Anesthesiology ranking near the bottom for both burnout and job satisfaction

[Nocturnist]

The rules for loan forgiveness have become way too loose

Word.

My understanding (and correct me if I'm wrong, but) that literally any non for profit hospital qualifies?

The hospital I moonlight at is 5 miles outside of the city, in one of the richest suburbs in the country, and almost all the hospitalists there are on the loan forgiveness track.

Either use loan forgiveness for its intended purpose by incentivizing folks to work in critical access/underserved areas or just call the child by its name and make higher ed close to free like the rest of the world.

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[triggermaster]

Word.

My understanding (and correct me if I'm wrong, but) that literally any non for profit hospital qualifies?

The hospital I moonlight at is 5 miles outside of the city, in one of the richest suburbs in the country, and almost all the hospitalists there are on the loan forgiveness track.

Either use loan forgiveness for its intended purpose by incentivizing folks to work in critical access/underserved areas or just call the child by its name and make higher ed close to free like the rest of the world.

Is that true? I don’t think it matters if the hospital is a 501(c)(3). If you are employed by a for-profit anesthesia group or if you are an independent contractor, then you don’t qualify. Right?

 

[nimbus]

From what I remember you work in Florida so this probably doesn't apply. But many normal private practice jobs in CA and TX now qualify for PSLF through a loophole.

Does Kaiser Permanente Qualify for PSLF? | White Coat Investor

Many doctors have benefitted from PSLF. But another adjustment to the program is coming, meaning many more docs could qualify.

www.whitecoatinvestor.com

Many many docs will get full loan forgiveness easily in those states now. Sounds like your millennial colleague would like CA. Live in coastal CA. Enjoy the lifestyle while still working for a normal private practice rather than the VA or academics. Make modest minimum qualifying payments and then PSLF tax free. Then you can leave after. The longer your training the better since more of the 10 year period happens in your low income training years.

You really are incentivized to take max loans with this kind of deal and start investing sooner.

Doctors in all states qualify for loan forgiveness as long as they work for a “qualifying employer”. If you work for Duke or Mayo or Cleveland clinic, you qualify.

The reason CA and Tx needed a loophole is because it is illegal for physicians to be directly employed by corporations in those states, regardless of whether they are nonprofit or for profit. The loophole in Tx and Ca allows physicians who work at nonprofit hospitals to qualify even if they are in private practice. It means they qualify if they work at a Sutter, Providence, or Scripps facility which are not for profit. They do not qualify if they work at a Tenet, HCA, or Prime Healthcare facility which are for profit.

 

[nimbus]

Is that true? I don’t think it matters if the hospital is a 501(c)(3). If you are employed by a for-profit anesthesia group or if you are an independent contractor, then you don’t qualify. Right?

The nonprofit hospital becomes the “qualifying employer” for PSLF purposes. Several of our younger partners have had their loans forgiven and I’m very happy for them.

https://www.cmadocs.org/Portals/CMA/files/public/PSLF%202023%20-%20What%20California%20Physicians%20Need%20to%20Know.pdf?ver=2023-07-12-102942-047

 

[GravelRider]

The numbers quoted on these forums as what you should have to be comfortable in retirement are hilarious…$10 million, $14 million, $24.3 million.

I never looked into it, but I guess pickleball club memberships are getting expensive. The ironic thing is that the more money you need to maintain your lifestyle in retirement, the less you are likely to have.

 

[triggermaster]

The nonprofit hospital becomes the “qualifying employer” for PLSF purposes. Several of our younger partners have had their loans forgiven and I’m very happy for them.


View attachment 381904

https://www.cmadocs.org/Portals/CMA/files/public/PSLF%202023%20-%20What%20California%20Physicians%20Need%20to%20Know.pdf?ver=2023-07-12-102942-047

So if you contracted at a non-profit that was legally prohibited for employing you directly, then it might count? That can’t apply to very many people.

 

[nimbus]

So if you contracted at a non-profit that was legally prohibited for employing you directly, then it might count? That can’t apply to very many people.

I’m in a single specialty anesthesia group. We are a partnership so we are all considered self employed.

We service about a dozen hospitals. They are all nonprofit. The vast majority of us primarily work in these nonprofit hospitals and all these hospital based anesthesiologists qualify for PSLF.

But we also have a significant minority (under 10%) who work primarily at for profit surgicenters and plastic surgery offices. Those people do not qualify for PSLF.

 

[triggermaster]

I’m in a single specialty anesthesia group. We are a partnership so we are all considered self employed.

We service about a dozen hospitals. They are all nonprofit. The vast majority of us primarily work in these nonprofit hospitals and all these hospital based anesthesiologists qualify for PLSF.

But we also have a significant minority (under 10%) who work primarily at for profit surgicenters and plastic surgery offices. Those people do not qualify for PLSF.

Are those hospitals legally prevented from employing anesthesiologists?

