Why would anyone go into primary care nowadays?

[Mad Jack]

---

Members do not see this ad.

And that's gonna be a high quality retirement I'm sure. But yeah he did it so great, my point is that he's 1/1000000 and you're acting like being that is so easy. Look if someone is going to retire at 38 with 700k in assets and are married, they're planning on living extremely frugally.

Sorry, you don't understand what retirement is to people that are in the whole early retirement camp. Retirement just means you stopped working because you have to- most ERE types still work, but only on things they enjoy, when they want to. It isn't about not working, it's about the freedom that comes with knowing that you don't need to work and that you're living life on the terms you want to. Basically his expenses are only 22k a year, so anything he works over that is just free money since all of his expenses are covered by his investment interest. He's still working part-time for the hell of it and pulling in another 60k+ a year.

I'm not saying everyone should retire like he did. Just that it is totally possible to pay off your loans using the exact same strategy he used to retire early. He payed off his loans AND condo in around 4 years, it's doable, that's the point. That he chose to continue living the same lifestyle and retire early is beside the point. He's not the only physician on the ERE forums- there's plenty of them, and a lot of lawyers with similar debt:income ratios as physicians that have done the exact same thing.

 

[DermViser]

So, y'all talk like 48k a year is poverty, and that "living like a resident" means not being able to have a house, a spouse, and children.

I challenge your premise. A great many of your patients are going to be people that don't come close to making 48k a year, and they have all of those things. I have managed to have all those things (sub in impoverished extended family in place of children) on less than that, as the sole income in the household. If you have a spouse, if they manage a similar income, you are pushing 100k, which is wealth beyond the wildest dreams of MOST American families.

It is a question of paying sooner or later, and how much. If you pay the loans off earlier, you don't inflate your lifestyle at the first opportunity, and in return you get 20-25 years of making several thousand dollars more per month that you aren't spending on loan repayment. Or, you can rush to live the so-called good life and find yourself stuck in it, as you struggle to keep up with all the additional debt you take on through mortgages, car payments, etc.

If the latter were my plan, since I care about financial freedom, Family Medicine would be insane. Hands down. You win the argument, @DermViser.

But, my plan for my first two years out of residency is to stick with my current lifestyle, work 60+ hours a week doing locums or moonlighting or whatever it takes to earn 200k above what I need to live on, after taxes and other expenses. 400k will pay off my loans and my house. At that point, I could decide that I only wanted to do direct care for people who can mostly only afford to pay me in barter and pies, and it won't matter because I won't have huge monthly payments to fret about. More realistically, I could end up ONLY taking home $150k or so and still living a better lifestyle than someone who rushed out to get the nicest car they could finance the moment they became an attending. I would be keeping more of what I earned than someone who had to pay it all out to banks as quickly as it came in.

Because I know what I want out of life, Family Medicine makes sense to me.

So much fallacies in your arguments in your post, it's not even funny.

Oh, Jack. You know very well that you and I haven't ever experienced anything. Just ask medical students. They will tell you all about yourself.

Yup, I guess the same goes for residents too right? Yet even with all your "life experience" you still seem to be quite clueless on the realities of the situation.

 

[DermViser]

Damn, that's true. However, it still adds only a few more years to the resident lifestyle phase. As a crude, oversimplified estimate, say your overall income tax on such a salary is 25% (http://taxes.about.com/od/Federal-Income-Taxes/fl/Federal-Income-Tax-Rates-for-the-Year-2014.htm). 25% of 138K becomes 34.5K. Deduct that from the 90K earlier, and you still have a respectable 55.5K. 300K/55.5K comes out to a little less than 6.

I admit I made a big mistake that you quickly caught (thanks), and that I may potentially still be missing something else. If I'm not, though, I think an extra 6 years of a resident lifestyle is a reasonable price to pay for the subsequent liberation from debt. I mean, I'm not exactly living it up now as a student, nor was I at any point prior to enrollment at med school...

Again, do you not know what compounding interest is? Your 300 K debt at the end of med school will be a completely different number at the end of residency.

 

[DermViser]

I hate to be the contrarian, but there are lots of Midlevel hospitalists in MA. I did my subi on a hospitalist service that used NPs to carry 5 patients each.

The VA up here uses hospitalist NPs.

And my current residency program uses hospitalist PAs.

MA also wanted to pass a bill mandating that doctors accept Medicaid. Fully expected by MA to stick it to doctors.

 

[DermViser]

Premeds just go away. You guys and your silly holier than thou attitude are so obnoxious. You think you're the only ones who came into medical school looking to help people? You think you're going to be better than the doctors now and live like a resident forever because you were poor? No one's impressed and we aren't an admissions committee. I see right through your bs. All the kids who start the year yapping about international health and underserved populations are the ones who gun for derm ortho ophtho uro etc. I've met exactly one person who is still a resident and is still planning on international medicine. Even they are wavering because of the burden of student loans.

