just a quick point- education in many districts/states isn't a bad deal from a financial perspective. Virtually no student loan debt, and it's very easy to move into mid level school administration. Making 115k as an assistant superintendent(there are literally dozens of these in many districts) overseeing middle school math cirriculum for the district is a pretty sweet deal....especially when you consider there is little to no student loan debt, continuous work since age 22(you go to grad school while working full time), and benefits/retirement that would make even the VA employees blush. Someone like that in their mid 40s who is making 115k in that position is actually making more 'real' money than a lot of psychiatrists I know who make 180kish when you consider everything(opportunity cost, benefits, etc).....
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just a quick point- education in many districts/states isn't a bad deal from a financial perspective. Virtually no student loan debt, and it's very easy to move into mid level school administration. Making 115k as an assistant superintendent(there are literally dozens of these in many districts) overseeing middle school math cirriculum for the district is a pretty sweet deal....especially when you consider there is little to no student loan debt, continuous work since age 22(you go to grad school while working full time), and benefits/retirement that would make even the VA employees blush. Someone like that in their mid 40s who is making 115k in that position is actually making more 'real' money than a lot of psychiatrists I know who make 180kish when you consider everything(opportunity cost, benefits, etc).....
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Nothing. These are market forces and advocacy issues more than residency training. And although there's always a population that does handwringing, this is not a psychiatry issue, it's a MEDICINE issue. Psych and FP has NPs, gas has nurse anesthesists, path has outsourcing, rads has nighhawks, etc. etc. etc.
If you're looking for something to calm your fears you either have to do some navel gazing and resetting of expectations, get involved with reshaping healthcare, or getting involved with physician advocacy groups. Your residency programs aren't the solutions here.
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Once again, bureaucratic process rules.
I'll avoid digressing about the VA and the care. Suffice to say, there are current inconsistencies that you and Vistaril have about the environment.
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No defense of social work as a path to affluence?
But seriously, I have enough teacher friends (both young and middle-aged) to know how difficult it is to become and remain an administrator. Politics, parents, and on and on. And I know how few of them complete their higher education with no debt (spoiler alert: zero).No defense of social work as a path to affluence?
you know a very different set than me then. I have lots(> 10) of family and extended family who were K-12 teachers and later administrators(most still are). None of them racked up any educational debt, and none of them had trouble 'remaining' in their job. Heck, even when a middle school principal around these parts does something really really really bad, they usually just get a lateral transfer and not fired or demoted.
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Awesome! Looks like I have good news for my teacher friends in the rural Midwest who are struggling make ends meet, pay rent, and pay down their loans. They will be happy to hear how well-off they are.
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Back to the OP, you mention your in one of the 10 biggest cities in the US. I don't think psych is the only field where people are finding the job markets to be a little less than ideal in the big cities. I know path has issues in big cities these days, optho is super saturated in many areas and rads folks are having to do a couple fellowships to find jobs they want in big cities. Obviously all those other specialties will pay higher than psych in the same market, but they are still having some issues with jobs in big cities as well.
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... and nearly every job type has over-supply in big cities. That's part of the definition of a big city - oversupply.
hmmm....well that's especially puzzling because the Midwest contains some of the states with the highest salaries out there. It's not unusual for classroom teachers(not asst principals or cirric coordinators) to have 80k+ average salaries in many Midwestern disricts, with some experienced teachers topping 100k.
As for debt....I don't know what to tell you there- if they borrowed lots of money and are school teachers, they were going to borrow lots of money to do anything. You only need a bs before you star working full time in the field, so why would they need to borrow lots of money to do that? That is nonsensical, and speaks more to them than it does the field of education.
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Yeah they are terrible people who had to borrow a bunch of money for undergrad since they had no scholarships and parents who couldn't help them. Undergrad costs money these days.
so go to a cheap state school and work part time(both of which are VERY feasible for someone who is an education major)......there is no excuse for someone to come out of an undergrad education major owing a bunch of money. none.