 

[nimbus]

Are those hospitals legally prevented from employing anesthesiologists?

Yes. It’s California.

Nelson Hardiman - Healthcare Lawyers - Understanding the Corporate Practice of Medicine Doctrine and the Role of the Management Services Organization

Both California physicians and businesses that wish to do business with them are often confused about the parameters of what California law permits.

nelsonhardiman.com

In other states where physicians can be directly employed by not for profit hospitals, they can just list their actual employer as the “qualifying employer”.

 

[triggermaster]

Yes. It’s California.

Nelson Hardiman - Healthcare Lawyers - Understanding the Corporate Practice of Medicine Doctrine and the Role of the Management Services Organization

Both California physicians and businesses that wish to do business with them are often confused about the parameters of what California law permits.

nelsonhardiman.com

In other states where physicians can be directly employed by not for profit hospitals, they can just list their actual employer as the “qualifying employer”.

I worked for a non-qualifying group at a qualifying hospital and it didn’t count. That’s why I’m asking so many questions.

Also, even if your employer now qualifies, you probably aren’t on a qualifying payment plan, or if you are, you’ll pay off your loans before you make 120 qualifying payments.

 

[anbuitachi]

Missed your post earlier. These are the inflation numbers I was going by attached.

I'm 8 years out of residency. I moonlit my butt off, made more than my attendings, and paid my loans off in full a couple months after residency. My loans weren't 250k, though if they were I still would've paid them off my first year as an attending.

Here are my expenditures from another recent thread. I dont bother to subcategorize my credit card bills.

You said last 100 years but you sourced last 10 to 20 years which has been the lowest inflation rate in history. 3 percent is closer to avg over long term than 2s. So 3 percent is absolutely reasonable for calculations

Also based on your 25k a month, you spend 300k per year. The amount you spend is greater than my entire take home. You need about 500k salary here to take home 300k, before any expenses/insurance or retirement. To have another 8k a month to invest... Your income is higher than majority of physicians even in other fields, including anesthesiologists . Your salary is probably around top 10 percent of anesthesiologists.

You make a good deal of money. And it's great you can save that much.

 

[nimbus]

I worked for a non-qualifying group at a qualifying hospital and it didn’t count. That’s why I’m asking so many questions.

Also, even if your employer now qualifies, you probably aren’t on a qualifying payment plan, or if you are, you’ll pay off your loans before you make 120 qualifying payments.

The group doesn’t matter as long as the hospital qualifies. Please read the CMA link I posted above. Not speaking of myself. I’m old. I paid off my 60k in student loans less than 1 yr after residency. But we’ve had several members of our group who have already had their remaining loan balances forgiven after making 120 payments. It’s real.

 

[triggermaster]

The group doesn’t matter as long as the hospital qualifies. Please read the CMA link I posted above. Not speaking of myself. I’m old. I paid off my 60k in student loans less than 1 yr after residency. But we’ve had several members of our group who have already had their remaining loan balances forgiven after making 120 payments. It’s real.

Yeah, because TEPSLF allowed non-qualifying repayment plans to count, but that’s over.

 

[BLADEMDA]

This is just some click bate BS to make high income earners feel needlessly anxious about never being able to retire.

5%? I get a better return in my HYSA or MMF. That's an absurdly conservative calculation.

At an 8% return which is already fairly conservative, you'd need to save 39,600 per year.
At 10% which is closer to the actual historical average, you'd get there with only 26,400 a year.

Mind you that includes your own contributions plus employer match. You're telling me your employer doesnt kick in at least 10k a year? You're telling me you can't set aside 15-30k a year at your income?

which circles back to my original point-
Don't overthink it. Definitely don't think it's out of reach like this article wants you to..

Just max out a single retirement account and a single roth, take advantage of 100% of your employer's match, don't touch your money for 30 years, and I promise you you'll have much more than 5M by retirement. There's no reason any physician with a 30 year career should settle for any less.

First, I like White Coat Investor. He does a good job of telling it like it is. Second, My CFP uses a 5.5% return for my investments. That's the figure he uses to make sure I am not falling behind in my planning. Third, I personally recommend you plan for the worst in terms of returns, like the 10 years where the market did very little, vs. the boom years of 2010-2020.

Finally, you will need well in excess of $5 million to retire comfortably in 30 years.

 

[BLADEMDA]

The numbers quoted on these forums as what you should have to be comfortable in retirement are hilarious…$10 million, $14 million, $24.3 million.

I never looked into it, but I guess pickleball club memberships are getting expensive. The ironic thing is that the more money you need to maintain your lifestyle in retirement, the less you are likely to have.

