Best ways to make money outside of high paying specialties?

[PhillyMed777]

@Perrotfish was referring to passive income based on investment accounts. 2 million in index funds @5% return provides 100K in returns.

yeah you are right...my B
anyways the concept is hammered into others that don't know so no foul

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[libertyyne]

This is not verified but is widely attributed to Einstein :"Compound interest is the 8th wonder of the world", living frugally and investing in low fee index funds coupled with good diversification is an almost surefire way to be well off.

 

[kb1900]

This is not verified but is widely attributed to Einstein :"Compound interest is the 8th wonder of the world", living frugally and investing in low fee index funds coupled with good diversification is an almost surefire way to be well off.

Living below one's means isn't an easy thing to do especially when one's "means" quadruples the second they pay off their 6 figure loans. It's insane the amount of residents I saw at the hospital who are pumped to buy a new car as soon as they achieve attending status.

If they really wanted to make money they'd invest diversely as you said

 

[AcademicNeurosurgery]

Lol. "Unethical". It is nowhere near unethical for a person who spent 12+ years getting an education to see however few patients they desire, and for whatever cost they so please. If you do concierge medicine you can also do charity care for free here and there. Not everyone wants to be part of the corrupt ultra-consolidated government-hospital complex where the physician burn-out rate is >50%.

You can certainly argue that but everyone's motivations for medicine are different. Also, I would not be against someone who did what you describe but realistically, how many concierge docs are heavily involved in charity work? It's certainly possible but concierge medicine draws people with a certain perspective. You can sugarcoat it all you want and come up with one random example of someone who uses the resources they accumulate from concierge medicine to help those in need but this is not representative of the field in general.

 

[AcademicNeurosurgery]

First off, he/she did not contradict themselves, you are simply treating Kantian ethics as if they are the only valid ethical system in the world. "If everyone did it shows that it is an unethical practice" is an application of Kantian ethics, more specifically the formula of universality/the categorical imperative, which certainly isn't the only valid view of ethics and morality that exists in the world.

If you are a strict adherent of Kantian ethics, the following must be true: It is always unethical to lie. What if you lived in a society where petty theft was punishable by death? Is it unethical to lie about someone stealing $5 in order to save their life? Based on Kant's categorical imperative, he would say that it is. If you believe in your original statement, that "if everyone did it it shows that it is an unethical practice," it follows that you, like Kant, would say that lying in this instance is unethical, as lying is always unethical.

I think we can both agree that that is ridiculous and the context of a situation certainly should play a role in the morality of a decision, suggesting that Kantian ethics are, to a degree, flawed as a complete system of ethical reasoning.

Long story short: the only way for what you claim to be true is if Kantian ethics are the only valid ethical principles, which is not only close-minded but arrogant.

This is a completely false pretense, I'm not sure you understand his philosophies. I never suggested Kantian ethics is the only ethical system and my isn't based on his views. The OP contradicted themselves by saying it would be problematic if everyone did it but it's okay if only a few do it. This is implying that inherently the act is unethical but since only a few people are doing it, the consequences are not significantly pronounced and the ethical acts of the larger population outweigh the unethical acts of a few.

 

[aprilfools]

The OP contradicted themselves by saying it would be problematic if everyone did it but it's okay if only a few do it. This is implying that inherently the act is unethical.

This is quite literally taken almost verbatim from Kantian ethics.

By asserting this, whether you mean to or not, you are implying that Kantian ethics are the correct ethical principles.

 

[intubesteak]

This is the worst thread ever

 

[Elessar]

This is the worst thread ever

When a thread devolves into arguments about Kantian ethics:

 

[flapjack3d]

This is the worst thread ever

Yeah can we not flex our philosophy 101 knowledge on sdn

Suffice to say everyone has different opinions about what's right and wrong. As long as people are doing what they think is right, then they're doing better than most of us

 

[kb1900]

Yeah can we not flex our philosophy 101 knowledge on sdn

Suffice to say everyone has different opinions about what's right and wrong. As long as people are doing what they think is right, then they're doing better than most of us

How utilitarian of you to say!!!

 

[iqe2010]

In my very limited experience, doctors who make insane amounts of money (or significantly more than their colleagues) seem to have their own business in some way.

There's this older doctor that opened his own lab back in the 70s because there were none in the area where he worked. Fast forward to today it's one of the largest lab groups in that area and that dude is a millionaire.