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I'll tell them to return their degrees (yes, from a state university) and go to a cheaper state school. Oh wait, they went to the cheapest state school that was available. And yes, I am thinking of a specific couple in particular, and yes, they have educational debt from their 4-year degrees at their in-state university. Surprise. It happens. Frequently.
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Where the HECK do you get these numbers??????
Sometimes I think you are living in a completely alternate reality from the rest of us...
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He is on another planet it seems. The median annual salary for a kindergarten teacher in Duluth, Minnesota is $50,700, the 90th percentile being $68,963.
yes, that's one district. I didn't say every district in the Midwest had an 80k average. If one district has a 50k average, there is a good bet that some districts in the Midwest have a much higher average.
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Since you made it through college and medical school, I have to figure that you have some degree of book smarts and just lack life experience and common sense.
There are dozens of reasons that someone could graduate college without the opportunity of getting through debt-free. I can't fathom how you could make it through undergrad without meeting exactly these people.
Not everyone grew up where, when, and how you did, V...
I'll admit I am excluding special cases.....for example, having kids in college or whatever. But I think that's a reasonable assumption given that people in college can finish by the time they are 22.
So let's take a poor person age 18 who goes off to the state U to major in education. If he/she is truly dirt poor, they are probably eligible for pell grants(don't even get me started on that program). So that takes away a big chunk of the loan burden right there.
But let's say that for whatever reason they don't get pell grants and their non-improverished parents(since they don't get pell grants) refuse to contribute anything. Well let's imagine that they get a part time job averaging only 20 hours a week during the school year(reasonable being an education major). And let's say it only pays a dollar an hour more than minimum wage(again, very reasonable and conservative). Then let's imagine that during the summer they up this to a stil reasonable 30 hours at the same salary.
Now take all the money they earn at this low paid part time job and apply it against room and board at the cheap stateU. Heck even throw in some money for other things(cheap car, liability car insurance, etc)......my guess is that the person is going to graduate with no or very little debt. Now does every undergrad who goes to the stateU and majors in education do this? No. But that's in large part due to choices, and goes a lot towards the person making those choices....
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No. You can't weasel out of this one. Show me the data. Show me ONE (it should be more than one--since you think it's "not unusual") public district between the Rockies and the Great Lakes--oh hell, between the Rockies and the Appalachians--that has an average salary for a classroom teacher of over $80,ooo annually. Put up or shut up.
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Then what you said was wrong and not thought through. Nuff said.
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I don't know why I bother since you consistently double down when you're wrong, but I'm going to try just this once, since your comment smacks with the out of touch elitism so common in medicine that at least once a month I have to bite the inside of my cheek...
Let's say this student, call her Jane, works like you say, 20 hours a week, never takes a day off, never misses a shift for four years. And works 30 hours weekly during a 12 week summer. Also never missing a day. Heck, let's make it 40 hours during the summer.
At $8.25 per hour ($1 above federal minimum wage which is minimum wage for over half the states)? That comes to $10,560 per year. Before taxes. In a country where the average in-state university tuition and fees is $8,893. Leaving a balance of $139 per month for things like food and rent. Assuming she doesn't pay any taxes. Because if she pays taxes, she can't even afford tuition on that and will have $0 to live on. Car and insurance? You're out of your mind.
And this assumes that she isn't one of the "special cases" (by which I presume you mean "not like me"). This assumes she has no outside responsibilities during her college years. Assumes she doesn't have kids. Assumes she isn't supporting ailing parents. Assumes she doesn't get sick. Assumes she has nothing and no one to think of for those glorious four years other than having fun.
In my experience, Vistaril, the people who talk most about "choices" are the people who grew up blessed with "options." Be bigger than that.
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So many of our threads end up as Vistaril vs. The People. Nothing productive comes of it, and, as I pointed out 2 YEARS ago, the people end up worse off.
How can we ensure high quality threads around here?
How can we ensure high quality threads around here?
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We can stop the Chicken Little-ing.