Sorry Slim but this isn't the last bout of hyperinflation you will see in your lifetime. You better start saving up those dollars because they are going to buy a lot less in 20-30 years than they do today. The end result of massive federal deficits will be higher inflation down the road. By that time you will be too old and too burned out to make the $12 million it takes to retire. Hence, I recommend you go make the money NOW and invest it so you end up with $12+ million.
Those who are doing locums are pulling in $800K+ and can invest $200K+ per year to reach that goal. I strongly suggest you make hay while the sun is still shining.

 

[BLADEMDA]

20%

At least 20% of your income should go towards savings. Meanwhile, another 50% (maximum) should go toward necessities, while 30% goes toward discretionary items. This is called the 50/30/20 rule of thumb, and it provides a quick and easy way for you to budget your money.

So if you are clearing $300K per year, a low number, you should be saving 60K from your salary plus the employer match. The total number needs to be over $80K to have any real chance of retiring decently in 25 years. IMHO, those who are saving $100K+ annually are sitting pretty good for a reduction to half time by age 55-60.

 

[BLADEMDA]

Take on Another Job​

When you need some extra cash, one of the best things to do is get to work. Side hustle, here we come! Okay, so this one is going to take a little more commitment than one Saturday afternoon. But maybe you can work part-time three or four times a month to give your savings that extra push. A ton of places hire for part-time work—cashiers are always needed at retail stores, and you can even make your own schedule working for Uber, Lyft or DoorDash.

How much of your paycheck should you save from your second job? Heck, maybe you can save most of it. Wouldn’t that be awesome. And if you’re able to budget your regular income enough to cover all your monthly expenses, then there’s no reason why you can’t just dump a big chunk of this paycheck into your savings.

How Much of My Paycheck Should I Save?

You’re not alone if you’ve ever wondered, “Hey, how much of my paycheck should I save?” The answer? It all depends on your money goals and what matters to you.

www.ramseysolutions.com

 

[Nocturnist]

20%

At least 20% of your income should go towards savings. Meanwhile, another 50% (maximum) should go toward necessities, while 30% goes toward discretionary items. This is called the 50/30/20 rule of thumb, and it provides a quick and easy way for you to budget your money.

So if you are clearing $300K per year, a low number, you should be saving 60K from your salary plus the employer match. The total number needs to be over $80K to have any real chance of retiring decently in 25 years. IMHO, those who are saving $100K+ annually are sitting pretty good for a reduction to half time by age 55-60.

This is the correct advice right here.
But to make it a little more palatable, it might be easier for folks to look at it as around 12% of your gross income.

Also to build on this-
if you can save 100k a year for 10 years, youll have 1.525M (sorry bud, I'm sticking to my 8% returns).
if you never save another penny again, 25 years later you've got your 12M nestegg.

Einstein said that 'Compound interest is the eighth wonder of the world. He who understands it, earns it; he who doesn't, pays it,' and that 'Two things are infinite: the universe and human stupidity; and I'm not sure about the universe."

So to all you kids reading this: don't be stupid, start saving early. If you save enough in your 30s, you'll be set for life even if you never save another penny again.

 

[<(^_^)>]

Sorry Slim but this isn't the last bout of hyperinflation you will see in your lifetime. You better start saving up those dollars because they are going to buy a lot less in 20-30 years than they do today. The end result of massive federal deficits will be higher inflation down the road. By that time you will be too old and too burned out to make the $12 million it takes to retire. Hence, I recommend you go make the money NOW and invest it so you end up with $12+ million.
Those who are doing locums are pulling in $800K+ and can invest $200K per year to reach that goal. I strongly suggest you make hay while the sun is still shining.

Come on man, you honestly are saying people can't retire if they have <12 million dollars? Saving 200k a year nets you 20 million in today's money after 30 years. What on earth do you do for fun (especially at 60+) that is going to require that much money? Polo? Flying private jets? I just don't get it.

 

[Nocturnist]

Come on man, you honestly are saying people can't retire if they have <12 million dollars? Saving 200k a year nets you 20 million in today's money after 30 years. What on earth do you do for fun (especially at 60+) that is going to require that much money? Polo? Flying private jets? I just don't get it.

It's not that people can't retire, you're just in for a shock once you do.

You need $2.30 to buy what a buck in 1990 bought you. If you think that right now you need 5M to retire (to provide a 200k income in retirement), you're likely to need 12M in 30-35 years to have the same purchasing power.
Are you flying jets and playing polo with the future's equivalent of 200k/year?

Another way to look at it: what would your lifestyle look like on 80-90k instead of 200k a year today? Far from "cant retire", but probably nothing like what you imagined.

I do think for most physicians the number is somewhere between 5-10M. You should aim for 10. Less than 5 is not an acceptable target.

 

[<(^_^)>]

It's not that people can't retire, you're just in for a shock once you do.

You need $2.30 to buy what a buck in 1990 bought you. If you think that right now you need 5M to retire (to provide a 200k income in retirement), you're likely to need 12M in 30-35 years to have the same purchasing power.
Are you flying jets and playing polo with the future's equivalent of 200k/year?

