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Thanks for adding a series of logical and well written posts to the thread. I'm disappointed that some students/MD's would think they have a monopoly on valid inference for all things medical.
Looking again at JPP's original question brings up a series of thoughts for me:
1) These figures of 150K, 450K, etc. are averages collected on surveys.
2) If you prefer a salaried position over ownership or part-ownership of a private practice, these averages are more likely to apply to your future income.
3) In private practice there is a greater variance in income, and there must be a logical reason for this variance.
4) My best explanation to date for this variance is that medicine is a business, and some businesses are simply run in a much more profitable manner than others.
This goes to the heart of what you touched on, which is understanding the financial aspects of medicine. Doing so may just permit you to chose the specialty you enjoy most AND make more than you otherwise would.
I agree. I think it's natural for us to look to averages as "comfortable" assurances, of sorts. After all, if we're going to invest nearly a decade attaining our professional goals, why not expect a substantial return on that investment?
BUT -- obsession over averages ignores the fact that we are different, marketable people living in a relatively free capitalist society. Private practices can and will position themselves to provide a highly demanded service or fill a coveted niche. Understanding microeconomics and paying close attention to local market demands (along with some common courtesy and a little work ethic) will likely ensure a modest increase in income.
Thus, as you say, one ought to pick the specialty one enjoys and focus on using their enthusiasm for said specialty to market their skills and work hard to maintain a loyal and large client/patient base.