It's painfully obvious when someone has no real life experience. You never held a job, you never paid taxes, you never supported a family. You tell us about living at 50k a year and preach to us about living frugally. You make all these ridiculous calculations that are so poorly thought out that they aren't even worth responding to. You tell us about the average American family, just parroting crap from news articles with no supporting research written by pisspoor journalists. I've lived at 20k a year in a bad neighborhood so don't cry to me about your hard life as a 50k middle class family. It sucked hardcore and I'm here so I can make sure that my kids won't have to go through what I did.

Doctors don't have trouble paying off loans because they are buying cars. What a stupid myth and it's a useless strawman argument. You have no idea what is like to live as an attending or resident. It's not just rolling in the dough after seeing ten patients a day. There are so many other expenses that you've never even considered that don't go into your simplistic calculations. Licensing exams alone run into the thousands of dollars. Emrs are more expensive than you can imagine.

I'm going to be a doctor because I'm way into the top 1%. I've always excelled at everything I do because I'm smart and I work harder than almost anyone else. I don't need my own peers or wannabes telling me that I will be making too much money and don't deserve it. If you want to give away your money and live at 50k for the rest of your life, be my guest. But all of you will talk the talk. None of you will walk the walk and I challenge any of you to prove me wrong in ten years.

^^^^THIS. I have yet to meet a medical student who talks during MS-1 about how much they love "global health" and "serving underserved populations" actually end up doing it. I am sure there are people like that and if you look at the backgrounds many are people of very affluent circumstances in which debt is not a problem or they go into "health policy" --- the ones that get MBAs or MPHs bc they realize at the end of MS-3 "Oh ****, I really hate clinical medicine, what have I gotten myself into?!?!? I need an escape hatch!"

What's worse is the ones that yap about it, meanwhile being sinister behind the scenes. The ones who yap about how great primary care is, while going for a competitive specialty. The ones who volunteer at "free clinics" and do "international electives" to purposefully pad their ERAS CV, etc.

 

[DermViser]

To be honest with you, I was kind of surprised when someone said in that thread it would be difficult for a physician with 220k salary to pay back a 200k student loan in 7 years...

Here are terms you need to look up:

• what a starting salary is
• what taxes are (federal, state, income, etc.)
• compounding interest
• unsubsidized loans
• costs of marriage, having children, mortgage, food, etc.
• saving for retirement, etc.

 

[BestDoctorEver]

Here are terms you need to look up:

• what a starting salary is
• what taxes are (federal, state, income, etc.)
• compounding interest
• unsubsidized loans
• costs of marriage, having children, mortgage, food, etc.
• saving for retirement, etc.

🙄

 

[Pattycake25]

Again, do you not know what compounding interest is? Your 300 K debt at the end of med school will be a completely different number at the end of residency.

I stopped posting over 24 hours ago. I recognize now that I had no idea what I was talking about, like you guys said. In my defense, I was running on fumes when I made my first post, hence why I forgot really obvious things like interest and taxes, but still, I was clueless. I get it now, okay?

 

[PL198]

🙄

Ok post a reasonable budget for doing what you say one can do, and you'll get somewhere. I don't understand how some people communicate? Are you the same person that responds to posts, only using ellipses? Words are a lot easier to understand and interpret than smileys and dots.

 

[Espadaleader]

I love the ppl on the forum that keeps it real like @Psai and @DermViser. There is no way in hell primary care is an option for me. Why should I do it? I'm interested in underserved and minority comm. and I can do that in a field that pays triple without the hassles of primary care. I'm working in a primary care center now in the process of implementing process measured tied to physician reimbursement due to a ACO partial capitation repayment system. Look, you are at the mercy of MBAs and managers that tell you what to do and how to do it. All in a 15 min visit where you're trying to manage 5 different chronic diseases, social work, mental health etc. It's crazy. Outpatient primary care is a no-go. You cannot practice medicine. The time isn't there to do so. Medical schools don't even respect primary care. Don't even have depts. of family med. All I want is to pay off my debt, treat diverse and disadvantaged patients, and feed my family. If I can do that making 3x the salary of a primary care doc I'm gonna do it.

 

[DermViser]

I love the ppl on the forum that keeps it real like @Psai and @DermViser. There is no way in hell primary care is an option for me. Why should I do it? I'm interested in underserved and minority comm. and I can do that in a field that pays triple without the hassles of primary care. I'm working in a primary care center now in the process of implementing process measured tied to physician reimbursement due to a ACO partial capitation repayment system. Look, you are at the mercy of MBAs and managers that tell you what to do and how to do it. All in a 15 min visit where you're trying to manage 5 different chronic diseases, social work, mental health etc. It's crazy. Outpatient primary care is a no-go. You cannot practice medicine. The time isn't there to do so. Medical schools don't even respect primary care. Don't even have depts. of family med. All I want is to pay off my debt, treat diverse and disadvantaged patients, and feed my family. If I can do that making 3x the salary of a primary care doc I'm gonna do it.

