Would you take your dream job for less salary?

[Mass Effect]

I was recently offered an incredible job in a town I really want to live in. The catch? The salary is very low. It's an academic position and I will get a patient population I like. A lot of my time will be protected for a specific area of research I'm interested in and for resident education which I also like. Basically they'll let me do what I want in terms of clinic and very little of my time will be spent in clinic anyway. But the tradeoff is the salary. It pays in the 210K neighborhood. I used to be of the mindset that if you enjoy your job, money isn't important. But now that I've made more than that, I think that's BS.

Would you take a pay cut for a job you know you'd really like in a town you've been wanting to move to for a while?

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[WisNeuro]

Depends on the level of paycut. Probably also what your spouse does. I'd accept maybe a 25% paycut if a job was pretty much everything I enjoyed with minimal BS. But, I also have a physician spouse and between passive and active income, we have a good amount of money left over after maxing out retirement accounts as is.

 

[wolfvgang22]

Yes, absolutely. I have already done so, and nearly done so again last year. Money cannot cure burn out.

 

[Bartelby]

If you are really passionate about research and they will give significant protected time it seems likely worth the trade-off, it would be unusual for a job to pay you for research as if you were running a busy clinic. Of course that depends on your overall financial picture and goals. For me if I could still make a comfortable living I would consider it, especially if you can supplement with a side PP or other options.

 

[robellis]

I was recently offered an incredible job in a town I really want to live in. The catch? The salary is very low. It's an academic position and I will get a patient population I like. A lot of my time will be protected for a specific area of research I'm interested in and for resident education which I also like. Basically they'll let me do what I want in terms of clinic and very little of my time will be spent in clinic anyway. But the tradeoff is the salary. It pays in the 210K neighborhood. I used to be of the mindset that if you enjoy your job, money isn't important. But now that I've made more than that, I think that's BS.

Would you take a pay cut for a job you know you'd really like in a town you've been wanting to move to for a while?

Not a chance..there are nurses making more than that

 

[TexasPhysician]

That’s a pretty typical academic salary in my experience. Usually benefits are pretty good though. If you are good with the bureaucracy and the role, go for it. Enjoying your work is a very important aspect of life.

 

[dl2dp2]

^^ $210 sounds pretty good for academic lol.

edit: I just took a double-take. If your clinical FTE is <50% 210k is actually quite difficult to get. It's now very difficult to get this at top 10 institutions to get hard-money 50% protected research time. Essentially the expectation is external funding buy-out. If you want a career in research this type of job is ideal.

 

[psychacad]

210k is very good for an academic job with so much freedom and minimal clinic time. Of course only you evaluate your life circumstances, but I would definitely consider that over a higher paying job that is not fulfilling.

Anything 200+ is really attending level. Don't think one needs more than that for a decent life even in big metro places. Location/hours/fulfillment/quality of care/people I'm working with, are all factors that I weigh more heavily than $, as long as you cross that attending level threshold.

 

[Yoyomama88]

210k is very good for an academic job with so much freedom and minimal clinic time. Of course only you evaluate your life circumstances, but I would definitely consider that over a higher paying job that is not fulfilling.

Anything 200+ is really attending level. Don't think one needs more than that for a decent life even in big metro places. Location/hours/fulfillment/quality of care/people I'm working with, are all factors that I weigh more heavily than $, as long as you cross that attending level threshold.

I agree 210 for An academic job with protected research time is very nice. You can easily take a full time job with zero research that sucks but pays 250 or 300k and I would say the difference would not be worht it

 

[Sushirolls]

I have opened my own practice. Went from 300K down to 10k last year, and likely 70K this year.

Won't go back. Done with the Big Box Shops.

I had an opportunity to be an IP med director at a for profit hospital for notably more than 300K. Notably more. But passed on that.

Priceless being your own boss and not dealing with Suits and Big Box shops.

 

[ERK123]

I am a first year resident. I hope I never get to the mindset where I wouldn’t take that kind of job.

 

[Ironspy]

I would as long as the cost of living was reasonable. 210 affords a good lifestyle in most places.

