What am I getting into?

General Med Student Discussion
21
  • croooz Said:
I don't see doctors ever being out of work. I just see the compensation not being what it should be to keep them IN medicine. Very few will be the ones to stay in medicine if your are working 80+ hours/week to break even.



You Know before Medschool I was an RN for 19 years and I would hear this but knew Physicians made at least 200k on the average, now even in RURAL GA the average is 220k for FP yea, I know they claim this is not true but it is, you see it's like a secrete and we are to shut up about it, what do Docs think they should make a year? a million plus? LOL I never went into this for money and find that some of the DOCs in clinicals are the same, the GI Doc I'm with makes at least 300k a year, and the Hospital pays malpractice and for his office, there are good ways to make a good living, but being on your own may not be it, some kind of group practice is way better.

So I do not buy "It does not pay enough" I made on my best year as an RN about 70k and thats it, you cannot tell me 70k is better then 225k!
22

I think what is going on is that compared to back way back…docs are making less. Sure, physicians DO make money but it also takes a LONG time to get there…

23

Yes but I averaged 60 to 50 K a year as an RN, never never would I reach 225k a year or more, even with the years lost in pay I still will make out ( I know long story) but the point is this is more then the money, it has to be or I would not be here.

24

The vastly inflated expectations of the oldtimers are a big reason for the gripes about compensation. But the younger set has its own distortive set of expectations. Some NYC prrspective here: very elite students who have high grades and scores and graduate decetly from one of the FIRST-TIER (first-tier only) law schools now have starting salaries of over $200,000 as associates at the major manhattan lawfirms. At the major manhattan investment banks and brokerage houses, the market is even tighter (for elite MBA and finance grads) and compensation is stratospheric. So medical grads will never catch up to their friends who came out of Harvard, Yale or William and Mary (Go Tribe!!!) with stellar grades and scores.


BUT they are all miserable! Medical residents I have known are much happier than legal associates who seem to divide the two minutes a day they’re not poring over contracts between coke, screwing each other in the corporate sense, coke, screwing each other in the genital sense, crying, crappy takeout meals, sexual harassment scandals, and coke.


Dave’s takeaway though is essential for all you premeds: if you’re in the med thing for the money and you’re a supersmart high flyer, please do your future patients and colleagues a favor and find some other pursuit. You’ll get to the pot of gold quicker.

25

You know it’s quite interesting how the curve of the costs of medical school through residency to reaching a decent salary to overcome medical school loans compares with doing the same thing with nursing school.


Just for fun I did an excel spreadsheet comparing year by year gross expenses (undergraduate + graduate loans) and compensation (salaries from work during nursing school as a CNA and afterwards as an RN, against salaries after medical school for residency and afterwards as a licensed physician) for a nurse with a track to nurse practitioner (to cap at about $75,000) and for a physician with an average salary (about $135,000)), and for the first eleven years (including school) being a nurse is more lucrative against debt (for less hours of work) than going through medical school.


However after 11 years (including school) that salary difference starts to kick in, and suddenly being a physician becomes much more lucrative.


Granted that is a very simple model which does not take into account interest and other factors, but it is a good way to ballpark your age and goals. I figure, for example, if I go to medical school and retire at the age of 65, I will gross at least $750,000 more for retirement than I would as an NP.


Not that money is my focus for doing this, but with the tremendous cost of medical school, loan debt can go up to $250,000 for medical school plus whatever a person had for undergraduate loans. Recently the federal government has changed the rules for payback of Title IV loans to make it more difficult for forbearance of loans during residency. Realistically finances should be a concern for all of us because of the debt load which can be a real burden to us and to our families down the road.


Many hospitals, if you work as a CNA or EMT or other hospital staff, will pay you for continuing education if you work while you go to school. In medical school, you are pretty much on your own with staggering loans as most medical schools will not authorize you to work.


A resident in my hometown family practice that is sponsored by the hospital makes about $47-48,000 each year for three years of residency which comprises 60 hours of work a week plus 20+ on-call hours.