That's the worst part!!! Not even the salary, but at the end of it all, even if you like primary care, you don't even get to actually practice freakin' primary care!! You have to go out of the system (direct pay/concierge which only works in certain markets) to actually practice primary care. Half the time you're calling insurance companies, filling out pre-authorizations, filling out disability forms, yada yada. Since primary care is transitioning to a "Patient Care Medical Home" model, your role will be more as administrator/leader rather than 100% individual clinician. I don't know anyone who would go thru med school + residency just to do that.

 

[ballinsncbirth]

read through this entire thread and given that im an attending decided to wiegh in
2 years out and doing emergency medicine

1. You premeds and some med students are hilarious , but i cant be mad because i felt the same way when i was in your position

MOST prople go into primary care for one of 4 reasons (not in any particular order)
1. they didnt do well on step and /or med school and couldnt get into a competetive or high paying specialty
2. They arent sure what they wanted to do/didnt like surgery or most other specialities , and defaulted to primary care
3. went into primary care so they could get into other higher paying specialities ie cards, gi , etc
4. they actually like primary care (and or wanted to help people)

of all my friends in primary care that are # 4 ALL of them hate primary care and most either wished they hadent done it ... why?
most of primary care isnt actually medicine ( this day and age) but varying degrees of one of these two practices

Private practice= fighting beuracracy , midlevels, insurance, paying for office, staff, dealing owning a business,keeping up on all the ridiculous regulations ,
hospitalist = babysitting chronic bull crap , social admits, gomers, hospital politics, being on call, etc

all of this wouldnt be so bad and is found in a varying degrees in other specialties, however the big thing missing is MONEY

now i understand that while your in college or med school the average primary care salary seems like alot (and you think all these doctors are just whiners)
beleive me i was just like you .. thought all i needed was 80 k .. wanted to help people etc... help the underserved and minorities ( i am a minority and this was what i talked about most in all my interviewed)

figured it was much more than most people live on etc...

everyone thinks they can change medicine but noone realizes how medicine changes you

after 4 years medical school and 3-4 years soul crushing residency HELPING PEOPLE means JACK SH***T , and you will end up hating all those things you though you went into medical school for..
one day on rounds you will find yourself eerily thankful that the 80 demented gomer with every medical problem in the book died overnight... because you dont have to write his 3 page note and might be able to get out in time to see you wife and kids today


its hard to explain and im sure seems shocking.... AT FIRST

but after awile "saving lives" just wont do it for you , especially since all those cool life saving diagnosis and emergent stuff you saw on greys anatomy happens rarely especially in primary care

and even when it does after awhile you stop getting that warm fuzzy feeling and its replaced with indifference or "thank god a i caught that cus i coulda had the crap sued outa me"

i tell people all the time DONT go into medicine only because you want to help people ... YOU WILL BE SORELY DISAPPOINTED
YOU WILL NOT FIND LIFE GRATIFICATION SOLEY BY BEING A DOCTOR

and when you get to that point...... after giving up your twenties... to where you finally making a paycheck the most rewarding thing you will find is how much that paycheck allows you to be AWAY from medicine

i know you think you will continue to live like a resident for a couple years.. but you wont .. not because you couldnt but because YOU WONT WANT TO

you will want the house the car the lifestyle and guess what YOU DESERVE IT !!! im not saying go by a lambo with your first check but i cant tell you you wont want to live in the same 1 bedroom apartment .. eat fast food or ramen noodles everyday.. drive a crappy car... or only go on vacation once every 5 years...

my sepcialty EM has probably the most difficult and frustrating work enviroment of any specialty .high burnout ..annoying needy patients...high liabilty ... dumps... patient satisfaction crap... etc

but i am 30 years old.. i paid off my 100K debt in 1 year by writing a 100k check to sallie mae one afternoon .. live in a nice house... get time with my family ..just brought a boat and fish and relax on the water almost every weekend

I AM HAPPY.. but not because i enjoy goin to work or my specialty per say .. but because i enjoy what going to work ALLOWS ME TO DO
primary care is a great job to have.. and if you go in with the right expectations it can be a great career

but going into primary care with 250 k in debt,sacrificing 11 years of your life... expecting medicine to make you happy.... and that money means nothing is A RECIPE FOR DISASTER

MEDICINE IS A JOB ... NOTHING MORE !!!! understand that and you will be happy to...

PS I am a admittd horrible speller..a dn didnt proofread this post as i am on ****... so forgive my spelling and grammar errors.

 

[PL198]

^^ and there you have it.