I've read here on SDN that doctors can supplement their income by 100k/year if they open up an urgent care clinic and get a mid-level to run it.

And of course there are cash-based practices/DPC.

But I think most doctors are like everybody else, they don't want their own business. They want to leave work and not have to worry about being the boss. Business ownership isn't for most people, IMO.

 

[68PGunner]

You can easily double or triple your physician salary if you have some business sense. Being a doc will set you for life. However, if you want to reach the upper echelon of income, a business or investment sense is a necessity.

 

[Naruhodo]

Personally, I was pissed when the primary care provider my family (including grandparents) had gone to for years decided he wanted to switch to a concierge practice. It felt like a betrayal that he wanted to drop everyone except 200 people or so willing to pony up.

However, recently I have tried to be more generous in my thinking on this. Physician burnout, especially among those PCPs on the front lines is ridiculously high. Has anyone else here followed the Turntable Health story (started by the real life alter-ego of ZDoggMD)? Admittedly, it would be nice to have a health system incentivized to keep people well with preventative medicine, rather than to do billable things to patients once they are already sick.

 

[68PGunner]

Personally, I was pissed when the primary care provider my family (including grandparents) had gone to for years decided he wanted to switch to a concierge practice. It felt like a betrayal that he wanted to drop everyone except 200 people or so willing to pony up.

However, recently I have tried to be more generous in my thinking on this. Physician burnout, especially among those PCPs on the front lines is ridiculously high. Has anyone else here followed the Turntable Health story (started by the real life alter-ego of ZDoggMD)? Admittedly, it would be nice to have a health system incentivized to keep people well with preventative medicine, rather than to do billable things to patients once they are already sick.

The physician doesn't own you or anyone anything. At the end of the day, he is within his own rights to gear his practice in such a way that will maximize his happiness.

 

[AcademicNeurosurgery]

The physician doesn't own you or anyone anything. At the end of the day, he is within his own rights to gear his practice in such a way that will maximize his happiness.

Just because you have a right to do something, doesn't necessarily mean it is ethical. The goal is for the two to be congruent but that's not always the case. He has a right to see as many or as few patients as he'd like but whether or not it is ethical is up for debate as seen in this thread.

 

[AnatomyGrey12]

You can easily double or triple your physician salary if you have some business sense. Being a doc will set you for life. However, if you want to reach the upper echelon of income, a business or investment sense is a necessity.

Or just do elective spine surgery. A crappy pt population but basically a license to print money

 

[kb1900]

Just because you have a right to do something, doesn't necessarily mean it is ethical. The goal is for the two to be congruent but that's not always the case. He has a right to see as many or as few patients as he'd like but whether or not it is ethical is up for debate as seen in this thread.

You're the only one debating it lol

 

[68PGunner]

Just because you have a right to do something, doesn't necessarily mean it is ethical. The goal is for the two to be congruent but that's not always the case. He has a right to see as many or as few patients as he'd like but whether or not it is ethical is up for debate as seen in this thread.

So it's not ethical for him to see less pts, maximize his time off, and increase his happiness. Get out of here.

 

[dpmd]

Living below one's means isn't an easy thing to do especially when one's "means" quadruples the second they pay off their 6 figure loans. It's insane the amount of residents I saw at the hospital who are pumped to buy a new car as soon as they achieve attending status.

If they really wanted to make money they'd invest diversely as you said

Really, that is a situation where it is insanely easy to live below one's means. It is just that people don't prioritize wealth accumulation and focus on material goods.

 

[AcademicNeurosurgery]

You're the only one debating it lol

Your point? I'm more than happy to share what I believe in. If one person disagrees with something, it's debatable by definition.

 

[AcademicNeurosurgery]

So it's not ethical for him to see less pts, maximize his time off, and increase his happiness. Get out of here.

My point is to explain to you that rights do not equal ethics. And we're talking about this in the context of concierge medicine. I know it's hard to believe, but there are people with beliefs and motivations different than yours.

 

[68PGunner]

My point is to explain to you that rights do not equal ethics. And we're talking about this in the context of concierge medicine. I know it's hard to believe, but there are people with beliefs and motivations different than yours.

Yes, but that doesn't give you the right to label someone as being unethical bc they want to see less pts and maximize their happiness. If they are not breaking any laws, they should do whatever that makes them happy.

 

[AcademicNeurosurgery]

Yes, but that doesn't give you the right to label someone as being unethical bc they want to see less pts and maximize their happiness. If they are not breaking any laws, they should do whatever that makes them happy.