I just took an academic job for <200k with excellent benefits and great work life balance. Partner is a professional, we have no loans and are in a medium cost of living area. We live well, have everything we want, sending kids to private school this year despite good public schools, maxing out retirement accounts etc. on track to be able to retire early but don’t think I’d want to. We are not interested in fancy cars, clothes or luxury vacations though we could afford some of these things if we wanted

 

[robellis]

I have opened my own practice. Went from 300K down to 10k last year, and likely 70K this year.

Won't go back. Done with the Big Box Shops.

I had an opportunity to be an IP med director at a for profit hospital for notably more than 300K. Notably more. But passed on that.

Priceless being your own boss and not dealing with Suits and Big Box shops.

I don’t want to be rude but if you’re making 10k and 70k per year in private practice..you should probably go back to being employed

 

[TexasPhysician]

I plan to “semi-retire” in 9 years, and then I’ll take whatever/whenever fancies me.

 

[kopftonmd]

Is there a noncompete? (I assume there is since it's an academic gig). If not, though, doing something else on the side plus that would seem like the best of both worlds.

 

[Sushirolls]

I don’t want to be rude but if you’re making 10k and 70k per year in private practice..you should probably go back to being employed

Your assessment isn't rude, but merely takes into account money only as the variable. There are other variables.

I'd quit before I go back to working for Big Box Shops. Never again. So I either go be a [insert a dream here] or I keep doing what I'm doing that is growing at a pace I'm comfortable with, and quality patients, and 100% on my terms. So again, Priceless. Burn out thwarted. Big Box shops can keep their burn out recipe. I'm baking a different kind of pie.

 

[Mass Effect]

Thanks for the advice. This has been helpful.

To answer some of the questions:
Spouse will be working virtually going forward likely part-time due to child care. Has been this way since March and company says it's feasible for long-term.

No non-compete and two of the other faculty I spoke to both have private practices on the side. I just don't know if that's my thing. I've never been business-minded and don't know the first thing about it.

It's a HCOL area but we'll be ok financially I think. No non-compete.

 

[futureapppsy2]

I was recently offered an incredible job in a town I really want to live in. The catch? The salary is very low. It's an academic position and I will get a patient population I like. A lot of my time will be protected for a specific area of research I'm interested in and for resident education which I also like. Basically they'll let me do what I want in terms of clinic and very little of my time will be spent in clinic anyway. But the tradeoff is the salary. It pays in the 210K neighborhood. I used to be of the mindset that if you enjoy your job, money isn't important. But now that I've made more than that, I think that's BS.

Would you take a pay cut for a job you know you'd really like in a town you've been wanting to move to for a while?

What FTE is "a lot of your time"? Are they providing start-up funds for research costs?

 

[MacDonaldTriad]

If you can live reasonably comfortably doing something you like, go for it. Life is full of decisions.
Would you like to drive the BMW and hate your job, or drive a Hyundai and not hate going to work?

 

[thepoopologist]

If there's an easy out its worth a shot.

 

[SourceOfDenial]

Short answer yes, but salary has never been a deciding factor for me.

Im in the same salary range protected 75% for research and feel thankful for it. Big question is how long will you be protected before securing own funding, and how protected is protected.

If your clinical role is outpatient you are kind of always on, so those hours do bleed over to every other day of the week. Hindsight says inpatient blocks are easiest for me with research work.

 

[dl2dp2]

Im in the same salary range protected 75% for research and feel thankful for it. Big question is how long will you be protected before securing own funding, and how protected is protected.

If your clinical role is outpatient you are kind of always on, so those hours do bleed over to every other day of the week. Hindsight says inpatient blocks are easiest for me with research work.

People rarely get fired. If you run out of funding or if they identify a more promising candidate they'll just put you in a full-time clinical role. Nevertheless, especially at a place that's not too competitive (think outside of the top 10-20 programs), you can probably cruise for a long time without getting a grant, if the department is interested in building a research program without being able to recruit senior researchers.

The bigger issue is really that grant reviewers expect a type of productivity that might be difficult to achieve depending on where you are, how much you work, etc... so you can be stuck in a death spiral trying to put on a one-man show without a startup. But that's a separate topic.

 

[zolof]

I think it depends on your financial situation, but having a long term job that you truly enjoy and have autonomy is priceless. even if you run into an NP making similar or more, I am sure they are working double the hours or seeing tons of pts and in a crappy environment.