Another way to look at it: what would your lifestyle look like on 80-90k instead of 200k a year today? Far from "cant retire", but probably nothing like what you imagined.

I do think for most physicians the number is somewhere between 5-10M. You should aim for 10. Less than 5 is not an acceptable target.

200k a year doesn’t get you 20 million in 30 years. It gets you 20 million in today’s dollars in 30 years (or roughly 37.5 million in future $ if you want to say 3% inflation).

If I want the equivalent of 5M in today’s $ in 30 years I’ll invest ~50k a year.

My savings rate is much higher because I want to be able to say “I’ll just retire” if a job goes to crap and I like the area…or if I get to 50 and just want to go part-time I want the freedom to be able to do that.

 

[Nocturnist]

200k a year doesn’t get you 20 million in 30 years. It gets you 20 million in today’s dollars in 30 years (or roughly 37.5 million in future $ if you want to say 3% inflation).

If I want the equivalent of 5M in today’s $ in 30 years I’ll invest ~50k a year.

My savings rate is much higher because I want to be able to say “I’ll just retire” if a job goes to crap and I like the area…or if I get to 50 and just want to go part-time I want the freedom to be able to do that.

I'm not sure we're on the same page?

When I refer to 200k, I'm talking about the income I would like to draw per year from my future nest egg, which I am saying may need to be closer to 400-500k in 30 years adjusted for inflation.

I think you are talking about how much you need to save per year? I dont know, I'm not really clear what you're trying to say.

 

[aneftp]

Wealth doubles every 7-8 years.

Most of my friends who are retired do not even touch their principal balances.

Once you ready say 10 million. You literally can make 90k a day on the stock market in your taxable account like yesterday.

So once you get to your magic number. You will be amaze how much money makes itself.

Of course we are peasants compared to the scam artists private equity guys with their vast wealth. Most of that money obtained via shady highly leverage transactions with close to zero risk to them

 

[Nocturnist]

Wealth doubles every 7-8 years. at 9-10.2% return, if untouched. Not to say it cannot do that, but counting on that return in retirement might be aggressive for some.

Most of my friends who are retired do not even touch their principal balances. that's the idea of a safe withdrawal rate- to have a principle balance large enough to live off the interest/dividends.

Once you ready say 10 million. You literally can make 90k a day on the stock market in your taxable account like yesterday. or you can lose 1.2M in a day like in March 2020. The idea is to have a large enough number to ride out the turbulence and still sleep well at night knowing it'll all even out over time.

So once you get to your magic number. You will be amaze how much money makes itself. The 4% withdrawl rule comes from the trinity study from the 1990s (later extended through around 20-teens) retrospectively looking at success rates of various withdrawal rates over a 30 year retirement. 4% withdrawal rate had a success rate of 96% (defined as having any money left over after 30 years). A good percentage of the scenarios they ran at 4% were left with more money after 30 years than what they started with, though for some- a 4% failure rate is unacceptable and they may opt for a lower withdrawl rate. Many of us might also be looking at a retirement much longer than 30 years. Personally running out of money at any point in retirement is a much scarier thought to me than leaving my heirs multiples of what I retired with.

 

[pgg]

this isn't the last bout of hyperinflation you will see in your lifetime

Are we really calling the last few years "hyperinflation" now?

Hey I'm as concerned about US fiscal policy and national debt as the next guy, and I certainly favor a diverse plan to hedge for future inflation and bad economic times, but let's not distort what's actually happened with buzzword hyperbole.

To be clear: there has not been, and is not now, hyperinflation. And if you think there will be, you shouldn't be worried about accumulating some arbitrary collection of assets to a dollar-denominated goal.

 

[<(^_^)>]

I'm not sure we're on the same page?

When I refer to 200k, I'm talking about the income I would like to draw per year from my future nest egg, which I am saying may need to be closer to 400-500k in 30 years adjusted for inflation.

I think you are talking about how much you need to save per year? I dont know, I'm not really clear what you're trying to say.

Blade at one point said 200k savings a year, which is enough to have 20M in today’s dollars after 30 years. 50k a year is enough to have 5M in today’s dollars (roughly), or about 200k a year withdrawal rate. Especially once you factor in social security that’s a pretty darn comfortable lifestyle. For me personally a majority of my income goes to housing, kids, and savings so I probably would live better in retirement even with 5M.

Wealth doubles every 7-8 years.

Most of my friends who are retired do not even touch their principal balances.

Once you ready say 10 million. You literally can make 90k a day on the stock market in your taxable account like yesterday.

So once you get to your magic number. You will be amaze how much money makes itself.

Of course we are peasants compared to the scam artists private equity guys with their vast wealth. Most of that money obtained via shady highly leverage transactions with close to zero risk to them

Agreed. Mitt Romney’s dominos shenanigans come to mind.