 

[oldbearprofessor]

SDN is and has always been a place where primary care is often represented in a very negative light. Such threads are important so that students and others become aware of the challenges. However, they can be overstated as well and this thread has numerous overstatements in this regard. Pediatricians generally like what they do and this includes both general pediatricians and specialists in areas such as pediatric endocrinology where the pay is similar to general pediatrics as are many of the system-related challenges in pediatric specialties. Some of this is because they like working with children and some because of the importance they place on advocacy for children as part of their career. Of course, not all pediatricians are satisfied with their job and there are frustrations with the system, but implying that pediatricians don't like what they do is not accurate. Go out and ask a few dozen if you'd like a balanced view of this. It is not true either that medicine is a job and nothing more, anymore than it is true that medicine is nothing but self-sacrifice. Both of these are extreme perspectives that are not the reality of our careers as pediatricians.

I won't convince any of the folks here who claim that every pediatrician they know hates their job, but that is what I see and have seen and I talk to a lot of pediatricians about job related issues regularly. Is debt a big issue? Sure it is, but that's been discussed over and over again on hundreds of SDN threads and approaches to it have been discussed. In any case, I hope that those who might be interested in our field and in serving the health care needs of children will spend some time talking with pediatricians, few of whom post on SDN or on threads like this, about their careers and decide for themselves!

Carry on!

 

[PL198]

SDN is and has always been a place where primary care is often represented in a very negative light. Such threads are important so that students and others become aware of the challenges. However, they can be overstated as well and this thread has numerous overstatements in this regard. Pediatricians generally like what they do and this includes both general pediatricians and specialists in areas such as pediatric endocrinology where the pay is similar to general pediatrics as are many of the system-related challenges in pediatric specialties. Some of this is because they like working with children and some because of the importance they place on advocacy for children as part of their career. Of course, not all pediatricians are satisfied with their job and there are frustrations with the system, but implying that pediatricians don't like what they do is not accurate. Go out and ask a few dozen if you'd like a balanced view of this. It is not true either that medicine is a job and nothing more, anymore than it is true that medicine is nothing but self-sacrifice. Both of these are extreme perspectives that are not the reality of our careers as pediatricians.

I won't convince any of the folks here who claim that every pediatrician they know hates their job, but that is what I see and have seen and I talk to a lot of pediatricians about job related issues regularly. Is debt a big issue? Sure it is, but that's been discussed over and over again on hundreds of SDN threads and approaches to it have been discussed. In any case, I hope that those who might be interested in our field and in serving the health care needs of children will spend some time talking with pediatricians, few of whom post on SDN or on threads like this, about their careers and decide for themselves!

Carry on!

I'm not sure how old you are, but I think there's a big difference between people going into primary care now vs attendings already in it, or even people that have been in it 10, 15 ,20 etc years. It's only going to get more unfavorable for the doc and give them more hoops to jump through, so in my opinion it's basically a negative derivative if we want to think of it like a graph.

 

[EMDO2018]

read through this entire thread and given that im an attending decided to wiegh in
2 years out and doing emergency medicine

1. You premeds and some med students are hilarious , but i cant be mad because i felt the same way when i was in your position

MOST prople go into primary care for one of 4 reasons (not in any particular order)
1. they didnt do well on step and /or med school and couldnt get into a competetive or high paying specialty
2. They arent sure what they wanted to do/didnt like surgery or most other specialities , and defaulted to primary care
3. went into primary care so they could get into other higher paying specialities ie cards, gi , etc
4. they actually like primary care (and or wanted to help people)

of all my friends in primary care that are # 4 ALL of them hate primary care and most either wished they hadent done it ... why?
most of primary care isnt actually medicine ( this day and age) but varying degrees of one of these two practices

Private practice= fighting beuracracy , midlevels, insurance, paying for office, staff, dealing owning a business,keeping up on all the ridiculous regulations ,
hospitalist = babysitting chronic bull crap , social admits, gomers, hospital politics, being on call, etc

all of this wouldnt be so bad and is found in a varying degrees in other specialties, however the big thing missing is MONEY

now i understand that while your in college or med school the average primary care salary seems like alot (and you think all these doctors are just whiners)
beleive me i was just like you .. thought all i needed was 80 k .. wanted to help people etc... help the underserved and minorities ( i am a minority and this was what i talked about most in all my interviewed)

figured it was much more than most people live on etc...