 

[finalpsychyear]

I plan to “semi-retire” in 9 years, and then I’ll take whatever/whenever fancies me.

Jumping on this boat. I always plan to work 1- 2 days telepsych/va 9 years from now even at that point. However, if one got lucky in the stock market and finds themselves at 40-50x their fire number instead of the basic 25x then that may get tricky in terms of liability and other risks going forward.

 

[SourceOfDenial]

People rarely get fired. If you run out of funding or if they identify a more promising candidate they'll just put you in a full-time clinical role. Nevertheless, especially at a place that's not too competitive (think outside of the top 10-20 programs), you can probably cruise for a long time without getting a grant, if the department is interested in building a research program without being able to recruit senior researchers.

The bigger issue is really that grant reviewers expect a type of productivity that might be difficult to achieve depending on where you are, how much you work, etc... so you can be stuck in a death spiral trying to put on a one-man show without a startup. But that's a separate topic.

Thank you for explaining my job to me.

 

[brycew85]

Money is just one aspect to a job - albeit an important one. It really depends on how much weight you put on money vs enjoying your day-to-day work vs location vs lifestyle, etc

When programs rank applicants they give a certain weight to grades, board scores, LORs, extracirriculars, etc. Same thing here

 

[WisNeuro]

I imagine part of it comes down to having "enough" money, wherever you set that subjective mark. I'm sure others have too, but I have had positions I have hated, and positions I liked. Even if those hated positions paid much more, my quality of life was so much lower than when I was in grad school, despite making nearly 10X my grad stipend. So, for me, it would come down to not wanting to hate living 4-5 days of the week to earn more money than I need.

 

[finalpsychyear]

I imagine part of it comes down to having "enough" money, wherever you set that subjective mark. I'm sure others have too, but I have had positions I have hated, and positions I liked. Even if those hated positions paid much more, my quality of life was so much lower than when I was in grad school, despite making nearly 10X my grad stipend. So, for me, it would come down to not wanting to hate living 4-5 days of the week to earn more money than I need.

I guess the issue is more when you haven't reached that "enough" number do you stay more time in a job less ideal but will get you there sooner. Academia paying 200k vs 9-5 plus side gig could easily get you close to at least 50% more than that salary. If invested properly that could get your working career in half or reach your number in half the time.

 

[ArdorAyurveda]

My dream job commands a high salary

 

[Mass Effect]

I guess the issue is more when you haven't reached that "enough" number do you stay more time in a job less ideal but will get you there sooner. Academia paying 200k vs 9-5 plus side gig could easily get you close to at least 50% more than that salary. If invested properly that could get your working career in half or reach your number in half the time.

The problem I see with this way of thinking is you take a job you hate and you waste half your life being miserable just to live it up in retirement? Life is short. Sure you can deal with the unhappiness now for the happiness tomorrow, but then what when you die before then?

 

[robellis]

The problem I see with this way of thinking is you take a job you hate and you waste half your life being miserable just to live it up in retirement? Life is short. Sure you can deal with the unhappiness now for the happiness tomorrow, but then what when you die before then?

Then you’re dead so you don’t reflect on your mistake

 

[Mass Effect]

Then you’re dead so you don’t reflect on your mistake

That's one way of looking at it. Let's change the question. What if you're disabled before you can enjoy your wealth? I'm more of a save for the future, but also live in the moment person.

 

[finalpsychyear]

That's one way of looking at it. Let's change the question. What if you're disabled before you can enjoy your wealth? I'm more of a save for the future, but also live in the moment person.

For sure. i agree with you. I was hard core saving (nearly 60% gross) for the last 4 years and it put it in perspective about enjoying the NOW but maybe my experience was more based about live like a resident lifestyle as my job is very relaxed. I agree that aside from maybe hating your job because your working like 60 hours is one thing but being in a very malignant environment i don't think anyone should do that simply due to plentiful opportunities.

I do wish more people did the 3-5 years live like a resident thing. Knocking out debt early on is one of the big benefits.

 

[sloh]

The problem I see with this way of thinking is you take a job you hate and you waste half your life being miserable just to live it up in retirement? Life is short. Sure you can deal with the unhappiness now for the happiness tomorrow, but then what when you die before then?