I never said it's unethical to see less patients in order to maximize happiness. Frankly, depending on the situation, less patients may mean less burnout, more time with each patient, and ultimately better patient outcomes. Again, this discussion originated from the concept of concierge medicine - it's not with regards to someone who has a balanced payer mix.

You're killing me with the last sentence. You know very well that legality and ethics do not always go hand in hand. Plenty of absurd things were once legal.

 

[Future.miss.doctor]

Is making 6 figures not good enough anymore?

 

[aprilfools]

Is making 6 figures not good enough anymore?

Thank you for the very useful self-righteous contribution to this thread.

 

[tymont12]

Is making 6 figures not good enough anymore?

low six-figures is very different from high six-figures.

 

[sloh]

Conventional PCP practices generally force physicians to see patients within an allotted time frame that makes quality and comprehensive care difficult, if not impossible, to achieve.

One of the most salutary (and ethical) aspects of concierge/DPC practiced is that there is more time to increase the chances of a physician providing quality and comprehensive care. Also, consider that burnout is less likely when you don't feel like you're chronically exhausted running on a hamster wheel thereby extending your career and providing care for more patients via a longer career.

A nice thought experiment is this: "as a patient how would you feel if your physician provided you with substandard care because he had to rush to see the next patient?"

When the demand of patients exceeds the supply of doctors, IMO the solution should be to increase the number of physicians, not decrease the quality of care we provide. Yes, that means some patients may go without care but we don't live in a utopia



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[Naruhodo]

I feel like I should add that in the case of our family physician, concierge medicine was his way of easing into retirement after a long career spent with a broad patient base. Totally within his rights, but I was just posting about what my gut reaction was when I was on the patient-end of his decision to transition from being a regular PCP to the concierge model.

 

[MSTP18]

low six-figures is very different from high six-figures.

Similarly, low six figures in manhattan or SF is very different from low six-figures in rural iowa.

 

[iqe2010]

Really, that is a situation where it is insanely easy to live below one's means. It is just that people don't prioritize wealth accumulation and focus on material goods.

What's the point of making money if you can't buy shiney new things?

 

[dpmd]

What's the point of making money if you can't buy shiney new things?

Financial independence is a whole lot more satisfying than any shiny thing.

 

[libertyyne]

What's the point of making money if you can't buy shiney new things?

If you save enough , quickly enough and invest it, you can buy those shiney things without working.

 

[dpmd]

If you save enough , quickly enough and invest it, you can buy those shiney things without working.

Plus by then you come to realize that time and experiences are so much more valuable than things

 

[cbrons]

Personally, I was pissed when the primary care provider .

lets not use nursing lobby political terms

 

[masaraksh]

Plus by then you come to realize that time and experiences are so much more valuable than things

Yeah time and experiences are very important, which is what pushes me away from high paying surgical subspecialties.

 

[Hakuna Matata]

Is making 6 figures not good enough anymore?

It's a little more complicated than that when you're $400k in debt at 7% interest and in a primary care specialty.


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[Perrotfish]

Conventional PCP practices generally force physicians to see patients within an allotted time frame that makes quality and comprehensive care difficult, if not impossible, to achieve.

One of the most salutary (and ethical) aspects of concierge/DPC practiced is that there is more time to increase the chances of a physician providing quality and comprehensive care. Also, consider that burnout is less likely when you don't feel like you're chronically exhausted running on a hamster wheel thereby extending your career and providing care for more patients via a longer career.

A nice thought experiment is this: "as a patient how would you feel if your physician provided you with substandard care because he had to rush to see the next patient?"

When the demand of patients exceeds the supply of doctors, IMO the solution should be to increase the number of physicians, not decrease the quality of care we provide. Yes, that means some patients may go without care but we don't live in a utopia

The issue, though, is that volume is what makes a good physician. Doctors who see less than half a clinic per week get really crappy, really quickly. Clinic doctors generally see 1-2 serious kinds of pathology in a 25 appointment/day clinic, and its barely enough to keep up. I have no idea how a DPC doc keeps up skills with 25 patients per week.

 

[MSTP18]

The issue, though, is that volume is what makes a good physician. Doctors who see less than half a clinic per week get really crappy, really quickly. Clinic doctors generally see 1-2 serious kinds of pathology in a 25 appointment/day clinic, and its barely enough to keep up. I have no idea how a DPC doc keeps up skills with 25 patients per week.