everyone thinks they can change medicine but noone realizes how medicine changes you

after 4 years medical school and 3-4 years soul crushing residency HELPING PEOPLE means JACK SH***T , and you will end up hating all those things you though you went into medical school for..
one day on rounds you will find yourself eerily thankful that the 80 demented gomer with every medical problem in the book died overnight... because you dont have to write his 3 page note and might be able to get out in time to see you wife and kids today


its hard to explain and im sure seems shocking.... AT FIRST

but after awile "saving lives" just wont do it for you , especially since all those cool life saving diagnosis and emergent stuff you saw on greys anatomy happens rarely especially in primary care

and even when it does after awhile you stop getting that warm fuzzy feeling and its replaced with indifference or "thank god a i caught that cus i coulda had the crap sued outa me"

i tell people all the time DONT go into medicine only because you want to help people ... YOU WILL BE SORELY DISAPPOINTED
YOU WILL NOT FIND LIFE GRATIFICATION SOLEY BY BEING A DOCTOR

and when you get to that point...... after giving up your twenties... to where you finally making a paycheck the most rewarding thing you will find is how much that paycheck allows you to be AWAY from medicine

i know you think you will continue to live like a resident for a couple years.. but you wont .. not because you couldnt but because YOU WONT WANT TO

you will want the house the car the lifestyle and guess what YOU DESERVE IT !!! im not saying go by a lambo with your first check but i cant tell you you wont want to live in the same 1 bedroom apartment .. eat fast food or ramen noodles everyday.. drive a crappy car... or only go on vacation once every 5 years...

my sepcialty EM has probably the most difficult and frustrating work enviroment of any specialty .high burnout ..annoying needy patients...high liabilty ... dumps... patient satisfaction crap... etc

but i am 30 years old.. i paid off my 100K debt in 1 year by writing a 100k check to sallie mae one afternoon .. live in a nice house... get time with my family ..just brought a boat and fish and relax on the water almost every weekend

I AM HAPPY.. but not because i enjoy goin to work or my specialty per say .. but because i enjoy what going to work ALLOWS ME TO DO
primary care is a great job to have.. and if you go in with the right expectations it can be a great career

but going into primary care with 250 k in debt,sacrificing 11 years of your life... expecting medicine to make you happy.... and that money means nothing is A RECIPE FOR DISASTER

MEDICINE IS A JOB ... NOTHING MORE !!!! understand that and you will be happy to...

PS I am a admittd horrible speller..a dn didnt proofread this post as i am on ****... so forgive my spelling and grammar errors.

Its hard to take you seriously as an attending when you spell as if you are in 5th grade.

 

[oldbearprofessor]

I am older than dirt and graduated medical school so many years ago that I even had a black doctor's bag, but that doesn't invalidate what I wrote. I understand you don't agree with me, my point wasn't to change your opinion, but to speak to those with an interest in pediatrics and suggest they speak to pediatricians about the field, both young and old about what they like and don't like about the field rather than assume that SDN's allo forum has all the career info they need to reject the field.

 

[PL198]

I am older than dirt and graduated medical school so many years ago that I even had a black doctor's bag, but that doesn't invalidate what I wrote. I understand you don't agree with me, my point wasn't to change your opinion, but to speak to those with an interest in pediatrics and suggest they speak to pediatricians about the field, both young and old about what they like and don't like about the field rather than assume that SDN's allo forum has all the career info they need to reject the field.

Right but what I'm saying is, you saying peds is cool is great but you're not going to have to jump through the hoops they will in 20 years. You have to forecast how the field is changing, rather than it's current state.

 

[Mad Jack]

What makes me so sad about this is that in 10 years, when I finally come back to this thread, none of the original payers will still be here for the "I told you so."

 

[Nidor]

.

 

[DermViser]

I am older than dirt and graduated medical school so many years ago that I even had a black doctor's bag, but that doesn't invalidate what I wrote. I understand you don't agree with me, my point wasn't to change your opinion, but to speak to those with an interest in pediatrics and suggest they speak to pediatricians about the field, both young and old about what they like and don't like about the field rather than assume that SDN's allo forum has all the career info they need to reject the field.

Actually it does. You have no where even close to the debt that our generation has. If one wishes to do Peds there are a LOT less hoops to jump thru as an NP or PA in Peds.

 

[DermViser]

Just like every generation has complained about the previous since the ancient greek (http://www.goodreads.com/quotes/63219-our-youth-now-love-luxury-they-have-bad-manners-contempt) perhaps it is in our nature to assume we medical students will have it way worse then those before us? We'll have our challenges when we go into Medicine, but I find it naive to assume everything is going to change for the worst. Nobody can predict how our field will change in the years to come.

If you love Dermatology or another more competitive field go for it, but don't do it for a cushy life style. Don't throw away what you're passionate about out of pragmatism. I've done several jobs that I hated and loved at times (call center employee, factory line worker, waiter, etc) allot of your job satisfaction and quality of life depends on your attitude towards what you do and the team you work with.

The problem is what people are passionate about in primary care doesn't exist in the fields they're interested in. It's been taken away by the govt.

 

[Psai]

What makes me so sad about this is that in 10 years, when I finally come back to this thread, none of the original payers will still be here for the "I told you so."