The average RN’s salary is about $50-60,000 for 36-40 hours per week, plus shift differentials, overtime, benefits, and critical needs pay.


p.s. I & O works for physical Input and Output as well as Income and Obligations! There’s a whole lot of similarities there.

26
  • OldMeezer Said:


Just for fun I did an excel spreadsheet comparing year by year gross expenses (undergraduate + graduate loans) and compensation (salaries from work during nursing school as a CNA and afterwards as an RN, against salaries after medical school for residency and afterwards as a licensed physician) for a nurse with a track to nurse practitioner (to cap at about $75,000) and for a physician with an average salary (about $135,000)), and for the first eleven years (including school) being a nurse is more lucrative against debt (for less hours of work) than going through medical school.

However after 11 years (including school) that salary difference starts to kick in, and suddenly being a physician becomes much more lucrative.





Well where do you get the 135k? SO far all the Docs I have been in Clinicals with tell me privately they are able to make between 250 to 300k a year take home, and that is out here where there is a Doc shortage. I asked if I could make 200k out of residency, and I was told by several, if I'm not making more then that then I'm doing something wrong. I think the internet and what is reported officially pales in reality, and why should Docs tell everyone how much they make? Have you ever thought that?

( by the way:
  • In reply to:
A resident in my hometown family practice that is sponsored by the hospital makes about $47-48,000 each year for three years of residency which comprises 60 hours of work a week plus 20+ on-call hours

I made about this and did these hours as a hospice nurse, the only addition is the pay for oncall, so 48k was 55 to 60k)

One last important point: If you are doing this for money alone then do not do it you will not be happy. Just my opinion
27

I thought I would make a couple of points here on salaries…

  1. certainly physician salaries are going to vary quite a bit depending on both your specialty and where you are practicing in the country.


    The statistics I pulled were from the U.S. Bureau of Labor Statistics:


    http://www.bls.gov/home.htm


    Salary.com’s salary wizard was also helpful:

  • In reply to:
Specialty Median Salary

Oncologist/Hematologist $214,075

Surgeon $213,178

Neurologist $155,588

Pediatrician $129,542

Anesthesiologist $244,753

Source: Salary.com, September 2003



and I always try to pick the median or more conservative salary based on where I live, rather than the top-end one, when I'm doing my mockups, because the market, particularly for GP's in family practice, which is what I am aiming for, has been rocky with its salaries--one has to consider global trends in medicine like the Baby Boomers on Medicare and how much insurors are willing to compensate physicians.

One of the physicians I know (whose husband is also a physician) was telling me that there have really been no strides in increased salaries for physicians in the past decade, in fact there has been a gradual decline in salary vs. cost of living, although physician salaries are fairly generous.

One must also consider that if you have your own office, you must pay out for malpractice insurance, and various overhead from your earnings as well. Being in a higher tax bracket also means that you can end up paying a hefty load of income taxes as well.

In fact, the days of an individual private practice where I live are pretty much gone. Most people are working in group practices to help offset the cost of minimal government insurance payouts, etc.

Also, having the expectation that you will earn the top salary immediately may not be realistic--unless as you mentioned you are in an area with a physician shortage and your specialty is in high demand. Now if you are a top resident surgeon who graduated from Harvard with a long line of credentials and contacts, that may indeed be the case globally, but whenever doing long-term fiscal planning, I think it is wise to err on the lower end of the spectrum. The key to the higher salaries is often "experience."

2) If anyone is just after money, this is not really the profession to get into, because it requires years of dedication and poverty before it has the opportunity to become lucrative, and it is a career that is highly demanding of time and mental & spiritual energy. As I said before, I'm not in this for the money, although I acknowledge the long-term rewards, as to do so otherwise would be naiive. If those rewards are better than expected, then great! We'll all be set for a liveable retirement and can help the kids and the grandkids go through school!

