this money. Again, that is crap. What about Veterinarians then? I read the Veterinarian forums daily, and I cant believe the difference in attitude between the vet forums and here. Veterinarians go to school for just as long (if they do a residency) and even if they dont they still go to school minimum of 8 years. They START OUT at 55k. None of this crybaby 55k after loans, taxes, etc are taken into account. 55k a year period. And Vet school tuition is right up there with Med Scool tuition. (Dont believe me, go look at OOS tuition for the various schools). You would think that Vets would not be able to survive AT ALL if Primary Care docs cant make it off of 150k a year. Heck they must be living on the street. Thats what I thought. But they are all making it just fine. Probably not living anywhere NEAR luxury, but they all LOVE what they do. I think the most astounding thing to me is that they make WAY less and have the same debt load (some more) and yet they never complain like these gold-digging med students do. All they do is say how happy they are to be in vet school, and how much they love what they are doing, and that they dont care about the money ( same with the veterinarians themselves). I actually remember posting in a vet thread similar to this one about how I couldnt believe that some of these kids were taking out 350k in loans to be a vet and though that was fiscally irresponsible. I still think it may be. However, if only we had more selfless kids like these vet students going into Human Medicine, healthcare would probably be a lot better. Instead we get these super smart doctors who dont care about patient care at all, just about getting fat paychecks and respect because they think they are entitled to it, but dont realize they have to be compassionate and GOOD doctors to earn patients respect first.

Nice post.

Guess I don't know where the line is discerning entitlement verses reasonable-expectations after a huge chronologic sacrifice plus a 200K student debt load.

I know what my expectations were.

Call that entitlement if you wish.

Interestingly, I did my residency with a dude....Jeff Pisto.....who was a DVM before going to med school.

He changed careers because he was making 30K as a vet.

 

[sophiejane]

Guess I don't know where the line is discerning entitlement verses reasonable-expectations after a huge chronologic sacrifice plus a 200K student debt load.

What was the sacrifice, again? Let's see...4 years of taking out loans and basically studying for a living, which amounted to about 8 maybe 12 hours a day of occupied time, then rotations...okay, sleeping in the call room, playing doctor, no real accountability, whatever. Yeah that really sucked. Terrible.

Then 3 years of residency...80 hour workweek wasn't around in your day, so maybe that's where some of the resentment is coming from.

I'm not really feeling that cheated. I thought medical school was challenging and fun and I'm having a great time in residency. I get two weekends off a month and most months, am easily doing less than 70 hours a week. Between my and my husband's salary, we own two homes, take nice vacations, and are saving money.

 

[jetproppilot]

Who is really "called" to anesthesia? I mean, if it payed $180K and FM payed $300K, which would you have chosen?

How about answering that instead of focusing on my choice of small cars and radio station, hmmm? Neither of which have anything to do with being a doctor, by the way.

Anyone? Anyone? Bueller?

I respect your choices.

You bring up some good points.

I'm wanna those dudes that wasnt "called" to anything in medicine.

My life outside my work is my focus.

Not my work.

Doesnt mean I'm not a good doctor....or that I dont enjoy what I do (actually I love what I do).....there are many people who know me who post on SDN anesthesia who can attest to that...but you'll just haffta take my word for it..

I wake up every day before the alarm clock goes off, I enjoy my job...

But a "calling?"

No.

I'd say, Sophie, that you are one of the few philanthropists in medicine. I have the utmost respect for that.

Called to it?

No way.

I'm called to my kids, my writing, my time off.

BTW, no Lexus for me.

I drive a monsta truck.

I do, however, think this is an important discussion.

That you won't hear about on your ward rotations as a med student.

 

[Voodoo]

I'm always intrigued by your posts. I've read a lot of your posts during residency. I think you can come off as extremely condescending at times, whether or not you mean to. That's probably what rubbed KentW the wrong way.

I can tell you that physicians bickering over salaries is not constructive in any shape or form. We should ALL be working together to help increase reimbursement, REGARDLESS of specialty. I've talked to several FP's at my hospital who are upset about the upcoming July '08 10% medicare cutback. I just laugh at them and tell them their cutback means a whopping $0.02 loss to me. My point is that my medicare reimbursement as an Anesthesiologist is 20 cents on the dollar. I don't know how much FP's are, but regardless, there are things that EVERY specialty has to change, and bickering among ourselves helps nothing. Educating the public does.

