Emergency Medicine Wins!!! More Residency Positions

[Rekt]

Not sure why this graph doesn't include neuro. Neurology is one of the fastest growing resendencies as well. Was trying to find the data source but some of this crap is pretty hard to find.

---

Members don't see this ad.

 

[miacomet]

There's a large shortage of neurologists that's been going on for a long time - that's not new. Some of the differences with us and other specialties is:

1. Reliance on history/exam over testing/imaging makes it difficult to "fake" your way through, which turns off midlevels
2. Not a lot of med students are interested in neurology because, let's face it - the subject matter is not for everyone!
3. We can't pound through 50 patients/day like derm can because so much of what we do relies on a thorough history/exam, so neuro is just not as lucrative to VCs

You rely on the physical exam. An APP can order a study and bill more!
Students may think ortho is more appealing, but once neuro is $$$ they will flock to it.
You can pound through a ton of patients when they flood the market with neurologists.

 

[GeneralVeers]

You don't need a neurology physical exam when you can just MRI a patient from head to toe.

 

[curiousneuro]

You don't need a neurology physical exam when you can just MRI a patient from head to toe.

And that's going to diagnose your GBS patient? Or your INO that has a DWI-negative stroke?

That's why pan-imaging in neuro just doesn't cut it.

 

[curiousneuro]

You rely on the physical exam. An APP can order a study and bill more!
Students may think ortho is more appealing, but once neuro is $$$ they will flock to it.
You can pound through a ton of patients when they flood the market with neurologists.

Without the physical exam and clinical context, the studies are meaningless. But, your right - doesn't mean APPs aren't just going to pan-order stuff and hope to nail something down. But in neurology, it'll be like stumbling in the dark. But I guess it doesn't mean they won't try....

 

[Apollyon]

And that's going to diagnose your GBS patient? Or your INO that has a DWI-negative stroke?

That's why pan-imaging in neuro just doesn't cut it.

Sarcasm, person!

 

[curiousneuro]

Sarcasm, person!

My apologies, long day on inpatient service, that went right over my head.

 

[GeneralVeers]

My apologies, long day on inpatient service, that went right over my head.

View attachment 336546

Mostly sarcasm with a grain of truth. NPs pan-image patients in the ED and ICU without doing a real exam, so I would expect the same garbage workups in neurology as well.

 

[skougess]

And that's going to diagnose your GBS patient? Or your INO that has a DWI-negative stroke?

That's why pan-imaging in neuro just doesn't cut it.

Again, the administration doesn’t care about good medical care. They have no qualms about bouncing the GBS patient from NP to NP after they’ve stripped the insurance company of 3 MRIs and 30 lab tests before finally getting to the single neurologist they’ve hired in their system.

What you would consider a bug, they consider a feature.

 

[emergentmd]

Wait, what. Nothing neurology does an NP can't do until tomorrow with a neurologist at home to consult for a whole city. If an NP can run an ICU overnight, an NP can't run neurology consult? What?

 

[emergentmd]

So in 7 yrs, 14000 new slots? They project 100K shortage. So in about 9 yrs it would surpass the 100K shortage and essentially be oversupplied by 14K/yr. In 20 yrs, there will be 140K oversupplied.

I will pray for all the premed students. I will make my $$$ while I can still make it.

 

[Splenda88]

College and medical school teaches altruism and tells students that they need to "help people". They are told time and time again that money isn't important, and if it is to them then they aren't right for medicine.

During my med school opening day (at a big reputable school) the Dean said that he was disheartened that anyone would talk about what kind of Mercedes they were going to buy when they graduate. He stated that if any student in the room thought that was important they should leave now.

Lol. Was he/she really serious?

I just signed a contract and I am already thinking about buying an E-class next year.

 

[wamcp]

Wait, what. Nothing neurology does an NP can't do until tomorrow with a neurologist at home to consult for a whole city. If an NP can run an ICU overnight, an NP can't run neurology consult? What?

Let’s not confuse “can” with “permitted”. Noctors are allowed to run ICUs for the sake of admin bonuses, but they can’t actually run them in any competent manner

 

[Taurus]

Again, the administration doesn’t care about good medical care. They have no qualms about bouncing the GBS patient from NP to NP after they’ve stripped the insurance company of 3 MRIs and 30 lab tests before finally getting to the single neurologist they’ve hired in their system.

What you would consider a bug, they consider a feature.

Pan scanning = job security for radiologists

When the radiology leaders were trying to predict future workforce needs, one of the important variables they factored in was increased utilization of midlevels and their predisposition to order more and often unnecessary imaging studies.