The other thing many people miss is 4% threshold is set so that you have a >90% chance of your money lasting longer than 30 years. But if you retire at 60 you have just a 17% chance of living beyond 30 years. At 65 a 5.2% chance of living beyond 30 years.



So you’re looking at roughly 0.17 * 10 = 1.7% chance of going bust while still alive if you retire at 60 with 4% withdraw rate, and a 0.052 * 10 = 0.52% chance of going bust while still alive if you retire at 65 with a 4% withdraw rate.



Meanwhile you have a 9% chance of dying between 50 and 60. I don’t see any reason to be paranoid about running out of money at 87 when you are 5x more likely to die before ever retiring at all.

 

[<(^_^)>]

So historically at least 4% withdrawal has a 95% chance of success over 40 year period with stocks. Compare that to a 91% chance of success for making it to 60 from age 40.

Risk averse people think aggressively saving and working into old age is conservative, but that only is true if they don’t ever want to spend any of the money they saved and just want the highest possible number. It’s actually very risky in terms of the odds of failing to enjoy any amount of time in retirement. You are far more likely to die before 60 than to run out of money with a 4% withdrawal rate even over 40 years. Sort of similar to Buffett saying bonds are actually far riskier than stocks, as you risk underperformance.

 

[Dr. Rude]

So historically at least 4% withdrawal has a 95% chance of success over 40 year period with stocks. Compare that to a 91% chance of success for making it to 60 from age 40.

Risk averse people think aggressively saving and working into old age is conservative, but that only is true if they don’t ever want to spend any of the money they saved and just want the highest possible number. It’s actually very risky in terms of the odds of failing to enjoy any amount of time in retirement. You are far more likely to die before 60 than to run out of money with a 4% withdrawal rate even over 40 years. Sort of similar to Buffett saying bonds are actually far riskier than stocks, as you risk underperformance.

Yup. We have all seen people or their spouse die or get a terrible medical diagnosis totally out of the blue in their 50s and 60s. While we all think that we will be that rare vital mentally sharp person who makes it to 90ish.
If work gives you purpose and meaning...keep working, at least part time. I am much happier napping, screen time, playing with the dogs, exercise than nine out of ten days at very part time work.

 

[sloh]

Error

 

[GravelRider]

Sorry Slim but this isn't the last bout of hyperinflation you will see in your lifetime. You better start saving up those dollars because they are going to buy a lot less in 20-30 years than they do today. The end result of massive federal deficits will be higher inflation down the road. By that time you will be too old and too burned out to make the $12 million it takes to retire. Hence, I recommend you go make the money NOW and invest it so you end up with $12+ million.
Those who are doing locums are pulling in $800K+ and can invest $200K+ per year to reach that goal. I strongly suggest you make hay while the sun is still shining.

Don’t call me Slim.

I save a lot. The nice thing about saving a lot is my lifestyle is cheap…even in HCOL area. That was the point of my post…the more you need to maintain your lifestyle, the less you are likely to have. That’s all I said. I save and invest well over $200K per year, but thanks for the advice.

 

[aneftp]

Don’t call me Slim.

I save a lot. The nice thing about saving a lot is my lifestyle is cheap…even in HCOL area. That was the point of my post…the more you need to maintain your lifestyle, the less you are likely to have. That’s all I said. I save and invest well over $200K per year, but thanks for the advice.

Wife ? Kids?

 

[nimbus]

Don’t call me Slim.

I save a lot. The nice thing about saving a lot is my lifestyle is cheap…even in HCOL area. That was the point of my post…the more you need to maintain your lifestyle, the less you are likely to have. That’s all I said. I save and invest well over $200K per year, but thanks for the advice.

Ok chief

I’m the same. I’m cheap and I don’t spend a lot. My hobbies are running, dog walking, and listening to hi-fi. The hi-fi was kinda expensive until I decided I was satisfied. Nowadays the only money I spend on it is for a hi-res streaming service. Occasionally I’ll splurge for concert tickets. Don’t really see myself changing my habits after I retire.

 

[GravelRider]

Wife ? Kids?

Both. House too. Spouse is part time and earns <$100k.

 

[GravelRider]

Ok chief

I’m the same. I’m cheap and I don’t spend a lot. My hobbies are running, dog walking, and listening to hi-fi. The hi-fi was kinda expensive until I decided I was satisfied. Nowadays the only money I spend on it is for a hi-res streaming service. Occasionally I’ll splurge for concert tickets. Don’t really see myself changing my habits after I retire.

Chief or sir are both acceptable 😉

Both my wife and I come from blue collar kinds of backgrounds. Neither of us care about luxury items like jewelry, clothes, or cars. It’s just not in our personality. Our house is in a nice neighborhood with a good school district, but would not meet HGTV standards of kitchen updates and white/gray walls. We could update our 15-20 year old kitchen, but it seems like a waste of $150k. It’s functional and meets our needs as a family. We splurge on dinners out and vacations. We could spend another $20-30K per year on vacations and still be fairly frugal. I imagine our kids will cost us more as they grow up, but I will probably have met or surpassed certain financial goals by then.