The public thinks healthcare already costs too much. Do you think they would change their mind if they knew how crappy our compensation is for certain patients? Let me frame it differently: Imagine taking the lady out for a "night on the town" and going to a nice restaurant, getting a bottle of wine, and then getting a bill for $100. What do you think would happen if you handed the waiter a note that said "I.O.U. $20, and will probably repay you in 3-6 months?" You'd go to jail. I don't think the public realizes that this is how their elderly -- often the sickest patients -- are treated.

Maybe our efforts shouldn't be focused on throwing rocks at one another - they should be probably be at letting people know what a disaster medicine is turning into, and how the brightest and most eager minds will eventually STOP going into it. Like Jet said, there are people out there in my class who I kicked around regularly who were out buying houses when I was in a tiny apartment in med school. They were buying yachts when I was in residency, and now I have $220,000 in debt and they're trying to decide whether to buy a vacation home in San Diego or Aspen. It is SMART to take care of yourself, and eventually the best of the best will find other things to do than to become physicians. It's sad, but true.

That's my $0.02. Sorry it's kinda off topic, but I think it's something that needs to be said.

Jet, if you read this, I hope you don't take too much offense. I really do hold your opinion in high regard. It got me through a lot of the horrors of residency.

 

[uppi]

Post was not necessarily geared towards you, jet. More towards every Pre Med, Med Student, or Doctor on the Human Medicine forums who COMPLAIN on here about money. Your not necessarily complaining about money. Yes, im sure there are vets who change to Human Medicine, or who hate that they are super poor and want out of Vet Med (or NEED to get out of Vet Med for that matter, because they cant afford to stay in it with their debt load). Im just saying if you go and read their forums, there tune is much more towards the "glass is half full" then here where its almost always "the glass is half empty".

 

[2oRadio]

Let me frame it differently: Imagine taking the lady out for a "night on the town" and going to a nice restaurant, getting a bottle of wine, and then getting a bill for $100. What do you think would happen if you handed the waiter a note that said "I.O.U. $20, and will probably repay you in 3-6 months?" You'd go to jail.

1) Excellent post.

2) It's worth a shot. I'll let you know how it goes

 

[sophiejane]

Called to it?

No way.

I'm called to my kids, my writing, my time off.

So, here's the great thing about FM for me:

I get to do a job I feel "called" to, which gives me a lot of satisfaction,

and I also have time

to play the cello,

cook fantastic Indian food,

travel,

garden,

raise kids,

drink wine,

paint my dining room,

visit family, etc etc etc etc...

do I bank $400K? nowhere close...

but I do bank time, and happiness, and quality of life

(its very satisfying also to make people have to scroll down for what could have been a 5 line post)

 

[jetproppilot]

I'm always intrigued by your posts. I've read a lot of your posts during residency. I think you can come off as extremely condescending at times, whether or not you mean to. That's probably what rubbed KentW the wrong way.

I can tell you that physicians bickering over salaries is not constructive in any shape or form. We should ALL be working together to help increase reimbursement, REGARDLESS of specialty. I've talked to several FP's at my hospital who are upset about the upcoming July '08 10% medicare cutback. I just laugh at them and tell them their cutback means a whopping $0.02 loss to me. My point is that my medicare reimbursement as an Anesthesiologist is 20 cents on the dollar. I don't know how much FP's are, but regardless, there are things that EVERY specialty has to change, and bickering among ourselves helps nothing. Educating the public does.

The public thinks healthcare already costs too much. Do you think they would change their mind if they knew how crappy our compensation is for certain patients? Let me frame it differently: Imagine taking the lady out for a "night on the town" and going to a nice restaurant, getting a bottle of wine, and then getting a bill for $100. What do you think would happen if you handed the waiter a note that said "I.O.U. $20, and will probably repay you in 3-6 months?" You'd go to jail. I don't think the public realizes that this is how their elderly -- often the sickest patients -- are treated.