 

[.Asterion]

I think EM is first, then anesthesiology. Rad Onc and Pathology will continue to wallow.

After that will be a straight across the board decline of the hospital based IM subspecialties. Pushed in part by expansion of ARNP/PAs filling more and more roles. One can already see this in Sleep Medicine. Look at the job postings. More and more are ARNPs. Most places only want one sleep doc, and then an army of ARNPs/PAs which is the impending Big Box shop model for everything.

Surgical specialties will start to decline some, too, straight across all surgical specialties as re-alignments of insurance pay suppression intersects with Big Box Shop medicine gobbling up more percentages of surgical practice. That even if they are still well compensated that money will go to the employer overlords and not the docs. States with Certificate of Need will prevent the exodus to surgery centers meaning everyone is stuck in the hospital - a bad place to be. They will decline, not crumble, and the financial pay in concert with the shorter career span, and higher opportunity cost to get there, means anyone really thinking will ask themselves - is this really worth the cost?

Derm will be next to be crushed, but not as bad as EM or Rad Onc or Path. Some degree of patient loyalty will exist for the annual skin checks and if the determined derm puts the shingle up, gets rocked for a few years financially they will eventually have their own. Their own little practice with stable patients and freedom, but it will be a harder road to achieve when surround by Big Box shops and every wannabe derm out there. FM/IM/EM reborn/NDs/ARNPs, etc.

Radiology will likely start to succumb to the pressures or midlevel encroachment, too.

OB/GYN simply won't grow. They will continue on as is, because all future growth will be in duloas and midwives etc. Hospitals will continue to need them for coverage of "oh shoot we need a c-section stat!" but the rest of their expertise and skill will be disregarded like the rest. Over time, the independent OB groups slowly trickle down because of Draconian hospital Big Box shop practices that push out any independent groups and their quest to have only their medical groups.

Next to fall is CC, as EM flood into its ranks, with anesthesiology too, then the Big Box shop pressure to staff with layers of ARNPs/PAs will hasten its decline.

Next to fall is Pain because of the cascading dominos of exit seekers seeing fellowships as their out. Pure saturation. Same for hospice; but hospice will also have midlevel encroachment.

Ophthalmology will get hit by declining reimbursements, Optometry expansion and similar to the other surgical specialties, is it worth the cost?

Peds will fall next because all the ARNPs completing FNP certifications will simply see them as 'little people' and a weekend CME course will get them up to speed. Some protection will exist for peds to flee to fellowships for awhile, but they too will become populated by ARNPs/PAs with only few signatory docs around for ornamental purposes. There will be unemployed Pediatricians.

PM&R will suffer next, but quietly, because there are so few of them and most people don't even know they exist. Token docs will be kept around for Rehab hospitals, but their only outpatient future rests on graces of ortho/neurosurgery groups keeping them around. There will be unemployed PM&R.

Psychiatry won't fall, but it will get tough. Big Box Shop jobs will become saturated by ARNPs/PAs. I'm in a saturated area now and already seeing it. My practice is growing slowly, so I'm a bit more in the front of the wave than other locations in the country. Hospitals will only keep around token docs for being med directors. The remaining Psychiatrists will flee to niche environments like eating disorders or addiction facilities but these are such low volume anyways, quickly they saturate, too. The rest flee to outpatient practice but there they are met with steep competition from ARNPs already in practice. Some will choose the path of very slow insurance based practice growth with rates that are well below medicare; others will opt cash but quickly the realties of cash and med check focus isn't enough volume and they have to do therapy. There is room for therapy/med check and patients will delight in this. Because a patient goes from being 400+ down to 100+ there is room for this surge. It will in some circles be considered a positive rebirth for psychiatry as more niche practices develop. Trauma clinic, GAD clinic, depression clinic, etc. Even hallucinogen therapy clinics... But one barrier to this, will be the psychology prescribing as they get their scope of expansion, because they are ticked off at the masters levels therapists. Psychiatry will survive, but it will be tough, it will be slow rate of growth and it will be very focused on niche practices and the niche wave will push further and further rural. Psychiatry will be akin to dentistry and people will look to take over (even buy?) retiring practices. Some practices will expedite their growth by liberally using benzos and stimulants; This will persist until/if an opioid epidemic reality strikes at the level of national players that seek to eliminate benzos are tighten down on stimulants - but before it happens there will be a flood first.