3) Finances, especially to nontraditional students who have families and obligations, cannot be disregarded either. There is a huge financial committment in order to get through medical school in the U.S.A. A quarter of a million dollars, which is the upper limit of student loans, but would take into account living expenses plus tuition for many medical schools, is a huge investment and a huge debt to repay as well. If you have a family, you will not really be able to be the primary support unless you live on a very meager budget, and this may be true for a decade, or until residency is completed, and during residency, depending on the terms of your loans, you may be required to pay back your student loans and/or accrue interest on a quarter million dollars. Say you have a 5% loan on 250,000... interest alone each year would be about $12,500 or $1000 per month or about 1/4 of your income before taxes as a resident. (see http://studentdoctor.net/blog/2008/01/02/stude nt-l... )
28

My salary as a family medicine resident was $42K to $49K and I did NOT get on-call pay (ha). Resident salaries vary a little bit - I remember reading about a family medicine residency program in Indiana which paid a $10K signing bonus and had some sort of housing allowance. They were pretty desperate for residents; my residency program has traditionally not had to work that hard to attract strong applicants.


Starting salaries for myself and my colleagues ranged from $100K to $120K last year. Over the past few years, a few residents have gotten more by going to more rural areas. But those high starting salaries in rural areas come at a price… there’s a guaranteed salary for the first few years and then you transition to a production bonus formula which often results in a DECREASE in pay.


Salaried family physicians (as opposed to partners) are not seeing anything like the kind of money you’re talking about, Bill. Partners may, depending on the way their business is set up and what sort of practice it is.


Mary

29

I understand , I live in a very high need area, it’s something I researched about,


Rural Part of the state with several medium sized cities near us (Southern GA) Physician shortage now only increasing due to the loss of 5 to 6 IM/FP Docs in the nest 2 years, So the shortage will only increase.


We have other factors I cannot discuss but I can tell you I should have privileges in 3 to 4 Hospitals in the area.


This is all due to my best friend who I will go into practice with ( a working practice) and our business plan. We have lots of research on this.


I guess what I’m saying is we know the changes that have and are happing and we have plans to still do well ( yea a lot of work but I like to work hard anyway) We may end up 2 of the few Doctors in a 50 to 70 mile radius the way it is going with retirement and other things happing in the area.