Seriously, I get that things may seem like this in some parts of the country, but I haven't seen this happening. None of our grads had trouble finding well paying jobs last year, all in metro areas.
Are NP's a threat? Sure. But, there's simply not enough of them to go around. PCP's have this same fear, but there's not enough NP's to fill that shortage either, and that's assuming ALL of the NP's went into family med. The reality is that psych is not what most NP's want to do.
Secondly, if they're such an amazing source of profit, why aren't you all opening private practices and hiring an army of NP's?
We have an NP school at my residency. In my 2 years so far, I've seen exactly 1 NP student expressing even an interest in psychiatry. One. They don't even remotely have the numbers to fill our shortage.
Some areas of the country do have a relative oversupply of psychiatrist. I remember Charleston SC coming to mind when I was interviewing. They have a large residency, and an old one. So many residents have stayed in town after graduating that it has filled most of the need there...or so I was told when I was interviewing. Other market forces, like the hospital system exodus in Fonzie's city, may cause temporary over-supply in some areas, but the fact is that most areas are begging for psychiatrists (or NP's).
I agree that we should limit NP's ability to practice fully independently, except possibly in the most extreme rural or underserved areas, where some care would be better than no care...
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I didn't want to feed the troll, but it really touches a nerve when (as was mentioned above) people in medicine simply can't see beyond themselves to the realities around them. People are struggling. To diminish or dismiss that struggle as "they weren't working hard enough" or "they didn't take advantage of their options" is incredibly insulting. There are many people with full-time employment who are genuinely fighting to stay afloat, particularly those who recently graduated and have a pile of loans they couldn't avoid. Sorry this thread turned into a trainwreck. One could argue that perseverating about the demise or non-demise of this profession is equally useless, but that's part of what we do here I suppose.
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LoAWhere the HECK do you get these numbers??????
Sometimes I think you are living in a completely alternate reality from the rest of us...
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If we extend the car maker analogy from the previous post. We have a situation where residency programs are turning out a product that ends up being fungible with one that takes a third of the time to produce.
Either the process needs to be retooled so it takes less time. Or product quality needs to be improved so people can see the clear difference between a physician and a fancy nurse.
The idea that training doesn't need to adapt to the times just doesn't make any sense though. If training doesn't adapt medicine will no longer be an attractive option. Why take on the training and debt burden when a NP can do the same work for the same money?
I really don't see how we've let ourselves get to this point. What do our professional organizations actually do for us? You don't see paralegals with the right to take on clients. We seem to have given away the keys to the kingdom.
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Ignore feature works like a charm.
Admittedly, I signed out to read his posts this time because everyone is talking about him.
Notdeadyets post obliterated his argument. I did laugh at "unusual" or special circumstances, he's on his own planet.
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Like what? Residency? That saves 1 year max. The MD needs to lose 1 year also, 2 years is at least significant.
How many years are you suggesting? We'd need 3 or more to change the landscape.
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No. I don't actually think medical training needs to be shortened. I think there is something of real value in our training. I'm a physician, I studied at a university that predates the discovery of the New World. I very strongly believe in the existing tradition of medical training, and the idea that a physician is more than a technical worker. I don't think we need to turn into vocational school, and I think it'd be a tragedy if we did.
On the other hand we seem to have reached a point where the public, employers, governments no longer see that value in us. The rise of independent practice and prescriptive authority for NPs is essentially medicine as a profession being told that the our extra training doesn't add value.
I think we need to figure out how to show the value we have or add more.
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Gotcha. I disagree with shortening the training process. To follow your analogy, this would be a luxury car maker lowering standards to appeal to a broader market (which has been attempted). What happens is that you can never really compete with the low cost leader and you dilute your brand value amongst discerning buyers.
We are not going to compete with NPs on price point, nor do we want to. It is impossible to do without drastically lowering physician salaries, which we don't want.