PCPs will be more resilient as they are PRIMARY. They will be able to open all sorts of independent practices. Cash/ retainer/ DPC/ boutique/ whatever. As their numbers surge, and they start to have only a handful of token docs around for the Big Box Shops, niche practices will start to develop. But this will also intersect with the earlier waves of disenfranchised EM and other docs who opened random niche clinics. Perhaps around this time something drastic happens. MD/DOs cease granting degrees and ARNPs inherit the land, or a flexner style report happens again, cleans house and shuts down all ARNPs, PAs and a bunch of medical schools and completely re-tools the medical sphere.

Neurology is the real winner. Because even PAs and ARNPs know that neurology is tough and few dare to enter in the first place and those who do get chewed up and spit out quickly. Neurology numbers expand that Big Box shops rejoice to know that every stroke service is adequately staffed and every outpatient clinic is adequately staffed. And although Neurology becomes the winner in this race to the bottom they are equally bitter as everyone else. Because now in the hospital they feel like a cog, meaningless rag like everyone else, and in the outpatient clinic they feel like a Psychiatrist with every single non-neurological psychosomatic complaint that gets referred to them by every ARNP elsewhere in the health system. HA of two days, see Neurology! 22yo tripped and hit their head while drunk on spring break in Cancun, no deficits or further symptoms, go see Neurology! (just to be sure...) They can't complain about filtering out BS consults because, well, they know they are truly the last to turn out the lights.

Radiology doesn’t have a midlevel problem.

 

[Prehealth1011]

Neurology graduates can work outpatient. EM can't

That's the big problem here. Yeah "all specialties are fked" to some extent but not all of them need a hospital to be built for jobs to be created

 

[sylvanthus]

Radiology doesn’t have a midlevel problem.

Yet

 

[GeneralVeers]

Lol. Was he/she really serious?

I just signed a contract and I am already thinking about buying an E-class next year.

He was serious. This kind of Communist/Altruistic approach was all too common at my big, academic medical school.

 

[Mad Jack]

I wonder how the EM match in 2022 will compare to nephrology
View attachment 336506View attachment 336508


View attachment 336509

AY 2020 Nephrology Match

The difference between a fellowship and a residency is a fellowship doesn't buy someone a potential ticket to the United States on a permanent basis. PGY-1s will always fill with hopeful IMGs, who will then work for any wage offered so long as it comes with a J1 waiver in a saturated market.

 

[CajunMedic]

I've never understood the G wagons. I've never ridden in one or driven one, so maybe I don't know what I'm missing. But what's so good about them? To me they just look like an overpriced Jeep designed to separate yuppies from their money. Turn me into a G-wagon fanboy.

My wife is more of the G-Wagen fan than I am. I’ve ridden in them. The ride and interior is typical Mercedes. It does feel a little top-heavy. It has 3 locking differentials for actual off-roading (for people that actually off-road in them, they do exist!) A fully depreciated one can be had in good condition for a fraction of a new one.

I wanted a Porsche Panamera Sport Turismo for my “Attending Car”, but given what’s going on in EM, decided to wait until the student loans are paid off. Got a great deal a couple of months ago on a Volvo V90 Cross Country with the Polestar performance package. Surprisingly quick, plus it’s all wheel drive. My commute to work after residency is 45 minutes to an area that gets more snow than where I live. Seemed to be a good compromise

 

[sloh]

911 Turbo S. CMS can eat it.

 

[Birdstrike]

My wife is more of the G-Wagen fan than I am. I’ve ridden in them. The ride and interior is typical Mercedes. It does feel a little top-heavy. It has 3 locking differentials for actual off-roading (for people that actually off-road in them, they do exist!) A fully depreciated one can be had in good condition for a fraction of a new one.

I wanted a Porsche Panamera Sport Turismo for my “Attending Car”, but given what’s going on in EM, decided to wait until the student loans are paid off. Got a great deal a couple of months ago on a Volvo V90 Cross Country with the Polestar performance package. Surprisingly quick, plus it’s all wheel drive. My commute to work after residency is 45 minutes to an area that gets more snow than where I live. Seemed to be a good compromise

I just sold my "attending car," a 2014 BMW M6 Coupe, which I must say, was pretty bada$s. But my family outgrew it. So I sold it and got a Volvo s90, which is pretty great actually. It's super comfortable, huge inside and isn't a money pit like the M6 was. It's also all wheel drive and moves pretty quick for a very big sedan. I might keep this one a very long time.