Oh and we keep our house at 62-64 degrees in the northeastern winters. A sweatshirt is a lot cheaper than natural gas or oil.

 

[nimbus]

Oh and we keep our house at 62-64 degrees in the northeastern winters. A sweatshirt is a lot cheaper than natural gas or oil.

I grew up in the Midwest and my immigrant parents did the same. Sometimes my mom wore insulated ski bibs around the house.

Btw-the worst is when a salesman you just met calls you “my friend.” 100% chance they will try to rip you off.

 

[triggermaster]

Yeah, because TEPSLF allowed non-qualifying repayment plans to count, but that’s over.

Reading up on this I learned that there is a PSLF buyback program in which you can pay what you would have paid during a deferment period and get credit toward PSLF. I had 95/120 credits already and if this buyback works I’ll get loans forgiven as soon as it can be processed!
It’s hard to keep up with the constantly changing rules. Hopefully this works! I’ve already paid way more than my original loan amounts, but I’ll be happy to have the rest forgiven.

 

[rowsdower88]

Reading up on this I learned that there is a PSLF buyback program in which you can pay what you would have paid during a deferment period and get credit toward PSLF. I had 95/120 credits already and if this buyback works I’ll get loans forgiven as soon as it can be processed!
It’s hard to keep up with the constantly changing rules. Hopefully this works! I’ve already paid way more than my original loan amounts, but I’ll be happy to have the rest forgiven.

Thanks for sharing, could save me 3mo.

 

[jope]

Came across this graph from some medscape survey confirming we're near the top of burnout too.

 

[coffeebythelake]

Dermatology is at 46% burnout? Etf

 

[HemorrhagicShock]

Dermatology is at 46% burnout? Etf

PE has been hyper-aggressive with dermatology, as it is one of the medical businesses/specialties out there with a juicy margin

Humans are far more averse to loss than they are to the happiness/contentedness of being successful, especially when Derm is a specialty that is fought with opportunities to compare oneself to the next guy (or gal). The perceived loss of income ("I'm making the same as yesteryear despite inflation and increases in COL!"), perceived loss of practice autonomy ("Ugh, these partners are dragging me through the mud and I have to grind out XYZ patients/cases/whatever per day, when am I going to become a partner?"). The comparison one I bet is huge too - "My co-resident from 10 years ago is now a famous dermatology influencer and has multiple industry deals, and she's married with 2 beautiful children and a very successful husband that just bought their second house in a VHCOL area that I've been dreaming about for the last 5 years!"

Add in the kind of high-achieving personality that gets into derm and practices it for a few years, and all of a sudden you see where that burnout starts to creep in despite it being an objectively fantastic career.

I bet the solution to being a burned-out dermatologist is to have them work in an ER for 3-4 months. Or hell, even an anesthesia gig for 3-4 months. That burned-out dermatologist will be quickly cured and will be begging to go back to their previously perceived "sh*tty" situation.

 

[emergentmd]

This is the continuous battle most struggle with between saving and enjoying. There is no right or wrong answer.

Two docs both take home 300k both have 5M life policies until they are 90.

Doc #1 spends 50k/yr and saves 250K, and going to the $1 movies is high spending.
Doc #2 spends 300k/yr living a great life traveling and saves nothing

Who is right? No one can tell b/c you can't predict the future.

Scenario #1 has both docs getting cancer and dying at 50. I would take Doc #2.
Scenario #2 has both docs living til they are 90. I guess I would take Doc #1 but in all likelihood doc #1 still is penny pinching living a similar lifestyle to doc #2 but Doc #2 has great memories with little regrets.

If given only these two choices, I rather be doctor #2. I rather be live poor when I am old rather than living poor when I am young. Being somewhere in the middle is probably the best option; dying with just a few millions to give to your heirs. If you save/die with a lot, all of that money is likely going to go to your heirs who will spend/waste it anyways. I don't see the point of living a frugal life. I get some will say they don't need it, but I rather have a house cleaner spend 6 hrs every week than waste 6 hrs cleaning.

 

[DesiredMemberName?]

This is the continuous battle most struggle with between saving and enjoying. There is no right or wrong answer.

Two docs both take home 300k both have 5M life policies until they are 90.

Doc #1 spends 50k/yr and saves 250K, and going to the $1 movies is high spending.
Doc #2 spends 300k/yr living a great life traveling and saves nothing

Who is right? No one can tell b/c you can't predict the future.

Scenario #1 has both docs getting cancer and dying at 50. I would take Doc #2.
Scenario #2 has both docs living til they are 90. I guess I would take Doc #1 but in all likelihood doc #1 still is penny pinching living a similar lifestyle to doc #2.