So we have to compete with NPs on quality. Show that we can offer something they don't. We are slow to come around to this idea because the medical industry has an inherent ego built into it that we are coming around to realizing too late the most of the world does not share. And that belief is that no one can replace a doctor doing anything…
So how do we compete? We can do so with service offerings. Things like ECT, consult liaison, standalone inpatient psych, etc. we have a very specific value add when we position ourselves as PHYSICIANS that specialize in mental illness.
Where we have a harder time is when we find ourselves in essentially non-physician roles. As therapists? We need to be able to show that we can provide better product than our psychologist and NP counterparts. As care team leads? Same thing. Doing outpatient medication management? Same thing.
So the impetus is in my mind is to improve on quality. Lots of psychiatry residencies are already doing just that. I haven't heard many folks that go to the especially strong psychiatry residencies complain about not being able to find satisfying and good paying work after graduation. But when the pinch comes, it's going to be more felt at the weaker programs. Programs in which therapy training isn't strong and produces ho-hum therapists that are limited to a little CBT and MI that waters down the MD brand and makes patients think they're better off with psychologists or MFTs. Programs in which stressing the integrative care model and psychiatrists acting as physicians is not a strength, so they are unable to function as effective leaders. Programs that don't offer opportunities's to specialize in very specific areas of care in which psychiatrists can establish themselves and thrive.
So when we talk about improving residency training, I wholly support really improving the training at particular programs, attracting stronger applicants, and holding everyone to higher standards of training. This gets rid or reduces the shockingly sizable number of psychiatrists out there that are REALLY bad, don't do their job well, reduce the credibility of the specialty, and dilute the brand. This is how we will establish ourselves as something that is not very easy to replace. If you want to sell more cars, you make a better car.
But dumb down the training to try to compete with NPs on price point? That's a very bad strategy…
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I'm one of those that doesn't post very often on the forums (life's busy, often a lurker).
I will say that I'm:
- A recent grad (<2 years ago).
- I'm in a big metro area as well.
- I'm in a similar position to f0nzie in that I have a cash private practice on the side and have other income 3 days a week (basically locums).
With out going into too much detail, the sky is not falling. Make the most out of your opportunities and don't merely be a pushover. I had several job offers outside of residency and didn't take a single one of them (Kaiser, few different community MHCs, inpatient work, etc). I didn't like a single one of them because of various things (# of patients per day, restrictions of not being able to work elsewhere - Kaiser, pay, or some combination of the above).
I was doing locums/shift work for a while before I decided to take a job working 4 days a week (four 10 hour shifts). After a while it became evident I needed to spend more time on my PP, so now I'm back to doing 3 x 10s in a locums sense. The PP is still a work in progress and will continue to be.
Yes we have our challenges, and yes there will be socioeconomic and macroeconomic pressures, but figure out a way to over come them.
On a side note: At some point people (that are able to) will realize you get what you pay for. You can shop at Walmart or Sears for clothes, yet Nordstrom, Louis Vuitton, etc are doing better than ever. You can buy lunch at McDonalds or Taco Bell, yet Whole Foods, Chipotle, etc are doing just fine.
I will say that I'm:
- A recent grad (<2 years ago).
- I'm in a big metro area as well.
- I'm in a similar position to f0nzie in that I have a cash private practice on the side and have other income 3 days a week (basically locums).
With out going into too much detail, the sky is not falling. Make the most out of your opportunities and don't merely be a pushover. I had several job offers outside of residency and didn't take a single one of them (Kaiser, few different community MHCs, inpatient work, etc). I didn't like a single one of them because of various things (# of patients per day, restrictions of not being able to work elsewhere - Kaiser, pay, or some combination of the above).
I was doing locums/shift work for a while before I decided to take a job working 4 days a week (four 10 hour shifts). After a while it became evident I needed to spend more time on my PP, so now I'm back to doing 3 x 10s in a locums sense. The PP is still a work in progress and will continue to be.
Yes we have our challenges, and yes there will be socioeconomic and macroeconomic pressures, but figure out a way to over come them.