Maybe our efforts shouldn't be focused on throwing rocks at one another - they should be probably be at letting people know what a disaster medicine is turning into, and how the brightest and most eager minds will eventually STOP going into it. Like Jet said, there are people out there in my class who I kicked around regularly who were out buying houses when I was in a tiny apartment in med school. They were buying yachts when I was in residency, and now I have $220,000 in debt and they're trying to decide whether to buy a vacation home in San Diego or Aspen. It is SMART to take care of yourself, and eventually the best of the best will find other things to do than to become physicians. It's sad, but true.

That's my $0.02. Sorry it's kinda off topic, but I think it's something that needs to be said.

Jet, if you read this, I hope you don't take too much offense. I really do hold your opinion in high regard. It got me through a lot of the horrors of residency.

Thanks for your post, Dude.

No offense taken.

 

[jetproppilot]

So, here's the great thing about FM for me:

I get to do a job I feel "called" to, which gives me a lot of satisfaction,

and I also have time

to play the cello,

cook fantastic Indian food,

travel,

garden,

raise kids,

drink wine,

paint my dining room,

visit family, etc etc etc etc...

do I bank $400K? nowhere close...

but I do bank time, and happiness, and quality of life

(its very satisfying also to make people have to scroll down for what could have been a 5 line post)

Thats fantastic.

What if you could do all that and make 400K? Or 300K?

Its revolting to me that CRNA salaries are above alotta primary care docs.

PRIMARY CARE DOCS NEED TO MAKE MORE.

So what does it take to make that happen?

You should be making at least 250K. Starting. Or put your number in there. Point being its a travesty what you start at.

WHAT DOES IT TAKE?

Lobbying med schools to forgive debt if one chooses primary care early on?

Hospitals targeting med students, forgiving their debt if they come on as a primary care doc at their private institution at the end of their residency?

Sorry. I don't think the debt-burden should be on the individual if they are choosing primary care as a specialty...given the paucity of primary care docs.....

You guys can tout independence/schedule etc all you want....but many primary care docs....at least the ones I'm familiar with at my institution....work their a sses off.

Med student debt continues to spiral upward.

Something should be done for med student debt for those who select primary care.

The ball has to start somewhere....

so far "the ball" hasnt done much.

 

[Disciple]

PRIMARY CARE DOCS NEED TO MAKE MORE.

So what does it take to make that happen?

You should be making at least 250K. Starting. Or put your number in there. Point being its a travesty what you start at.

WHAT DOES IT TAKE?

It all depends how the pie (Medicare expenditures for physician services) is divided up.

And that depends on who has the power when recommendations are made to CMS.

 

[sophiejane]

Med student debt continues to spiral upward.

Something should be done for med student debt for those who select primary care.

We've got AMA and AAFP and AOA and you name it supposedly working on reimbursements but anyone working specifically on medical student debt? I was an AMSA officer in med school and know they have been working on it, but apparently no real progress...

I know it is expensive to pay all those researchers, etc...but I do believe that is what drives up the price. Medical schools can't just teach doctors, they have to do cutting edge research, and that costs a lot of money.

I would be interested in what the ACTUAL price of medical education is. Granted, we have to pay inflated salaries to administrators and heaven knows THAT is non-negotiable. And we have to support our obscure research into ion channel mutations in South American albino lemurs, so THAT must continue.

Really.

 

[ioh]

Good call on the flames in the original post, Jet. And thanks for ironically taking them for while saying FM should be paid higher salaries.

I agree this is a good topic to discuss, because if you don't look out for what you deserve no one else will do it for you. Money is an important part of life.

Given my penchant for economics and finance, I'm a big fan of the guy who happens to be the richest in the world right now (Warren Buffet). I live in the belief that even if I'm "only" making 150K, I'll follow his lead and a lot of it will end up going to charitable causes. People are the most important part of life.

I guess you can chalk me up as another one for altruism.

 

[jetproppilot]

It is SMART to take care of yourself, and eventually the best of the best will find other things to do than to become physicians. It's sad, but true.
.

And THIS is what motivates alotta my posts.

Medical school/residency is not a time where individuals think alot about themselves....all you're thinking is if I can get through this, it'll be OK...

I find it important to raise issues to my colleagues in training that nobody wants to talk about.

 

[SDN]

As an FM doc, I'd like to give my opinion.