If given only these two choices, I rather be doctor #2. I rather be live poor when I am old rather than living poor when I am young. Being in somewhere in the middle is probably the best option dying with just a few millions to give to your heirs but if you save/die with a lot, all of that money is likely going to go to your heirs who will spend/waste it anyways. I don't see the point of living a frugal life. I get some will say they don't need it, but I rather have a house cleaner spend 6 hrs every week than waste 6 hrs cleaning.

There’s a lot of truth there.

Most people spend less in retirement for a variety of reasons. Less active, poorer health, less energy, etc.

Those who spend their entire life scrimping and saving are not likely to just turn on a dime and ramp up spending when they hit retirement. In fact, it can be extremely difficult for people with a scarcity mindset to ever feel good about increasing their spending.

The other thing is that the utility of money spent at a younger age (e.g. 35-45) is likely greater than the utility of the same money spent at an older age (e.g. 65-75).

None of that even accounts for the possibility of death or significant disability that can be just a CVA/MI/Car crash away for any of us at any time. I’m far more concerned about the prospect of missing out on my life than the danger of not having enough money in retirement.

It’s great to plan/save responsibly for retirement, but I think some people on here take it too far. Maybe it has to do with the “nose-to-the-grindstone” mindset of those who spent the first couple decades of their adult life deferring gratification. I can see how it could be hard to turn that off.

 

[emergentmd]

Case #1 - Relative who make 100K+ starting in the 80's retired at 65. I would guess atleast 5M in assets if not more. Never spent much on anything. I can't think of one nice thing he bought/has. Vacations were just plain basic stuff. Wanted to buy a Tesla. Wife said no, why do you want one at this age (I have one and he liked it). No less than 1 yr into retirement had bacterial endocarditis, threw a bunch of septic brain emboli and now has limited mobility with a 10 yr old cognitive abilities.

Worked hard for 40+ years, didn't enjoy the $$$, have 5M+ and now his wife/kids gets to spend it all.

This is literally the most miserable scenario I can think of.

A 20K vacation at age 20 > at age 30 > at age 40 >> at age 50 > at age 60 >>> at age 70 >>>>>>>>>at age 80.

What is the point of going to Hawaii at age 70 and you can barely move around? I want to go to Hawaii snorkeling, swimming with the turtles, zip lining. When I am 70, I probably will just want to be left alone b/c everything hurts.

To this, I am at FIRE right now and spend more than most take home in a year on this thread. Yeah its a waste, but I have worked hard and want to enjoy it/enjoy it with my family. I feel sorry for the penny pinchers who retire being penny pinchers b/c their head can't get past "wasting" money. I can guarantee you that someone will spend your money as 3 generations money is typically gone.

 

[GravelRider]

This is the continuous battle most struggle with between saving and enjoying. There is no right or wrong answer.

Two docs both take home 300k both have 5M life policies until they are 90.

Doc #1 spends 50k/yr and saves 250K, and going to the $1 movies is high spending.
Doc #2 spends 300k/yr living a great life traveling and saves nothing

Who is right? No one can tell b/c you can't predict the future.

Scenario #1 has both docs getting cancer and dying at 50. I would take Doc #2.
Scenario #2 has both docs living til they are 90. I guess I would take Doc #1 but in all likelihood doc #1 still is penny pinching living a similar lifestyle to doc #2 but Doc #2 has great memories with little regrets.

If given only these two choices, I rather be doctor #2. I rather be live poor when I am old rather than living poor when I am young. Being somewhere in the middle is probably the best option; dying with just a few millions to give to your heirs. If you save/die with a lot, all of that money is likely going to go to your heirs who will spend/waste it anyways. I don't see the point of living a frugal life. I get some will say they don't need it, but I rather have a house cleaner spend 6 hrs every week than waste 6 hrs cleaning.

You are also using that money to buy time, so to speak. Your scenarios didn’t discuss retirement age and hours of life spent working. I’m frugal, but I pay for a house cleaner and someone to mow my lawn. I don’t enjoy doing either, so it’s a good use of my money. I can use that time to do something I enjoy. By saving more while you are younger, you are buying time that your older self can spend doing something other than work. The earlier you achieve financial independence, the earlier you can exercise options like working part time or retiring fully. You may be able to overcome that by working more while you are young to both enjoy a richer lifestyle and achieve financial independence, but then you are right back where you started where you are wasting your youth.

There’s always a trade off when you are required to use your labor to earn income, like most of us. Finding that balance is an individual decision. My idea of a successful life saving and investing is that I bounce the final check to the funeral home.

 

[lotsapain]

I mean...out of all the variables related to people wanting to leave the Anesthesia work force, you landed on DEI?