I just cannot believe the Pay here

  • In reply to:
Specialty Median Salary


Oncologist/Hematologist $214,075


Surgeon $213,178


Neurologist $155,588


Pediatrician $129,542


Anesthesiologist $244,753


Source: Salary.com, September 2003



I found this from a more up to date site: 2006 figures

  • In reply to:
SPECIALTY Years 1-2 >3 Max

Allergy/ Immunology $158,000 $221,000 $487,000

Ambulatory $ 80,000 $112,000 $152,000

Anesthesiology: Pediatrics $ 283,000 $311,000 $378,000

Anesthesiology: General $207,000 $275,000 $448,000

Anesthesiology: Pain Management $315,000 $370,000 $651,000

Cardiology: Invasive $258,000 $395,000 $647,000

Cardiology: Interventional $290,000 $468,000 $811,000

Cardiology: Noninvasive $268,000 $403,000 $599,000

Critical Care $187,000 $215,000 $320,000

Dermatology $ 195,000 $308,000 $452,000

Emergency Medicine $192,000 $216,000 $295,000

Endocrinology $171,000 $187,000 $260,000

FP (with OB) $182,000 $204,000 $241,000

FP (w/o OB) $161,000 $135,000 $239,000

FP - Sports Medicine $ 152,000 $208,000 $363,000

FP - Urgent Care $ 128,000 $198,000 $299,000

Gastroenterology $265,000 $349,000 $590,000

Hematology/Oncology $181,348 $245,000 $685,000

Infectious Disease $154,000 $178,000 $271,000

Internal Medicine $154,000 $176,000 $238,000

IM (Hospitalist) $161,000 $172,000 $245,000

Medicine/Pediatrics $139,000 $168,000 $271,000

Medical Oncology $198,000 $257,000 $455,000

Neonatal Medicine $286,000 $310,000 $381,000

Nephrology $191,000 $269,000 $447,000

Neurology $180,000 $228,000 $345,000

Obstetrics/Gynecology $211,000 $261,000 $417,000

Gynecology $159,000 $213,000 $358,000

Maternal/Fetal Medicine $286,000 $322,000 $610,000

Occupational Medicine $139,000 $185,000 $290,000

Ophthalmology $138,000 $314,000 $511,000

Ophthalmology Retina $280,000 $469,000 $716,000

Orthopedic Surgery $256,000 $342,000 $670,000

ORS - Foot & Ankle $228,000 $392,000 $791,000

ORS - Hand & Upper Extremities $288,000 $459,000 $770,000

ORS - Hip & Joint Replacement $330,000 $491,000 $715,000

ORS - Spine Surgery $398,000 $670,000 $1,352,000

ORS - Sports Medicine $266,000 $479,000 $762,000

Otorhinolaryngology $194,000 $311,000 $516,000

Pathology $169,000 $321,000 $610,000

Pediatrics $135,000 $175,000 $271,000

Pediatrics - Cardiology $145,000 $282,000 $607,000

Pediatrics - Critical Care $196,000 $259,000 $398,000

Pediatrics - Hematology/Oncology $182,000 $217,000 $251,000

Pediatrics - Neurology $175,000 $189,000 $362,000

Physiatry $169,000 $244,000 $313,000

Podiatry $128,000 $168,000 $292,000

Psychiatry $149,000 $169,000 $238,000

Psychiatry - Child and Adolescent $158,000 $189,000 $265,000

Pulmonary Medicine + Critical Care $215,000 $288,000 $417,000

Radiation Oncology $241,000 $385,000 $787,000

Radiology $201,000 $354,000 $911,000

Rheumatology $179,000 $229,000 $378,000

Surgery - General $226,000 $291,000 $520,000

Surgery - Cardiovascular $336,000 $515,000 $811,000

Surgery - Neurological $354,000 $541,000 $936,000

Surgery - Plastic $237,000 $412,000 $820,000

Surgery - Vascular $270,000 $329,000 $525,000

Urology $261,000 $358,000 $619,000

SOURCE: Allied Physicians, Inc., Los Angeles Times and Rand McNally

*Updated June, 2006

30
  • Mary Renard Said:


Starting salaries for myself and my colleagues ranged from $100K to $120K last year. Over the past few years, a few residents have gotten more by going to more rural areas. But those high starting salaries in rural areas come at a price.... there's a guaranteed salary for the first few years and then you transition to a production bonus formula which often results in a DECREASE in pay.

Salaried family physicians (as opposed to partners) are not seeing anything like the kind of money you're talking about, Bill. Partners may, depending on the way their business is set up and what sort of practice it is.

Mary



Yes I agree with most of this there are some of these Docs out here, but it depends on the Deal, just 4 years ago one Doc from my school ( yes I found this out once here) Did a deal with a Hospital, they payed for his loans, built a clinic and payed him 220k a year for the next 5 years, the plan was that he would see patients and refer them to the Hospital for everything, all services and be a staff Doc for them. Then after 5 years he would be on his own and pay the hospital payments on the cost of the clinic over so many years ( Like a loan) Well....... there has been some funny stuff here and he has all this and now since a relative is on the board things have changed in this docs favor.......I can tell you more but feel I should not.......... The world is different out here in the real Rural Ares and I'm learning this everyday. The Doctor shortage is real and at crises levels in some places, Imagine no Doctor for 75 or 50 miles or Doctors near you that will not accept new patients when you move there and the closest Doc is 50 miles in either direction, then there is the problem of what Doctors people like..........As I said in areas like this the right Physician can make it really well, but you have to like living where it is not metro at all. The closest nice city with really decent stores, like Kohls, Macys, or even Best Buy is 70 miles away.
31

Don’t worry about the passing out/vomiting thing…if you feel like either one will happen just excuse yourself. DO NOT wait and see if you will get better…they do understand and would prefer if you would leave before any of that happens. If you are at all concerned they can put a nurse, tech or another student in charge to keep an eye on you. They will also give you other opportunities if you want, instead of putting you in a situation that you are not comfortable in.


When I first started as a nurse tech in the ED, I would get lightheaded, and for me, all I had to do was keep moving and I was ok. Now, I have put tubes in people’s chests, throats, “cracked” a chest and done open heart massage without thinking anything of it.


Rachel Yealy, DO


Staff Emergency Medicine