On a side note: At some point people (that are able to) will realize you get what you pay for. You can shop at Walmart or Sears for clothes, yet Nordstrom, Louis Vuitton, etc are doing better than ever. You can buy lunch at McDonalds or Taco Bell, yet Whole Foods, Chipotle, etc are doing just fine.
https://www.dailyherald.com/article/20121114/news/711149940/
Illinois counts right? That took all of about 2 seconds, and there are clearly *lots* of districts in just that one midwestern state that pay over that.
no, 'excuses' being the key word. Having children as a late teen or 20 yo when you can't support yourself yet is not a good excuse. Do people make poor decisions and get themselves into pickles, financial and otherwise? sure......
of course not, and that's the point- those are crappy jobs imo. I had the same choices and like you passed. But not taking crappy jobs(for the reasons you cite) and then ending up taking a locums position is hardly an argument that the sky isn't falling.
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It's telling that you latch on to that (or half of that, as sick parents aren't a choice) and conveniently ignore how the work-study plan you proposed yourself as evidence of how one has no excuse to graduate from undergrad with debt specifically shows that over half the country couldn't even cover tuition on that and many-to-most couldn't cover rent.
because your numbers don't jive(or is it jibe? and why can I never remember?) with reality- for example you mention that those numbers exclude income tax. Yes, they do, and that changes the numbers significantly....but not how you intended. People who work and make those sorts of salaries have a tremendously negative tax burden....just taking EITC and the federal education tax credit, both of which your hypothetical poor student would be eligible for, tacks on 4k or so annually to to the mix. Just like that. And that's not even going into all the other possibilities....the chance that this person doesn't qualify for pell grants, any state grants based on low income, have any state education programs they are eligible for, etc is very very low.
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Oh sweet irony. The numbers were supplied by you. I just did the calculations to show you were wrong. Re-read your post, man. You stated folks would have no excuse for student loans if they worked 20 hours/week during the year and 30 hours/week during summer making $1 above minimum wage excluding grants and all the rest. That reality came from you. You are really giving the image of the disgruntled kid in short pants moving the goal posts when his shots don't go where they want...
It's jibe, by the way. I always have to stop and think about that one before I type it too...
No, I didn't. Re-read. I said these numbers exclude taxes. She will not be paying income tax (though I believe minimum is still going to be about 10% unless that's changed), but she still will need to pay SS, medicare, and the like. If someone is paid using a valid SSN, they do not take home all of their salary without paying the government.
No, even with tax credits it reduces their tax burden. It doesn't increase their income. So even when you exclude all taxes and this person essentially gets paid cash (the best case scenario for take home), this person makes $138/month after paying tuition. You proposed this was enough to live on and avoid taking loans. This is wrong.
We are not going into the "other possibilities" because you stated that even without the other possibilities, someone would have no excuse to get through undergrad with debt if they were willing to work 20 hours during the school year, 30 hours over summer, making a buck an hour above minimum wage. Re-read your post. You supplied this scenario and the conditions in its entirety and now that you are seeing you don't like the results, you are shifting the scenario rather than acknowledge that maybe your assumption wasn't right. Your inability to incorporate new evidence into your (mis)understanding of something is why when you make claims to the contrary with folks, there is a credibility issue.
By the way, since you give the impression of someone who isn't real familiar with the financial aid system, a pell grant maxes out at $5,600/year. This still would not reduce the cost enough for the student above to attend without taking loans (unless you feel that $600/month is enough for rent, food, car, insurance, books, etc.). And the pell grant eligibility isn't determined based on her income, it's done based on her parents income. It's great your mom and dad were able to pay for your college, not every student has that option, even if they earn more than the poverty level. Though I acknowledge you likely see this as an "excuse."
Nuff said, evidence to the contrary is there. You are unable/unwilling to accept and would prefer to remain right than actually learn a little bit about a segment of our population that is probably much larger than you realize. Understood. I've done my best to shed an alternate colored light, but my impression is that the mind is closed tighter than a kettle drum. I'll leave you to it.