This also depends on how much you work. Some people will gladly work 20 hrs/week at a job they hate if pay is very lucrative. Leaves plenty of time for other hobbies, interests, passions—that are not polluted by any financial incentive (do it for the pure intrinsic joy/interest)

 

[deleted1012620]

I'm still a resident and single w/o kids, so maybe my perspective is skewed, but can the attendings give me some perspective?

When I run numbers online for a 230k salary, I get something like 12-14k per month take home depending on state.

If you're saving 4k a month for retirement, you're living on 8k a month at minimum. Seems you'll likely have more than 8k due to 401k match and tax benefits of contributing to 401k.

Are people out there finding it hard to buy everything they want and then some with 8k a month?

 

[finalpsychyear]

I'm still a resident and single w/o kids, so maybe my perspective is skewed, but can the attendings give me some perspective?

When I run numbers online for a 230k salary, I get something like 12-14k per month take home depending on state.

If you're saving 4k a month for retirement, you're living on 8k a month at minimum. Seems you'll likely have more than 8k due to 401k match and tax benefits of contributing to 401k.

Are people out there finding it hard to buy everything they want and then some with 8k a month?

Your question is very relative and most importantly one would need to know where you are planning to rent/buy... texas vs cali for example that money will go a long ways or much less so.

Also, most have loans maybe you are lucky or have minimal but payments on avg are 1000-2k so that effects things.

For example, i am in the midwest i was paying 1100 rent in east coast for 900 sq feet now live in midwest paying 1600 for 2000 sq ft. I kept an expense budget of what my take home pay per month in residency was per month about 3k and started there as an attending as i always saved even then. Slowly grew into my salary by increasing my monthly budget 1k per attending year worked. This allowed me to save a ton and with the market crashing able to invest at one of the best times ever.

This was the best thing i did and if you follow something similar and save and invest you may be looking at being able to FIRE in half the time otherwise.

 

[Mass Effect]

I'm still a resident and single w/o kids, so maybe my perspective is skewed, but can the attendings give me some perspective?

When I run numbers online for a 230k salary, I get something like 12-14k per month take home depending on state.

If you're saving 4k a month for retirement, you're living on 8k a month at minimum. Seems you'll likely have more than 8k due to 401k match and tax benefits of contributing to 401k.

Are people out there finding it hard to buy everything they want and then some with 8k a month?

You are correct that yes you can buy everything a normal person would want with that much money and 99% of the country does just fine with less. But there's also nothing wrong with wanting more than the average person would want.

Say the job is in NYC, Boston, LA, or San Fran. In HCOL areas, you're going to be doubling or tripling the cost of housing. The same house that's 300K in Peoria would be upwards of 800K - 1 million in those cities. Add on property tax. Add on state income tax in addition to the federal tax. Now do you need the 800K house? No of course you don't. But there's also nothing wrong with wanting it and if you want it then it makes sense to take a job that allows you to purchase it. This is also not taking into account insane student loans and other expenses.

 

[thepoopologist]

I'm still a resident and single w/o kids, so maybe my perspective is skewed, but can the attendings give me some perspective?

When I run numbers online for a 230k salary, I get something like 12-14k per month take home depending on state.

If you're saving 4k a month for retirement, you're living on 8k a month at minimum. Seems you'll likely have more than 8k due to 401k match and tax benefits of contributing to 401k.

Are people out there finding it hard to buy everything they want and then some with 8k a month?

It's about your market value and cost of living in the area you're in. If you're getting 230k a year seeing 15 patients a day while everyone else is getting 300k a year seeing 8 patients a day then you'll still be able to go home and live fine on 8k a month, but you leave a lot of money on the table by being "fine" with a certain salary.

The most important thing money buys is time, so that you can retire at 50 instead of 65, or choose to work past retirement age instead of it being an obligation. Every dollar saved in your retirement now is an extra dollar keeping pace with or outpacing inflation when you get older. So yeah, 4k/month saved is great but 7k/month is better. You can still choose to live like a monk on the higher salary, no ones stopping you.

 

[psychacad]

I'm still a resident and single w/o kids, so maybe my perspective is skewed, but can the attendings give me some perspective?