I'm going to be here in ten years bumping this thread out of spite a la jalby

 

[oldbearprofessor]

Actually it does. You have no where even close to the debt that our generation has. If one wishes to do Peds there are a LOT less hoops to jump thru as an NP or PA in Peds.

I have found in my career that it is helpful to gain advice from people of a variety of ages and experiences. Some of us might not have the debt but might have spent time advising and providing career counseling to others with debt and just might have some knowledge of the issue, albeit not as much as you believe you do. I encourage young people to do the same and talk to a range of actual pediatricians and pedi residents about pediatrics if they have an interest in it. I also encourage them to speak to and seek guidance from both young and old pediatricians and see how they perceive the issue of NPs and PAs.

 

[oldbearprofessor]

Right but what I'm saying is, you saying peds is cool is great but you're not going to have to jump through the hoops they will in 20 years. You have to forecast how the field is changing, rather than it's current state.

Well, it's good to know that prophecy is not gone from the Earth. I'm actually thinking I might just still be practicing medicine in 20 years, but who knows? I'm not a prophet. I would be willing to bet that if medical students took my advice and spoke to pediatricians, young and old and in training about the field, some of them might have some ability to provide insightful (but imperfect, as we are not prophets) thoughts on the topic. This is what I'm suggesting. Nowhere did I say that "peds is cool", I said that people interested in it should talk to actual people in the field in real life about it, not take the advice on SDN about it, especially mine.

By the way, there are a lot of positive changes going on in our field right now. Things like the pediatric medical home, hospice care for children, etc. I know this won't meet your approval, but there is much to actually be positive about in how pediatrics is changing. Certainly there are negatives as with anything, but my limited view does not see it overall as a horrible downward slope. But, YMMV and as I've said in every post, folks should talk to a range of pediatricians to get their perspective.

 

[DermViser]

I have found in my career that it is helpful to gain advice from people of a variety of ages and experiences. Some of us might not have the debt but might have spent time advising and providing career counseling to others with debt and just might have some knowledge of the issue, albeit not as much as you believe you do. I encourage young people to do the same and talk to a range of actual pediatricians and pedi residents about pediatrics if they have an interest in it. I also encourage them to speak to and seek guidance from both young and old pediatricians and see how they perceive the issue of NPs and PAs.

With all due respect, since you do not have anywhere near the level of debt students now have, your opinions on the ability to pay off that debt, don't mean a hill of beans. Pediatric residents themselves don't know jack squat as they're just trying to get thru their rigorous training and move on with their lives and are playing the game of forbearance on their loans. The unadulterated truth is that if one is pursuing General Pediatrics, there's a lot simpler way to get there with a much higher ROI, either through Pediatric NP: http://www.nursing.vanderbilt.edu/msn/pednp.html, or thru PA school, without expensive MOC.

Is there really that much of a difference between the MD and NP pathway when at the end, either way you get to do this?

 

[DermViser]

Well, it's good to know that prophecy is not gone from the Earth. I'm actually thinking I might just still be practicing medicine in 20 years, but who knows? I'm not a prophet. I would be willing to bet that if medical students took my advice and spoke to pediatricians, young and old and in training about the field, some of them might have some ability to provide insightful (but imperfect, as we are not prophets) thoughts on the topic. This is what I'm suggesting. Nowhere did I say that "peds is cool", I said that people interested in it should talk to actual people in the field in real life about it, not take the advice on SDN about it, especially mine.

By the way, there are a lot of positive changes going on in our field right now. Things like the pediatric medical home, hospice care for children, etc. I know this won't meet your approval, but there is much to actually be positive about in how pediatrics is changing. Certainly there are negatives as with anything, but my limited view does not see it overall as a horrible downward slope. But, YMMV and as I've said in every post, folks should talk to a range of pediatricians to get their perspective.

I can not believe that you think that the PCMH is actually a good thing for Pediatrics. Don't you get it? People who graduate from medical school and residency want to practice their craft seeing patients (shocking, I know). They don't want to be the administrator/leader over a bunch of PAs and NPs and just get the cases that allow the physician to work at the "top of their license". Instead of making primary care better, you're actively destroying it.

 

[oldbearprofessor]

I can not believe that you think that the PCMH is actually a good thing for Pediatrics. Don't you get it? People who graduate from medical school and residency want to practice their craft seeing patients (shocking, I know). They don't want to be the administrator/leader over a bunch of PAs and NPs and just get the cases that allow the physician to work at the "top of their license". Instead of making primary care better, you're actively destroying it.

Is it possible to disagree with me minus this level of personal vitriol? It makes discussion of the topic impossible. Yes, although you can't believe it, I like the AAP itself strongly support the concept of the pediatric medical home. I'm sorry you don't agree, but as I've said in every single post of mine in this thread, people should ignore my on-line opinion and talk to real live pediatricians about what they think.