Anesthesia is a fantastic field; it's challenging and financially rewarding. I've even considered leaving my FM practice to go back to residency in anesthesia.

For those who don't like anesthesia or find it boring - that's OK, everyone is different.

Few specialists would want to do the work FM and IM docs do, and many FM and IM docs don't want to do the work specialists do. However, we're all reliant on each other and equally necessary.

Unfortunately, right now physician income is all about the procedures - and in General IM and FP, we simply don't get that many procedures, we mostly bill by the visit.

(BTW, if you want to read about FM's current problems and why we're in this mess, read some of the fantastic work by Thomas Bodenheimer, MD, MPH from UCSF. One article is available through the NEJM. Please read his JAMA articles too if you have access.)

I see this thread's argument as misplaced: proper fire, wrong direction. We shouldn't get upset at other professions or individuals - we should be upset that the healthcare system is so upside-down that it doesn't reward prevention. WTF, it's just so illogical.

The current healthcare system we have currently is not really even a system. It's just a patchwork of policies, each created to solve an individual issue. Each of these individual solutions then leads to a host of unintended consequences, each of which have their own solution - and so it goes... It's just a mess.

I would argue that FM is the right place to be today. America's healthcare is rapidly coming off the rails. Part of the solution will be to reward primary care and re-establish a proper income balance between primary care and specialty medicine.

As FM docs, we should be out there demanding some common sense from our lawmakers - it's the right thing to do.

 

[jetproppilot]

As an FM doc, I'd like to give my opinion.

Anesthesia is a fantastic field; it's challenging and financially rewarding. I've even considered leaving my FM practice to go back to residency in anesthesia.

For those who don't like anesthesia or find it boring - that's OK, everyone is different.

Few specialists would want to do the work FM and IM docs do, and many FM and IM docs don't want to do the work specialists do. However, we're all reliant on each other and equally necessary.

Unfortunately, right now physician income is all about the procedures - and in General IM and FP, we simply don't get that many procedures, we mostly bill by the visit.

(BTW, if you want to read about FM's current problems and why we're in this mess, read some of the fantastic work by Thomas Bodenheimer, MD, MPH from UCSF. One article is available through the NEJM. Please read his JAMA articles too if you have access.)

I see this thread's argument as misplaced: proper fire, wrong direction. We shouldn't get upset at other professions or individuals - we should be upset that the healthcare system is so upside-down that it doesn't reward prevention. WTF, it's just so illogical.

The current healthcare system we have currently is not really even a system. It's just a patchwork of policies, each created to solve an individual issue. Each of these individual solutions then leads to a host of unintended consequences, each of which have their own solution - and so it goes... It's just a mess.

I would argue that FM is the right place to be today. America's healthcare is rapidly coming off the rails. Part of the solution will be to reward primary care and re-establish a proper income balance between primary care and specialty medicine.

As FM docs, we should be out there demanding some common sense from our lawmakers - it's the right thing to do.

UHHHHHHHH.....

LEE'S THE DUDE THAT STARTED SDN....AND HE POSTED ON THIS THREAD.....

I GUESS THIS IS AN IMPORTANT (albeit uncomfortable) ISSUE, HUH?

 

[SDN]

Eh, I don't really find the topic to be uncomfortable at all. It's an important thing to discuss and those within organized medicine certainly have been discussing it with increased urgency over the past few years.

It's good to see that other specialties appreciate the financial penalty we take when we choose FM or general IM.

It just financially sucks for those of us in FM right now. We all know it. So, let's work on ways to resolve the inequality. Otherwise we're going to have nobody doing primary care anymore and then we'll all be in trouble.

Again, if you haven't read this NEJM article from Dr. Bodenheimer, check it out.

 

[jetproppilot]

Then 3 years of residency...80 hour workweek wasn't around in your day, so maybe that's where some of the resentment is coming from.
.

No resentment here, ma'am.

Reasonable expectations?

Yes.

Not resentment.

I think its naive to think that most individuals who incur a huge debt and concominantly spend their twenties outta society wouldnt want a monetary reward at the end.

And that opinion is corroborated by the plethora of med students selecting specialties over primary care.

Wanna say its not the money thats influencing them?

