Would you take your dream job for less salary?

[Psychresy]

Burnout.

I mean I hear that...but if those NSGY residents/fellows can do this for 7+ years for minimum wage....

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[TexasPhysician]

Part of me thinks about just working the minimal years possible and retiring super early. By calculations, it looks like correctional jobs can be had for about 280-300/hr. Bang out 70 hour weeks, take a month off a year, repeat for 5 years and you could finish with over 2M in the bank after taxes if you're living like a resident for 5 more years. Seems too simple though..what am I missing?

I wouldn’t recommend working so much in a correctional setting that you let your guard down. It’s a dangerous environment.

I don’t see the logic in this when there are easier ways, like half-retiring immediately after residency.

You could easily move to Puerto Rico and do telepsych for $150+/hr for 20 hours per week. Last I looked there are tax incentives for doctors where federal tax bracket was around 4% for tele options. Look out at the beach while doing telepsych. Spend 4 days/week at the beach.

 

[Jules A]

I am feeling really stupid, but if you earn 175k per year, how is your paycheck only $4200? I mean, 175/12 is 14k per month. I don't know much but that is pretty high. Are you talking about paychecks every 2 weeks? Even then, that would mean earning 8k and paying 6k out of taxes. Is it really that bad?

It would feel pretty bad to me if my colleagues were making an extra $125,000 each year.

 

[Stagg737]

I mean I hear that...but if those NSGY residents/fellows can do this for 7+ years for minimum wage....

Keep in mind that the general mindset of surgeons vs. psychiatrists is often very different. Many surgeons thrive on the fast-paced lifestyle and being workaholic. While there are some in psych with that mindset, most psychiatrists I know are much more laid back and would strongly prefer to never work 60+ hours a week after residency (or even in residency). This is even more true if you've got a family or want to have some semblance of a social life outside of work. I had the surgeon mindset for a long time, but now that I have a kid there's no way I could work the hours I previously thought I would. So you're really asking "what will keep me from burning out?" For the neurosurgeon mindset in this case, the idea that they will have more money to play with than they'll need prevents burnout. While the psych mindset described here is that more balance prevents burnout.

Looking at it from a numbers perspective: 7 years of min wage (residency) leading to $500k+ working 50 hours a week for the next 25+ years is a much different picture than working 50 hours a week making a modest but comfortable living (residency), then working 70 hours a week to make $500K+ to build a nest egg, then dropping to <50 hrs/wk to make ~$250k for the rest of the career. The surgeons in this case are taking an early hit to earn like kings the rest of their lives. Psychiatrists in general are looking to feel secure/comfortable the rest of their lives. The issue with the psych route you describe and written above is that you're going from a place of relative comfort in terms of work-life balance in residency to seemingly much more work afterwards, whereas neurosurgery is getting a huge raise in salary by working the same or often fewer hours. For someone with a more laid-back mindset, I think they're risking burnout much more by that significant increase in workload from residency to attending (even if only for 5 years) than someone who kept the fast pace from med school to residency but then gets to kick back compared to what they had been doing.

 

[Psychresy]

I wouldn’t recommend working so much in a correctional setting that you let your guard down. It’s a dangerous environment.

I don’t see the logic in this when there are easier ways, like half-retiring immediately after residency.

You could easily move to Puerto Rico and do telepsych for $150+/hr for 20 hours per week. Last I looked there are tax incentives for doctors where federal tax bracket was around 4% for tele options. Look out at the beach while doing telepsych. Spend 4 days/week at the beach.

I like the half-retiring idea. I don't think it's possible, but any chance one could live outside of US (or its territories) and do this? Would be awesome to post up in a cheap Asian country and live like a king while working a few days a week.

 

[finalpsychyear]

Part of me thinks about just working the minimal years possible and retiring super early. By calculations, it looks like correctional jobs can be had for about 280-300/hr. Bang out 70 hour weeks, take a month off a year, repeat for 5 years and you could finish with over 2M in the bank after taxes if you're living like a resident for 5 more years. Seems too simple though..what am I missing?