When I run numbers online for a 230k salary, I get something like 12-14k per month take home depending on state.

If you're saving 4k a month for retirement, you're living on 8k a month at minimum. Seems you'll likely have more than 8k due to 401k match and tax benefits of contributing to 401k.

Are people out there finding it hard to buy everything they want and then some with 8k a month?

There's nothing wrong with your calculation. You can live a very comfortable middle class life, even dare I say, upper middle class life on 180k+ even in the most expensive locations in this country. It does get a bit more complicated with family but then for the majority that salary should go up by quite a bit. That's why, certainly in my book, liking what you do, freedom..etc are more important once you break a certain level of $. You can't make that up with whatever sum of money.

 

[deleted1012620]

Appreciate the input.

I'm not against getting paid. I'm 100% on board with lobbying efforts to protect our livelihood.

I'm just trying to figure out whether it will be worth it to work hard to get above average income. More and more I'm leaning towards taking the cushiest job that pays >200k, as I don't figure the marginal dollars will improve my happiness.

Obviously, I'd love to figure out how to make 400k with a nice schedule but it seems like that involves some hustle up front and risk taking.

 

[hebel]

I'm still a resident and single w/o kids, so maybe my perspective is skewed, but can the attendings give me some perspective?

When I run numbers online for a 230k salary, I get something like 12-14k per month take home depending on state.

If you're saving 4k a month for retirement, you're living on 8k a month at minimum. Seems you'll likely have more than 8k due to 401k match and tax benefits of contributing to 401k.

Are people out there finding it hard to buy everything they want and then some with 8k a month?

I've been an attending for about 6 months, and have been pleasantly surprised to find that an attending salary really does feel like a lot more money. I recall hearing people further ahead of me saying stuff like "the money doesn't go as far as you think" or "I don't know where it all goes" and suspect they were just bad with money.

In my opinion, personal finance on a physician salary is relatively easy. I cannot imagine saving for retirement, buying a house, paying for insurances, investing, etc while making an average household income for the rest of my life. I really think life is hard for a lot of Americans.

 

[Jules A]

I really think life is hard for a lot of Americans.

I think our skewed American expectation of what is a necessity vs what is a luxury is what makes life hard. First world problems as they say.

As for OP the allure of academics hasn't ever made sense to me because quite simply I want top dollar for my time.

 

[Mass Effect]

It's about your market value and cost of living in the area you're in. If you're getting 230k a year seeing 15 patients a day while everyone else is getting 300k a year seeing 8 patients a day then you'll still be able to go home and live fine on 8k a month, but you leave a lot of money on the table by being "fine" with a certain salary.

The most important thing money buys is time, so that you can retire at 50 instead of 65, or choose to work past retirement age instead of it being an obligation. Every dollar saved in your retirement now is an extra dollar keeping pace with or outpacing inflation when you get older. So yeah, 4k/month saved is great but 7k/month is better. You can still choose to live like a monk on the higher salary, no ones stopping you.

Are there a lot of jobs paying 300K/yr seeing 8 pts a day? I have to be in a major city unfortunately due to partner's job. Otherwise I'd head for the hills (lakes) of the midwest to make more. Thinking about DC, LA, San Fran, maybe Seattle. Couldn't pay me enough to live in NYC again.

 

[dl2dp2]

Are there a lot of jobs paying 300K/yr seeing 8 pts a day? I have to be in a major city unfortunately due to partner's job. Otherwise I'd head for the hills (lakes) of the midwest to make more. Thinking about DC, LA, San Fran, maybe Seattle. Couldn't pay me enough to live in NYC again.

8*200*5*48=$384k, so yes, I think there will be plenty of jobs where you see 8 patients a day and end up making a RVU based profit of 300k.

Current Medicare reimbursement schedule for 99214 + 90833 = ~ $220. 99213+90833 = ~ $180. Mix in a few 90836s you should be able to gross $200 per visit.

It's also not difficult to do pure salaried jobs (i.e. VA, inpatient, etc) in major metros now for 250k+. Then you moonlight one weekend a month and you are there.

 

[Mass Effect]

8*200*5*48=$384k, so yes, I think there will be plenty of jobs where you see 8 patients a day and end up making a RVU based profit of 300k.