I know right? All that charting and a million routine checkups is way more educational than reading the literature or having time to engage in lengthier discussions with specialists.

 

[VA Hopeful Dr]

The issue, though, is that volume is what makes a good physician. Doctors who see less than half a clinic per week get really crappy, really quickly. Clinic doctors generally see 1-2 serious kinds of pathology in a 25 appointment/day clinic, and its barely enough to keep up. I have no idea how a DPC doc keeps up skills with 25 patients per week.

That's true, I mean if I didn't see that 20th URI in a day I'd be just the worst doctor ever.

 

[VA Hopeful Dr]

I know right? All that charting and a million routine checkups is way more educational than reading the literature or having time to engage in lengthier discussions with specialists.

I would put the skills of a DPC doc up against a FFS doc any day.

Let's face it, if you're seeing 30 patients per day anything unusual is getting punted to the specialist anyway since you don't have time to do a thorough evaluation anyway. Most of us manage way more complicated patients ourselves because we have the time to actually do it.

 

[DaTruMD]

I would put the skills of a DPC doc up against a FFS doc any day.

Let's face it, if you're seeing 30 patients per day anything unusual is getting punted to the specialist anyway since you don't have time to do a thorough evaluation anyway. Most of us manage way more complicated patients ourselves because we have the time to actually do it.

Are there groups that hire for direct primary care? Or do you usually have to start that by yourself?

 

[VA Hopeful Dr]

Are there groups that hire for direct primary care? Or do you usually have to start that by yourself?

There are a few corporate groups, but they tend to be employer-based meaning you'll be taking care of employees+/- families of a single employer.

There are quite a few DPC practices out there who are actively hiring, so you don't have to start your own practice if you don't mind potentially moving.

 

[Perrotfish]

I know right? All that charting and a million routine checkups is way more educational than reading the literature or having time to engage in lengthier discussions with specialists.

If reading and talking with specialists is the way to understand medicine then residency is a waste of time and we should just do board study courses instead. But we all know that isn't true. Doctors need experience. A strong study routine turns good doctors into great doctors, but doctors who read without seeing patients never even get to good.

The issue is that, while most patients are normal and boring, the sick/interesting ones rarely come labeled as such. If you're not working in an ICU then yes, you need to be doing 'a million routine checkups' so that you get to see the ones that aren't routine. Every serious or interesting thing I have seen this month came in labeled as either 'well child check' or 'cough/congestion/fever'. If I saw 1/5th as many check ups and URIs I would see 1/5th as many interesting patients.

 

[VA Hopeful Dr]

If reading and talking with specialists is the way to understand medicine then residency is a waste of time and we should just do board study courses instead. But we all know that isn't true. Doctors need experience. A strong study routine turns good doctors into great doctors, but doctors who read without seeing patients never even get to good.

The issue is that, while most patients are normal and boring, the sick/interesting ones rarely come labeled as such. If you're not working in an ICU then yes, you need to be doing 'a million routine checkups' so that you get to see the ones that aren't routine. Every serious or interesting thing I have seen this month came in labeled as either 'well child check' or 'cough/congestion/fever'. If I saw 1/5th as many check ups and URIs I would see 1/5th as many interesting patients.

And I guarantee there are things you've missed by not spending enough time with patients during those many well checks you do

 

[MSTP18]

If reading and talking with specialists is the way to understand medicine then residency is a waste of time and we should just do board study courses instead. But we all know that isn't true. Doctors need experience. A strong study routine turns good doctors into great doctors, but doctors who read without seeing patients never even get to good.

The issue is that, while most patients are normal and boring, the sick/interesting ones rarely come labeled as such. If you're not working in an ICU then yes, you need to be doing 'a million routine checkups' so that you get to see the ones that aren't routine. Every serious or interesting thing I have seen this month came in labeled as either 'well child check' or 'cough/congestion/fever'. If I saw 1/5th as many check ups and URIs I would see 1/5th as many interesting patients.

Or by virtue of allowing more than 15 minutes per patient, complex patients seek you out because they get superior care.

Also training and staying on top of things are two different modes of learning and require different demands. Why don't we require every physician to work residency style hours?

 

[W19]

Is making 6 figures not good enough anymore?

If that 6 figures is $999,999.00, that is a 'yes' for me...

 

[Naruhodo]

lets not use nursing lobby political terms

Oops. But seriously, the NPs at the hospital where I work basically run the ship.