Yes burnout is the case but it depends if you already have that type of thinking where you see the end. My residency friend is finishing his 5th year working 6 days/wk but more like 6-7 weeks vaca every other months strategically placed to offset the burnout. To be fair he is scaling back to 4 days a week but stated he doesn't regret it but he did it to clear out debt and get a large nest egg going as he was a bit older with a family on the way. If you are single you may still single if you do such a thing as it would make establishing relationships quite difficult or more challenging then doing 40 hour week with weekends off. If you are married or relationship is set and your partner on board then I feel maybe it is easier to do.

And to be honest i also had aspired to retire super early but as i have been going through the last 4 years as an attending I realized I only want the mental peace of knowing I could stop working but no longer see that happening anytime soon. Also corrections has its own risks since there is a reason those jobs are always available and the pay is higher. Good luck.

 

[NITRAS]

I am feeling really stupid, but if you earn 175k per year, how is your paycheck only $4200? I mean, 175/12 is 14k per month. I don't know much but that is pretty high. Are you talking about paychecks every 2 weeks? Even then, that would mean earning 8k and paying 6k out of taxes. Is it really that bad?

$6700/26 pay periods.

I was probably over withholding a little bit, but 25% in taxes gets you to $5000/payperiod then you have to pay for health insurance, life insurance, HSA. Even without taking out retirement I was in the low $4000’s. It’s a big jump from the $3200/month I was getting in residency, but you think making almost $200k a year And you feel like it is a ton of money. It really doesn’t. My income in in the low $300’s and my take home pay after everything is less than $200k.

I have friends who lease expensive cars and go on expensive vacations, and have $700,000+ homes.

 

[deleted1012620]

School/residency is a blindfold that blinds us on how the giant pot of gold is divided up. So it's natural to play the game of "I could be happy with [relatively low dollar amount] because I have X dollars left after taxes, which is more money than I've ever had or can imagine."

But in the real world, at some point, the allocation of money ceases to be about material objects, lifestyles, COL. It becomes a message. Like when the hospital board gives the $20 mil CEO a 6 figure bonus in the midst of a pandemic, but frontline workers get a $500 bonus, attendings get a paycut, and residents get zero.

Very true. It's hard to transition out of the supplicating med student mindset. Too eager to please and not advocate for yourself.

 

[psyguru]

You could always do the low paying dream job and supplement with non-clinical work at $400-500/ hr an hour (more for testifying).

 

[jbomba]

You could always do the low paying dream job and supplement with non-clinical work at $400-500/ hr an hour (more for testifying).

What are these non clinical jobs paying that?

 

[TexasPhysician]

I like the half-retiring idea. I don't think it's possible, but any chance one could live outside of US (or its territories) and do this? Would be awesome to post up in a cheap Asian country and live like a king while working a few days a week.

Yes you could. It may be a little more difficult as government plans don’t reimburse when you are outside the US. Commercial plans don’t care. There are tax incentives outside the US, but depending on your income, it is not as good as Puerto Rico. Depending on where you are, low cost of living could make up for that. High speed internet is a must to make this work.

By taking advantage of tax savings, cost of living, etc., it is quite possible to thrive off of $150k/year working PT while exploring the world.

 

[Psychresy]

Yes you could. It may be a little more difficult as government plans don’t reimburse when you are outside the US. Commercial plans don’t care. There are tax incentives outside the US, but depending on your income, it is not as good as Puerto Rico. Depending on where you are, low cost of living could make up for that. High speed internet is a must to make this work.

By taking advantage of tax savings, cost of living, etc., it is quite possible to thrive off of $150k/year working PT while exploring the world.

Wow. Travel was such a huge part of my life pre-medical school. Would love to be able to do that again. Any telepsych companies you could recommend looking into to allow for this?

 

[TexasPhysician]

Wow. Travel was such a huge part of my life pre-medical school. Would love to be able to do that again. Any telepsych companies you could recommend looking into to allow for this?

There are telepsych companies popping up every month looking for people. There are so many that I don’t think it would be too hard to find options.

 

[psyguru]

What are these non clinical jobs paying that?

I am a forensic psychiatrist. I do quite a bit of expert witness work (have 2 days a week for it). It is very interesting and adds some variety. There is other non-cliincal jobs and side gigs such as UR, medical surveys, etc. I don't believe they are as high paying.

 

[AD04]

You could easily move to Puerto Rico and do telepsych for $150+/hr for 20 hours per week. Last I looked there are tax incentives for doctors where federal tax bracket was around 4% for tele options. Look out at the beach while doing telepsych. Spend 4 days/week at the beach.