 

[DermViser]

Is it possible to disagree with me minus this level of personal vitriol? It makes discussion of the topic impossible. Yes, although you can't believe it, I like the AAP itself strongly support the concept of the pediatric medical home. I'm sorry you don't agree, but as I've said in every single post of mine in this thread, people should ignore my on-line opinion and talk to real live pediatricians about what they think.

I'm not referring to you, personally @oldbearprofessor, but the Pediatric establishment. The AAFP and ACP have also followed the same modus operandi, showing again and again, how far they are in their official press release stance from their actual members who work in the trenches full-time. Just like the AAP, ACP, and AAFP gave their full-throated support for Obamacare, even though many of their actual members are against it. I'll make a guess, you actually support Obamacare. Is that correct?

The PCMH is nothing more but serving as a gatekeeper (from patients getting to see their specialists), just like HMO's in the 1990s, and has never been shown to reduce costs.

 

[Porfirio]

I once had a conversation with a FM physician about the medical school debt to income issue. I found it rather funny; he said medical school was $18,000 for all 4 years. Granted, he came out of residency to make around $18,000 to $20,000 a year. I did not want to mention to him that he now makes over $200,000 a year. My medical school debt will be around $170,000 (without interest).

Can I expect to make 10 times my first year attending salary when I am 60 (if not before then)? If so, that will be about $1,800,000 to $2,500,000 (if not more) a year.

 

[DermViser]

I once had a conversation with a FM physician about the medical school debt to income issue. I found it rather funny; he said medical school was $18,000 for all 4 years. Granted, he came out of residency to make around $18,000 to $20,000 a year. I did not want to mention to him that he now makes over $200,000 a year. My medical school debt will be around $170,000 (without interest).

Can I expect to make 10 times my first year attending salary when I am 60 (if not before then)? If so, that will be about $1,800,000 to $2,500,000 (if not more) a year.

😆😆 Hence why talking to old primary care physicians in the field now is not smart.

 

[Nidor]

.

 

[DermViser]

So, just to reiterate, no listening to practicing physicians or residents, med students know best?

You are 100% free to listen to the much older physician who graduated in 1965, when Medicare was overflowing in money with a ridiculously low level of debt about which specialty you should enter. Just don't get mad when the Pediatric NP gets to do the same job as you do in less time and less hassle.

 

[Espadaleader]

Pediatrics is not all of primary care.

http://www.nejm.org/doi/full/10.1056/NEJMp1310778

 

[Slaol]

I once had a conversation with a FM physician about the medical school debt to income issue. I found it rather funny; he said medical school was $18,000 for all 4 years. Granted, he came out of residency to make around $18,000 to $20,000 a year. I did not want to mention to him that he now makes over $200,000 a year. My medical school debt will be around $170,000 (without interest).

Can I expect to make 10 times my first year attending salary when I am 60 (if not before then)? If so, that will be about $1,800,000 to $2,500,000 (if not more) a year.

There are plenty of opportunities in primary care to pay off your debt quickly. I have almost $500k in debt (undergrad + medical school + wife's school debt). I just signed a contract with an outpatient Family Medicine clinic in rural Texas that is paying $350k for the first two years, then gradually drop down to $250k over the next three - plus production bonus + Texas loan repayment of $40k per year.

The money is there if you don't mind going where there is a need. Once you are debt free, you can go anywhere you want.

 

[DermViser]

Pediatrics is not all of primary care.

http://www.nejm.org/doi/full/10.1056/NEJMp1310778

Who said it was? It was an example I used as the person I was responding to was a pediatrician. Your article on this issue proves my point.

 

[DermViser]

There are plenty of opportunities in primary care to pay off your debt quickly. I have almost $500k in debt (undergrad + medical school + wife's school debt). I just signed a contract with an outpatient Family Medicine clinic in rural Texas that is paying $350k for the first two years, then gradually drop down to $250k over the next three - plus production bonus + Texas loan repayment of $40k per year.

The money is there if you don't mind going where there is a need. Once you are debt free, you can go anywhere you want.

The issue isn't really paying off your debt. You have no choice. It's the level of heartache, money, blood, sweat, and tears, as well as continuing MOC to get to that point. There are MUCH easier ways to get to that same point.

 

[Slaol]

The issue isn't really paying off your debt. You have no choice. It's the level of heartache, money, blood, sweat, and tears, as well as continuing MOC to get to that point. There are MUCH easier ways to get to that same point.

Ah, point taken. I do agree. Looking back, I would probably not do this (med school and now residency) again if I had to.

 

[DermViser]

Ah, point taken. I do agree. Looking back, I would probably not do this (med school and now residency) again if I had to.