I beg to differ.

 

[jetproppilot]

These threads make me sick:

For the person who was complaining about a FM doc ONLY having 55k a year to pay the bills, take care of family, etc: NEWS FLASH, the average person only makes around 35-40k a year......

... I love how everyone tries to tell premeds that they cant go into medicine for the money, yet thats ALL med students (and doctors) complain about on here - not making enough. Also, the argument that I went to school for "x" amount of years, so I am ENTITLED to all this money, is crap.....

..... if only we had more SELFLESS kids like these vet students going into Human Medicine, healthcare would probably be a lot better. Instead we get these super smart doctors who dont care about patient care at all, just about getting fat paychecks and respect because they think they are entitled to it, .

Sorry, I disagree with you.

From a personal-planning standpoint, if I sacrifice a decade of my life and sign a 200K promissory note, I expect to make X dollars.

I can't speak for the PhDs, Vets, et al who take on said debt, knowing their earning future is in whatever range its in..

Why is that repulsive to you?

Do you listen to retirement-financial-dudes who advise you on how to plan for your retirement?

Does that equally repulse you?

Wouldnt you say pragmatic-profession-selection is kinda like the retirement dude that advises you on how to save for retirement?

BTW, being selfless like you post about leads to self esteem issues and codependence.

But thats a title for a different thread.

I'll pass on being selfless. Thanks.

 

[jetproppilot]

Eh, I don't really find the topic to be uncomfortable at all..

With all due respect, Sir, judging from the flame-posts it elicited,

I beg to differ with you.

It is uncomfortable.

As demonstrated by Kent's defensiveness, and the other flame's posts.

Kent continues his raves about how money isnt an issue with FM docs....no problems with money, no problems paying loans, blah blah blah.

I beg to differ with that as well.

But hey, I'm not a primary care doc. So maybe I just made all this stuff up and everythings peachy keen from a monetary standpoint, and (american trained) med students are funneling into FM in droves...

OH....I'll use Kent's favorite avatar right here....

 

[DukeOfEarl]

I left anesthesiology because I got tired of feeling like a surgeons lacky, I got tired of doing things that nurses do for other doctors, I got tired of some CRNAs and all of the politics that go with that. I decided you couldn't pay me enough for the misery of waking up at the crack of dawn and spending my day doing this boring specialty. No I am not currently in primary care, it was not a fit for me, but more power to those that like it. They should be commended for their dedication to patient care, and not made to feel bad because they have debt and don't make as much as you. If this makes you feel good, whatever. If you seriously wanted just to understand it, you would have phrased it differently in my opinion. If anesthesiology wasn't paying what it is now many people wouldn't go into it. I made the mistake of going into it for the money, but at the end of the day I had to enjoy what I was doing. Money, prestige, and material wealth don't make the man/woman.

 

[deleted87716]

It is uncomfortable.

As demonstrated by Kent's defensiveness, and the other flame's posts.

I agree with Lee. There's nothing "uncomfortable" about discussing reimbursement issues. In FM, we talk about this stuff all the time.

Your original post had nothing to do with solving the reimbursement problems in family medicine. It was, as you said yourself, intentionally inflammatory. Don't confuse a difference of opinion with "defensiveness."

Kent continues his raves about how money isnt an issue with FM docs....no problems with money, no problems paying loans, blah blah blah.

I beg to differ with that as well.

I'm posting about my experience and that of the people I work with and know professionally. Sure, FM reimbursement could be better, but most of the people I know are doing just fine, nonetheless. Do we think we deserve more? Of course! That's human nature. I've always maintained that anyone who feels truly satisfied with their income is probably overpaid.

I'm not a primary care doc. So maybe I just made all this stuff up and everythings peachy keen from a monetary standpoint, and med students are funneling into FM in droves...

You keep arguing points that nobody (as far as I can tell) has even contested. Yes, FM reimbursement is lower than most specialties. Yes, that influences specialty choice by medical students. Those aren't really even debatable...they're facts. Still, as many of us have repeatedly stated, money isn't everything, and family medicine is the right place to be. It's what we enjoy, despite being underpaid and underappreciated. Would we like that to change? Of course! Will it? Time will tell. Personally, I think things will probably get worse before they get better. As Lee said, change will require political action, with involvement from physicians in all specialties, not just primary care. I'm involved. Are you?