Do you know anyone who has successfully done this without being fluent in Spanish? Or do you know anyone who is treating patients in-person in PR? I read that lots of physicians in PR are going to Miami (FL) as the pay in PR is just too low.

Over the long run, the compounded growth of the taxes saved (assuming the difference is invested) will be larger than whatever earned income you can make in the 50 states.

 

[dl2dp2]

Do you know anyone who has successfully done this without being fluent in Spanish? Or treating patients physically in PR?

Over the long run, the compounded growth of the taxes you're not paying will be larger than whatever earned income you can make in the 50 states.

A very cursory Google search shows that it's not true. PR, as part of the US would subject you to the same US federal tax rates as any other state. This strategy also doesn't work anywhere else, since as a US expat you are subject to US taxes worldwide.

 

[AD04]

A very cursory Google search shows that it's not true. PR, as part of the US would subject you to the same US federal tax rates as any other state. This strategy also doesn't work anywhere else, since as a US expat you are subject to US taxes worldwide.

Tax-Weary Americans Find Haven in Puerto Rico | Frost Law | Washington DC

(IRC) §933, States Puerto Rico source income is excluded from U.S. federal tax. Puerto Rico's Act's 20 and Act 22-offer attractive tax incentives.

www.districtofcolumbiataxattorney.com

There are exemptions. But if I pursue this strategy, I would get professional assistance to make sure t's are crossed and i's are dotted as this is big money.

 

[TexasPhysician]

Do you know anyone who has successfully done this without being fluent in Spanish? Or do you know anyone who is treating patients in-person in PR? I read that lots of physicians in PR are going to Miami (FL) as the pay in PR is just too low.

Over the long run, the compounded growth of the taxes saved (assuming the difference is invested) will be larger than whatever earned income you can make in the 50 states.

There are ways to qualify by doing telepsych work to the continental USA.

 

[TexasPhysician]

A very cursory Google search shows that it's not true. PR, as part of the US would subject you to the same US federal tax rates as any other state. This strategy also doesn't work anywhere else, since as a US expat you are subject to US taxes worldwide.

Look deeper. They have many Act’s that you can qualify for. Act 14, 20, etc can significantly lower taxes and you can export your services via telepsych.

I’ve met radiologists and psychiatrists doing tele work from PR to the continental US while paying minimal taxes - like 4% Federal.

From other countries, there are foreign income tax deductions. You still pay taxes, but they are less.

 

[Mass Effect]

It's possible, but exceptionally rare straight out of residency in psych. Current PGY-4 in my program found a higher paying offer than that, but declined d/t location and expected workload. 800k is also pretty rare straight out of residency in ortho, but much more realistic if you're willing to kill yourself with your schedule.

I would be very skeptical of anyone claiming an offer for 800K in psych right out of residency. Even in the most rural areas of the country, the numbers I'm seeing are 400K

 

[Stagg737]

I would be very skeptical of anyone claiming an offer for 800K in psych right out of residency. Even in the most rural areas of the country, the numbers I'm seeing are 400K

I’ve personally seen 2 offers at that pay rate, but neither were jobs I’d consider taking even in the most geographically ideal situations. The jobs exist, but sounded as horrible as they were rare.

 

[Mass Effect]

I’ve personally seen 2 offers at that pay rate, but neither were jobs I’d consider taking even in the most geographically ideal situations. The jobs exist, but sounded as horrible as they were rare.

Can you describe them? I'm just curious because I've seen pretty horrible jobs that offer half that rate so I'm wondering how bad these jobs were.

 

[Stagg737]

Can you describe them? I'm just curious because I've seen pretty horrible jobs that offer half that rate so I'm wondering how bad these jobs were.

One was 6 mo locums position in Alaska covering multiple inpatient units, 40+ patients per day with significant travel between locations. Overnight call for full week straight (can’t remember exact schedule but I believe was one week on, one week off) for multiple units with weekend call shifts. Poor benefits. “Hourly rate” was supposedly ~900/hr when calculated as full time (40hr/week) but sounded like much worse pay given the number of hours sounded more like 80-100hr weeks.

Other one wasn’t quite as bad but involved supervising multiple mid-levels. Both were positions a co-resident came across that they showed me.