Which is why I'm saying that if you are interested in something like Gen Peds, FM, Gen IM, Geriatrics, etc. you can go through a much easier route thru the NP or PA path (heck they can even bounce between specialty medicine as well) with a much better ROI in terms of time, money, and lifestyle. I can't understand why that's so difficult for people to understand.

 

[deleted480308]

Which is why I'm saying that if you are interested in something like Gen Peds, FM, Gen IM, Geriatrics, etc. you can go through a much easier route thru the NP or PA path (heck they can even bounce between specialty medicine as well) with a much better ROI in terms of time, money, and lifestyle. I can't understand why that's so difficult for people to understand.

yeah, if I was an 18yr old freshmen and I wanted to do rural family care...I'd be aiming NP/PA. I didn't see how much chewing away they had done at the family docs when I was running through prereqs. Now I'm aiming EM or surgery

 

[DermViser]

yeah, if I was an 18yr old freshmen and I wanted to do rural family care...I'd be aiming NP/PA. I didn't see how much chewing away they had done at the family docs when I was running through prereqs. Now I'm aiming EM or surgery

That's the problem. Most haven't. The physician track is no longer the only track to be able to practice medicine and with Obamacare that monopoly will definitely cease to exist.

 

[sazerac]

So, just to reiterate, no listening to practicing physicians or residents, med students know best?

To explore the issues related to exponential student debt without a matching income, it would probably be best to speak with a lawyer friend three to five years out of law school.

If you want to talk about the changing face of the practice of primary care, then speak to old and young attendings.

 

[deleted480308]

That's the problem. Most haven't. The physician track is no longer the only track to be able to practice medicine and with Obamacare that monopoly will definitely cease to exist.

the oregon law that doctors weren't allowed to be paid more than NPs was the nail in the coffin for me

 

[Slaol]

the oregon law that doctors weren't allowed to be paid more than NPs was the nail in the coffin for me

In Minnesota, where I am doing residency, they have independently licensed Nurses who can prescribe without MD oversight.

 

[DermViser]

the oregon law that doctors weren't allowed to be paid more than NPs was the nail in the coffin for me

Well, more accurately in Oregon is that NPs could not be reimbursed less for the same services as physicians.

 

[Espadaleader]

Who said it was? It was an example I used as the person I was responding to was a pediatrician. Your article on this issue proves my point.

I'm on your side man, this was directed at the older gentleman.

 

[Espadaleader]

There are plenty of opportunities in primary care to pay off your debt quickly. I have almost $500k in debt (undergrad + medical school + wife's school debt). I just signed a contract with an outpatient Family Medicine clinic in rural Texas that is paying $350k for the first two years, then gradually drop down to $250k over the next three - plus production bonus + Texas loan repayment of $40k per year.

The money is there if you don't mind going where there is a need. Once you are debt free, you can go anywhere you want.

Why should I have to do this to work in primary care when I could do the same thing in a place I want to be in.

 

[oldbearprofessor]

I'm on your side man, this was directed at the older gentleman.

"older gentleman". I like it!!

I'm aware that not all or even most of primary care is pediatrics, however, I always discuss my field when involved in this type of discussion, because it it what I know best and I do not wish to generalize about other fields. I would encourage IM attendings (young and old), and FM attendings, etc to speak about their fields in these threads.

 

[DermViser]

"older gentleman". I like it!!

I'm aware that not all or even most of primary care is pediatrics, however, I always discuss my field when involved in this type of discussion, because it it what I know best and I do not wish to generalize about other fields. I would encourage IM attendings (young and old), and FM attendings, etc to speak about their fields in these threads.

My point was that I can't believe you are falling for the PCMH hype when it is no different than HMOs in the 1990s which were an utter failure - as patients rebelled against these practice structures (and rightfully so). On top of that, PCMH has never been proven to reduce costs. I can't believe you think that Pediatric residents would want to practice in a PCMH type of setting.

You are an MIT grad, so I know you're smart. (no putdown there, it's a compliment).

 

[deleted480308]

Well, more accurately in Oregon is that NPs could not be reimbursed less for the same services as physicians.

that's all semantics to me.....an insurance company not being allowed to recognize my exam produces more educated diagnosis than a nurse is insane.

The libertarian in me is ok with the concept of nurses competing as long as they have to label themselves as nurses and not use the misleading "doctor" from their watered down degree. What's not ok with me at all is the concept that I can't go to an insurance company and convince them my exam/diagnosis is more valuable and get paid more than a nurse. I'm not allowed to say, I'll save you money in needless testing because I actually know what I'm doing and can diagnose at a higher level of skill...and then get paid according to my skill. I'm cool if the insurance company just doesn't buy my argument as long we handle that conversation between us. But the idea that the government steps in and says the insurance company isn't allowed to agree with me drives me nuts. It's akin to oregon saying that the michelin star restaurant isn't allowed to charge more for a hamburger than the mcdonalds because....you know...."them's all burgers anyways"