 

[jetproppilot]

I left anesthesiology because I got tired of feeling like a surgeons lacky, I got tired of doing things that nurses do for other doctors, I got tired of some CRNAs and all of the politics that go with that. I decided you couldn't pay me enough for the misery of waking up at the crack of dawn and spending my day doing this boring specialty. No I am not currently in primary care, it was not a fit for me, but more power to those that like it. They should be commended for their dedication to patient care, and not made to feel bad because they have debt and don't make as much as you. If this makes you feel good, whatever. If you seriously wanted just to understand it, you would have phrased it differently in my opinion. If anesthesiology wasn't paying what it is now many people wouldn't go into it. I made the mistake of going into it for the money, but at the end of the day I had to enjoy what I was doing. Money, prestige, and material wealth don't make the man/woman.

Sounds like you've got issues, Dude.

Theres not one post I made that would make someone "feel bad" about their choice, as you put it.

Sorry I didnt phrase it like you think it shouldda been phrased.

Phrase it however you want.....the message is the same.

Reimbursement for primary care is challenging considering med student's current-day debt burden.

I agree "money, prestige, material wealth don't make the man/woman...."

but being able to comfortably pay ones bills after a decade of sleepless nights an indebtedness certainly contributes to inner peace.

 

[DukeOfEarl]

Sounds like you've got issues, Dude.

Theres not one post I made that would make someone "feel bad" about their choice, as you put it.

Sorry I didnt phrase it like you think it shouldda been phrased.

Phrase it however you want.....the message is the same.

Reimbursement for primary care is challenging considering med student's current-day debt burden.

I agree "money, prestige, material wealth don't make the man/woman...."

but being able to comfortably pay ones bills after a decade of sleepless nights an indebtedness certainly contributes to inner peace.

No, I don't have any issues. I am very happy with my current specialty. I was just trying to point out that anesthesiology is not the greatest specialty in the world like so many medical students fall for. I know, I was one of them, and I ended up hating it. I know other people that have left the field as well because it just wasn't a right fit for them. You have to have a certain type of personality in my opinion to like anesthesia. When I used to tell people what I did, all they ever had to say about it was the talking about the money, and then they would bring up how boring it was (this was the other residents/medical students/attendings. When I would tell non-medical people what I did, they thought you didn't have to even be a physician to do anesthesiology because of the mixup with the CRNAs. So, no, I don't have issues, I am just pointing out that it is not this great utopian specialty. If all you care about is money OR if you like anesthesiology, more power to you.
Maybe I am taking you the wrong way, as I am new on this forum, and I am not familiar with your "style". Primary care docs are definitely underpaid. I chose not to go into it partly for that reason, but not entirely. I just liked the specialty I do now much more. For all of you pre-meds/medical students reading this. Take it from me (as someone who switched specialties). Find what you love to do, and the things will work out. If all you care about is money, fine, then pick out the highest paying specialty that you can attain and tolerate.

By the way Turbo, one thing that everyone seems to miss, is that sometimes primary care chooses the medical student, and not the other way around (grades, USMLE scores, etc. etc.)

 

[jetproppilot]

As Lee said, change will require political action, with involvement from physicians in all specialties, not just primary care. I'm involved. Are you?

Uhhhh, I'm the dude that originated the thread....on a subject that all of you are obviously passionate about....

....so here I am, outta my environment, posting on your forum trying to stir up awareness....and you arrogantly ask if I'm involved?....on the coattails of Lee.....like a little chihuahua.....



Geez, I dunno if I'm involved, Dude.... I'll bet 30 med students read this and thought about this subject.....30 students that wouldntve even considered this subject since their attendings dont talk about it...


Apparently, Kent, you have an inability to look beyond your "talking in riddles", throwing-flames self.

Greater-than-1700-views (OH WAIT.....nearly 1900)..... in two days to this thread that you incessantly insulted me on says I'm involved.

Hmmmmm.....what have you done, Dude, to stir it up? Geez, I'm sorry I'm too politically incorrect for you.

Maybe you and yours should consider doing something different to attract attention.

Take off the bow tie, Dude.