Current Medicare reimbursement schedule for 99214 + 90833 = ~ $220. 99213+90833 = ~ $180. Mix in a few 90836s you should be able to gross $200 per visit.

It's also not difficult to do pure salaried jobs (i.e. VA, inpatient, etc) in major metros now for 250k+. Then you moonlight one weekend a month and you are there.

Do you do 90833 often? I very, very rarely use it because I don't know if I'm using it appropriately even though I do think I'm doing some form of therapy in most visits.

 

[clausewitz2]

Do you do 90833 often? I very, very rarely use it because I don't know if I'm using it appropriately even though I do think I'm doing some form of therapy in most visits.

It is easier for me to specify the times I do -not- bill 90833:
-someone is late enough to their appointment I am not going to be able to give them 16 minutes and I don't feel like just having them reschedule (though better believe we are arranging a sooner than usual follow-up typically)
-client is not a native speaker of English and is has a somewhat limited vocabulary
-a couple of people with ADHD who have had their diagnosis and same dose of stimulants for years and are doing just fine, thanks
-when I am also billing 99205, although I have been able to justify 99205+90833 on occasion.

 

[dl2dp2]

Do you do 90833 often? I very, very rarely use it because I don't know if I'm using it appropriately even though I do think I'm doing some form of therapy in most visits.

Typically at a facility job if your visit is only 15 min and the patient gets another therapy code on the same day you don't bill 90833. My friend who works for a facility told me about this. She sees way more than 8 patients per day tho.

However, this, if anything, increases your gross revenue. You end up generating two 99213/99214 per hour. If your facility is doing this, you should figure out a way to ask for >300k total comp (i.e. base + % RVU collected, etc). In PP I always do 30 min visits and therefore generally always bill 90833. Private patients vastly prefer 30 min visits.

 

[Stagg737]

I think our skewed American expectation of what is a necessity vs what is a luxury is what makes life hard. First world problems as they say.

Yep, in med school I lived off of $1200/mo and was fairly comfortable. Granted, I was not contributing to retirement or really socking any money away, but even an income of $35k/yr is very reasonable for individuals outside of the high COL cities for those not living a consumerist lifestyle. Throwing a family into the mix changes things, but $50-60k is still reasonable for raising a family in most areas.

It is easier for me to specify the times I do -not- bill 90833:
-someone is late enough to their appointment I am not going to be able to give them 16 minutes and I don't feel like just having them reschedule (though better believe we are arranging a sooner than usual follow-up typically)
-client is not a native speaker of English and is has a somewhat limited vocabulary
-a couple of people with ADHD who have had their diagnosis and same dose of stimulants for years and are doing just fine, thanks
-when I am also billing 99205, although I have been able to justify 99205+90833 on occasion.

Even for most of those cases pulling in $200+ per hour is very reasonable. In my MAC a 99213 by itself is ~$75. See three of those stable ADHD patients without co-morbidities in an hour and you're still clearing $200/hr. 99214 is ~$110 here, so even without the therapy add-on 30 minute follow-ups in my area would come out to >$200/hr.

 

[Stagg737]

Coming back to the original question, it depends on how low "very low" is and my financial status at the time. Currently, I feel very behind financially and will not consider a FT position with a base salary of less than $200k. I'd be more likely to take a higher paying job that isn't ideal for the next 5-7 years to catch up financially and feel more secure. If I were 10 years farther along and had a decent nest egg saved up I wouldn't hesitate to take my dream job for lower pay, especially because I don't ever see myself fully retiring.

That being said, if my dream job offered $225k+ out of residency I would probably take it with and live very sparingly for 4-5 years to catch up financially. I've found that luxuries (or just non-necessities) are far less attractive to me when I'm actually enjoying what I'm doing. So there's also the factor of how much more money do you need in that non-dream job to offset the loss of satisfaction in life from where you'd be with a dream job?

 

[AD04]

Why would anyone take a facility job with 15 minute follow ups? You see more patients and have less time to document, increasing risk of malpractice. And the pay isn't anymore than 30 minute follow ups as you can bill for add-on therapy.

To the OP's question, I would take my dream job even if the pay is lower. Someone who is financially prudent can retire with millions on $200k / year, even in a HCOL area.