I’ve found a couple of positions myself that sounded terrible, but those were closer to the range you quoted (~500k/yr).

 

[clausewitz2]

One was 6 mo locums position in Alaska covering multiple inpatient units, 40+ patients per day with significant travel between locations. Overnight call for full week straight (can’t remember exact schedule but I believe was one week on, one week off) for multiple units with weekend call shifts. Poor benefits. “Hourly rate” was supposedly ~900/hr when calculated as full time (40hr/week) but sounded like much worse pay given the number of hours sounded more like 80-100hr weeks.

So you are just the inpatient psychiatrist for the state of alaska generally.

 

[Stagg737]

So you are just the inpatient psychiatrist for the state of alaska generally.

Seemed like it. I’m sure there’s more than 3 MH units in Alaska, but it definitely sounded like a one and done kind of deal.

 

[FN9]

So you are just the inpatient psychiatrist for the state of alaska generally.

if you are young and single in addition to efficient, it can be done, its a temp job for 6 months then a month to recover followed by 5 months of easy job and you have made some serious coin.

 

[Splenda88]

Again? Depends on the lifestyle you want to live. Live like a resident on $50k per year and he doesn’t even need to have that 2.3 mil invested. Want to live like an ortho attending on $400k+, and he won’t even get a decade of retirement. General rule is that you can safely pull 4% out of retirement per year and be confident that you will have enough money to live off for 30 years. WCI’s book has a table looking at years money needs to last Vs. Annual % withdrawn and gives the probability that you could successfully live that way (don’t remember wha the source of the table was, but it was a large economic study).

Using those numbers, the doc you’re referencing could safely withdraw $92k/year to live off and be confident his money will last 30 years. This is assuming there is no additional income added to those investments with consistent amount of withdrawal. There’s plenty of calculators and reference tools to play around with to give an idea of retirement options.




This is the fastest and typically best way to build wealth. Front loading investments pays off in the long run, and working more when you’re younger and have the energy/motivation is a lot easier than having to to go back to the grind when you’d rather be cutting back.

That is my plan... Frontloading for 5-7 and try to get my home paid off in 10 yrs + 2-2.5 millions in the market. Then I will semi retire and split my time between the US and Malaysia...

I wish I was a psychiatrist because it seems like making 300k/year while not killing yourself is not difficult these days.

 

[Splenda88]

I like the half-retiring idea. I don't think it's possible, but any chance one could live outside of US (or its territories) and do this? Would be awesome to post up in a cheap Asian country and live like a king while working a few days a week.

Take a look at Malaysia... a country with good (not excellent) infrastructure and healthcare. 35-40k/yr will afford you an upper middle class lifestyle in a nice suburb near Kuala Lumpur.

 

[robellis]

Take a look at Malaysia... a country with good (not excellent) infrastructure and healthcare. 35-40k/yr will afford you an upper middle class lifestyle in a nice suburb near Kuala Lumpur.

Yes but then you’d have to be in Malaysia..

 

[Psychresy]

Take a look at Malaysia... a country with good (not excellent) infrastructure and healthcare. 35-40k/yr will afford you an upper middle class lifestyle in a nice suburb near Kuala Lumpur.

Spent a couple weeks backpacking around there when I was younger. The food in particular was...amazing.

 

[hallowmann]

Spent a couple weeks backpacking around there when I was younger. The food in particular was...amazing.

I could really go for some ayam masak merah or some satay right now. Malaysia is great, cheap, very livable, KL has a ton of expats too. I don't believe they recognize my medical degree though. If I didn't have kids I might live there 50/50. When residency is done, I'll settle for a couple weeks a year.

 

[Splenda88]

I could really go for some ayam masak merah or some satay right now. Malaysia is great, cheap, very livable, KL has a ton of expats too. I don't believe they recognize my medical degree though. If I didn't have kids I might live there 50/50. When residency is done, I'll settle for a couple weeks a year.

Telemedicine...

 

[jbomba]

I could really go for some ayam masak merah or some satay right now. Malaysia is great, cheap, very livable, KL has a ton of expats too. I don't believe they recognize my medical degree though. If I didn't have kids I might live there 50/50. When residency is done, I'll settle for a couple weeks a year.

Couldn't you just do telepsych to the US making your degree a non factor?