Put inna dippa Copenhagen.

Say a cuss word.

 

[secretwave101]

How many more times do we have to say it?

Apparently we have to now defend ourselves from people who are ostensibly so happy with their own choices they feel the need to try to protect people from making their own informed choices.

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.

Hear. Hear. This is an FP forum. We're happy about what we do. We're not making students come in here and take a look around. And said med students aren't stupid. They can check out gas any time they want. No need for gallant protection from kindly, concerned, wise specialists.

 

[jetproppilot]

Apparently we have to now defend ourselves from people who are ostensibly so happy with their own choices they feel the need to try to protect people from making their own informed choices.



Hear. Hear. This is an FP forum. We're happy about what we do. We're not making students come in here and take a look around. And said med students aren't stupid. They can check out gas any time they want. No need for gallant protection from kindly, concerned, wise specialists.

Yeah, whatever.

I'm sure you'll assure me that the med students of today are well versed in the monetary aspects of post-residency medicine, and how their decision making in med school affects their future.

I'm sure you'll assure me that they are making informed decisions...since med students are so well informed on the business of medicine, and how ones choices in med school influence ones future outside of medicine dramatically....

BTW, these posts arent solicitations for anesthesia. (Oh, BTW, nobody in "da biz" calls it "GAS".....if you showed up as a med student at the OR front desk and asked for the "GAS" attending, they'd laugh at you hysterically and wouldnt have a clue to what you were referring to...)

These posts are for med students who I know havent heard anything even close to these postings.

Despite your flames, I'll continue to propegate the travesty of a primary care docs poor reimbursement, and how this needs to change.


I've been very clear with my posts about going into anesthesia....the shortfalls.....what a clinician has to accept as a part of the specialty in order to be happy.....

I come here and Kent says ALLS GOOD.......noone has problems.....

...carrying a 200K student loan debt along with "lifes" expenses isnt gonna be easy if you emerge to a 150K salary.

 

[jetproppilot]

Oh, I agree with you, Secret.

They certainly arent stupid.

I think you'd agree theres a difference between being stupid and being uninformed.

 

[herpmed]

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.

The above quote is well said and from the heart. While debt is still a concern, if one's primary interest is in only income, one should become an investment banker or corporate attorney. In my view, choice of endeavour in medicine should be contigent on how one wishes to help PATIENTS. PATIENTS and the desire to help one's fellow human being should be the central driving motivation to enter any specific medical field. The individual's specific interest within the various medical disciplines dictates how one accomplishes this goal. It is disappointing and depressing to see many talented individuals base their career in medicine on primarily income expectation.
Is compensation important? OF COURSE! However, if you pose the query, "why make 150k when 450K is out there?, you and I have very different presuppositions and motivations regarding the art and scientific foundations of medical practice.

 

[sophiejane]

Uhhhh, I'm the dude that originated the thread....on a subject that all of you are obviously passionate about....

....so here I am, outta my environment, posting on your forum trying to stir up awareness....and you arrogantly ask if I'm involved?....on the coattails of Lee.....like a little chihuahua.....



Geez, I dunno if I'm involved, Dude.... I'll bet 30 med students read this and thought about this subject.....30 students that wouldntve even considered this subject since their attendings dont talk about it...


Apparently, Kent, you have an inability to look beyond your "talking in riddles", throwing-flames self.

Greater-than-1700-views (OH WAIT.....nearly 1900)..... in two days to this thread that you incessantly insulted me on says I'm involved.

Hmmmmm.....what have you done, Dude, to stir it up? Geez, I'm sorry I'm too politically incorrect for you.

Maybe you and yours should consider doing something different to attract attention.

Take off the bow tie, Dude.

Put inna dippa Copenhagen.

Say a cuss word.

Like I said, continue to make this personal and we shut it down. There was nothing in Kent's post that was in any way a personal affront to you, nor were there flames.

Simmer down, cut out the superfluous ego-driven BS and let's continue what has the makings of an interesting discussion.

 

[Doodledog]

I know it is expensive to pay all those researchers, etc...but I do believe that is what drives up the price. Medical schools can't just teach doctors, they have to do cutting edge research, and that costs a lot of money.