I agree that was the only conclusion ANEFTP made? why does everything have to constantly come down to
discrimination

 

[ucsfgaspain]

Although many of you are right about utility of enjoying life is front loaded. i.e. the utility of a year in your 20's is much more than in your 90's. The potential pitfall you fall into when living the "good life" early is that you artifically inflate your minimum baseline too early. Ie let's say you start flying first class or private in your early 20's. the pitfall is that your tolerance for economy may now be "weakened" Now you expect to fly every flight as first class, biz, or charter. This is a huge spend for a "luxury" and now the ;luxury becomes an essential. This is where you have to know yourself. Can you practice the ascetic lifestyle intermittently to reset your baselines?

As an old fart now, I am somewhat fortunate to have the ability to stay at all the "top tier luxury places". But you know what? The favorite memories I have of travel is being a poor college grad backpacking through europe sleeping in flea infested hotels with buddies. I now have a sanitized and curated experience all over the world which is still fun and interesting but not as visceral and engaging. I will every year however do a solo dirt bag trip somewhere in the world to go bikepacking to explore. These are awesome since I just eat street food and stay in places my spouse would never tolerate. It's how I've made good friends all over the world.

The other point I will make is that doing hard things or menial things i.e. cleaning the bathroom or fixing the broken sprinkler doesn't make sense in a pure economic sense. Except you are missing the potential external non fiscal benefits. i.e. it may be a benefit to do crappy things to build inner strength. i.e. develop grit and build self reliance. Yes I hate digging up broken sprinkler heads and messing it up so now I have to replace the pvc pipe...but it makes me feel good to figure out how to figure out simple plumbing and how to join pvc together with plumbers glue etc. Sure it would have taken way less time and probably cost a lot less if I just had my gardener do it. But there is a certain amount of self pride and self actualization when doing a project on your own.

Not saying that this appeals or works for everyone. But an alternative viewpoint from a guy that's been around the block. YMMV.

 

[emergentmd]

Bottom line is do whatever makes you happy, but look deep to be honest with yourself about what happiness is.

If working 60hrs wk, living like a college student, saving $$$ to give to charity/heirs is what brings you happiness, then do it.
If living check to check and realizing you will work until you are past retirement makes you truly happy, then do it.

Just don't be dishonest with yourself and penny pinch/live check to check making others around you miserable. Everyone knows those relatives and friends who penny pinch when its on their dime but when its on another person's dime spend lavishly. Those are the unhappy ones not true to themselves.

 

[pgg]

Came across this graph from some medscape survey confirming we're near the top of burnout too.

The only thing that chart really shows is that a lot of doctors feel burned out. No kidding.

I mean, it's not even actionable information for a medical student contemplating what specialty to go into. No med student who dreams of delivering babies is going to pick general surgery over OB/GYN based on that chart.

It's existential dread clickbait anxietyporn. Like this thread.

 

[pgg]

The other point I will make is that doing hard things or menial things i.e. cleaning the bathroom or fixing the broken sprinkler doesn't make sense in a pure economic sense. Except you are missing the potential external non fiscal benefits. i.e. it may be a benefit to do crappy things to build inner strength. i.e. develop grit and build self reliance. Yes I hate digging up broken sprinkler heads and messing it up so now I have to replace the pvc pipe...but it makes me feel good to figure out how to figure out simple plumbing and how to join pvc together with plumbers glue etc. Sure it would have taken way less time and probably cost a lot less if I just had my gardener do it. But there is a certain amount of self pride and self actualization when doing a project on your own.

Completely agree.

There's a fine line between paying other people to do laborious stuff for you, and paying other people to live your life for you.

Earlier this week I got home from work and hung some drywall. I'm in no hurry to get that part of our renovation done. It'll get done when it's done.

Today I'm pre-call and I'm going to spend a couple hours doing the final prep on about an acre of land I cleared (that I could've paid someone else to clear) so it'll be ready to plant a small orchard. In a couple weeks when the dormant trees are delivered I'll plant them, even though I could pay someone to do that. 10 years from now, when I'm picking fruit (that I could also pay someone to do), I'll be happy to think I planted them.

Obviously the better financial decision and time-conserving choice would be to drive to Walmart and buy fruit there. But that's not the point.

 

[GassYous]

Completely agree.

There's a fine line between paying other people to do laborious stuff for you, and paying other people to live your life for you.

Earlier this week I got home from work and hung some drywall. I'm in no hurry to get that part of our renovation done. It'll get done when it's done.

Today I'm pre-call and I'm going to spend a couple hours doing the final prep on about an acre of land I cleared (that I could've paid someone else to clear) so it'll be ready to plant a small orchard. In a couple weeks when the dormant trees are delivered I'll plant them, even though I could pay someone to do that. 10 years from now, when I'm picking fruit (that I could also pay someone to do), I'll be happy to think I planted them.

Obviously the better financial decision and time-conserving choice would be to drive to Walmart and buy fruit there. But that's not the point.

Best time time to plant a tree was ten years ago. Second best time is today.