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Agreed. My apologies for the participation in this. Against my better judgment. I'm done.
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Oh, I understand it's difficult to not debate dumb comments. I wasn't criticizing you. It's just funny how V's threads turn out.
No, tax credits(EITC + educational tax credits) do not simply make tax burdens neutral or reduce tax burdens for much of this population. not even close. It puts them into highly negative territories. There are tons of data on this. I'm not sure where you got this idea. Many of my patients who made less than 15k dollars last year actually got 7k or so 'back' in taxes.
As for me supplying the data and not including stuff like this in the calculations. Well that's because I'm not trying to do cpa level work here. My point was just to show that working part time creates money, and this combined with other sources of money(like pell grants and state funds) come together to make going to state schools for basically no debt very feasible. And note that I didn't say every state school. Or live a comfortable lifestyle while doing so. If you want to be debt free after undegrad it may mean not going out to eat, driving a beater car, living in the dorms, etc..... There are things called sacrifices some people choose to make.
My general impression is that there is FAR too much student aid available out there. Far too many loans(although you are right thats not the discussion at hand since I stated students should be able to get otu of undegrad loan free if they want). College is not a right, and as a country we are probably doing far too much to give people access to post-secondary education. It hurts many of them in the long run. Google all the articles on the education scam, student loan scams, etc.....the existence of federal grant(relevant to this discussion since it's grants) and federally backed loan money is basically a transfer of wealth from taxpayers(ie you and me) to commercial education interests(cappella, Virginia college, phoenix univ) and then the educational establishment at large.
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So I read a few sentences of V's previous post...
I hate when people do this, but you do have to admire the skillful trolling on display.
He's managed to find a single weakness in a global argument (taxes/blah blah) while completely ignoring the main point - which is that he had an elitist attitude towards anyone who had college debt (I did!).
The ability to ignore 97% of entire posts and then hinge onto a irrelevant issue and argue it - trolling of the highest order. Bravo.
I hate when people do this, but you do have to admire the skillful trolling on display.
He's managed to find a single weakness in a global argument (taxes/blah blah) while completely ignoring the main point - which is that he had an elitist attitude towards anyone who had college debt (I did!).
The ability to ignore 97% of entire posts and then hinge onto a irrelevant issue and argue it - trolling of the highest order. Bravo.
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Well you win...
I really had no idea that those particular affluent Chicago suburban districts would be considered representative of Midwestern teachers' salaries--but I challenged you to find me one example, and clearly you did. I have friends who've raised their kids in a couple of these top 5 districts, btw. Definitely exemplary, outstanding schools, funded in part by high property values in the communities, and characterized by their ability to "employ teachers who have longer-than-average careers, as well as a large number of teachers who have earned advanced degrees, which boosts salaries."
Now as to whether our mythical self-supported 4-year education BS student would be raking in these salaries when the "usual" state average salary for a teacher is ~$66K...I'll leave that as a speculative exercise for the reader, though it appeared to me that these districts are actually fairly UNusual in a number of respects. But your definitions of what might be "not unusual" are fairly different than mine. I'd have to add that it's also clearly "not unusual" for a student to graduate from, say, the University of Alabama with more than $20 grand in debt(1), and be going to work for $36k or less (2), maybe looking forward to making an average of $50k or so later in their career(3).
1-http://www.wbhm.org/News/2012/collegedebt
2-http://www.nea.org/home/2012-2013-average-starting-teacher-salary.html
3-http://www.teachingdegree.org/alabama/salary/
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, I believe Vistaril is correct regarding the Earned income tax credit.
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Check the calculation. Someone earning $10,500, filing single without children has an EITC of $292.
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That's not much. I meant that it added to income, but I guess $292 isn't worth mentioning. Of course with 1 child, it's over $3000, but I guess Vistaril's example was without kids.
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lol. Why are we discussing earned income tax credits in a psychiatry thread about current practice environment?