And we have to support our obscure research into ion channel mutations in South American albino lemurs, so THAT must continue.

Really.

Sophie: I greatly respect you, this forum and this discussion, but these comments were not accurate and are insulting to thousands of physician-scientists and biomedical researchers. In fact, virtually all of us pay our own way via research grants and clinical care. Most researchers must support 80-100% of their salary via direct grant or clinical dollars. An extremely small amount of medical school support may be used for start up funds or bridging funds, but this is tiny and is done to enhance the institution and as a "loss leader". In fact, via indirect grant support, biomedical research supports the institution financially, not the other way around. I bring in far more than 100% of my salary via grants and clinical dollars. A basic or transitional science researcher who loses their grant support is out of work or going to be doing other thinks quickly.

Finally, you should be aware that currently, only about 10% of investigator-initiated grants (R01s) are being funded. Although it is undoubtedly true that some grants are not going towards clinically useful (now or in the near future) research, the extreme competitiveness of the federal grant process does not support years of random research. The medications and care you provide now and in the future were developed based on the basic science and animal models you find distasteful. Regardless, that research funded itself (via grants), your tuition most certainly did not go up because it was being done at your medical school.

End of hijack, but I didn't want the thousands of readers of this thread to believe that their debt burden was caused by biomedical research or that if they went to a school with less research, they would pay less tuition because of it.

 

[jetproppilot]

P.S. - Don't worry, I'm not going to keep writing like this, with everything on different lines and bold-facing all over the place. This was just an experiment. IMO, all of the bold-faced type makes it look like I'm yelling, which I'm not.

I think it looks good.

 

[Beau Geste]

My mom is an FP. I keep urging her to open a spa clinic and add a rehab clinic on to her practice.

I would so do that if I were going into FP

 

[dillpickles]

Just wanted to say that I thought I would do family practice or internal medicine - I ended up really liking my anesthesiology rotation. I find a lot of satisfaction in being calming and kind before someone goes to sleep for surgery, which many patients find to be a stressful experience. I tried many FP rotations in med school - on campus, away and rural - but ultimately did not like being in the clinic. I never would have expected it, but am much happier in anesthesiology and do not regret my choice for a minute.

It's good to hear those of you in FP who also enjoy your work - that's important!

 

[SDN]

Redirecting the topic a bit - I wonder what our profession thinks about this article in the WSJ today:

http://online.wsj.com/article/SB120710036831882059.html?mod=hpp_us_inside_today

 

[Ypo.]

I'm attracted to primary care for a lot of reasons, and I don't mind the pay. Honestly, even though it pays more I couldn't do say, anesthesiology, simply because I can't stand crossword puzzles. (kidding!) Jokes aside, I have to do what I'm passionate about.

I do worry that in the future, especially if radical changes are made to our health care system, that there is going to be a lot of pressure to use NPs and "doctor nurses" and PAs to do the primary care. In the future I can see more caps on lawsuits and pressure to find more affordable health care. I would imagine that this would provide a large incentive to have midlevels take on more of the burden of primary care. I just don't see any way around it, unless we can convince the government not to cut costs. But when has that ever worked in the past?

 

[deleted87716]

I do worry that in the future, especially if radical changes are made to our health care system, that there is going to be a lot of pressure to use NPs and "doctor nurses" and PAs to do the primary care.

Don't forget the "trickle-down" effect on specialties. Many specialists are already hiring mid-levels to offload some of their non-procedural workload, and we can expect that trend to continue as more routine care ends up in specialists' offices by default. Already-overburdened hospital emergency departments will get even busier, too. None of this will result in less expensive care...quite the opposite, actually. That's what people like Ms. Mundinger are counting on. Family physicians have other ideas, but it will take political backing and support to bring them to fruition.

 

[Ypo.]

Don't forget the "trickle-down" effect on specialties. Many specialists are already hiring mid-levels to offload some of their non-procedural workload, and we can expect that trend to continue as more routine care ends up in specialists' offices by default. Already-overburdened hospital emergency departments will get even busier, too. None of this will result in less expensive care...quite the opposite, actually. That's what people like Ms. Mundinger are counting on. Family physicians have other ideas, but it will take political backing and support to bring them to fruition.

You aren't reassuring me!