 

[Birdstrike]

911 Turbo S. CMS can eat it.

I love 911's. Haven't gotten one yet. Closest I ever got was my M6.

 

[Splenda88]

I just sold my "attending car," a 2014 BMW M6 Coupe, which I must say, was pretty bada$s. But my family outgrew it. So I sold it and got a Volvo s90, which is pretty great actually. It's super comfortable, huge inside and isn't a money pit like the M6 was. It's also all wheel drive and moves pretty quick for a very big sedan. I might keep this one a very long time.

Isn't the price of M6 100k+?

 

[GeneralVeers]

Isn't the price of M6 100k+?

Yes. Any decent attending car is $100k now. Car prices have gone up astronomically in the last 5 years.

I tend to look for dealer lease specials. Got my last BMW 6 wagon for $640 per month which was great on a $73K car.

 

[turkeyjerky]

And here I thought my new (to me) mazda3 was hot ****

 

[aafisahar]

And for the more procedure-based specialties (cross post from Pain):

For all the ills of socialized medicine, literally zero countries with universal care have this problem. It's precisely the free market that's ****ing us. Quality will always take a back seat to profits in any industry.

 

[GeneralVeers]

For all the ills of socialized medicine, literally zero countries with universal care have this problem. It's precisely the free market that's ****ing us. Quality will always take a back seat to profits in any industry.

It will be great under single-payer when we are paid $100/hr to see a minimum number of patients, meet "government quality controls", and have no backup or recourse. For all the ills of venture capital and crony capitalism, I'll take them over being a government employee.

 

[Splenda88]

Yes. Any decent attending car is $100k now. Car prices have gone up astronomically in the last 5 years.

I tend to look for dealer lease specials. Got my last BMW 6 wagon for $640 per month which was great on a $73K car.

Do people who make < 1 mil/yr spend that much in car? I guess I am too conservative.

You got a steal on that lease. My friend just lease a 64k car and his payment $775, but he got 15k miles/yr.

 

[aafisahar]

It will be great under single-payer when we are paid $100/hr to see a minimum number of patients, meet "government quality controls", and have no backup or recourse. For all the ills of venture capital and crony capitalism, I'll take them over being a government employee.

Citation needed for basically that entire post.

 

[GeneralVeers]

And here I thought my new (to me) mazda3 was hot ****

If you enjoy it, then it is.

My first "Attending Car" was a bright red Porsche Cayman with manual transmission. That mid-engine car was like a go-cart to drive. Amazing fun.

Had to get rid of it because the SO said it was too small, and couldn't drive a stick.

 

[GeneralVeers]

Do people who make < 1 mil/yr spend that much in car? I guess I am too conservative.

You got a steal on that lease. My friend just lease a 64k car and his payment $775, but he got 15k miles/yr.

Yes, just look at the doctor's parking lot. Filled with Porsches and Mercedes usually. If you don't live in a high cost area, it's very easy to afford a decent house, great car and still put away money on $400K.

 

[GeneralVeers]

Citation needed for basically that entire post.

None needed. Do you really think a bankrupt government is going to pay you more than what you make now?

Department of Veterans Affairs salaries: How much does Department of Veterans Affairs pay? | Indeed.com

The average Department of Veterans Affairs salary ranges from approximately $36,239 per year for Certified Medical Assistant to $204,576 per year for Medical Director.

www.indeed.com

That's 167K divided by 1400 hours = $119/hour

 

[Splenda88]

Yes, just look at the doctor's parking lot. Filled with Porsches and Mercedes usually. If you don't live in a high cost area, it's very easy to afford a decent house, great car and still put away money on $400K.

I see. There is no physician parking lot in the academic center that I am now, and it is an issue to find parking after 8am. Hope when I start working in a few months at a smalerl hospital, there will be parking lot for docs and a physician lounge.

 

[GeneralVeers]

I see. There is no physician parking lot in the academic center that I am now, and it was an issue to find parking after 8am. Hope when I start working in a few months at a smalerl hospital, there will be parking lot for docs and a physician lounge.

It's very different at community hospitals. The hospital admin provides amenities for mainly the cardiologists and orthopedic surgeons who bring in $$$. They want them to be able to park easily and make money. Fortunately us lowly cogs get to mooch off of the "productive" doctors.

 

[sloh]

Do people who make < 1 mil/yr spend that much in car? I guess I am too conservative.

You got a steal on that lease. My friend just lease a 64k car and his payment $775, but he got 15k miles/yr.

You don't need to make 1 million/year to responsibly afford a 100k+ car.

The average household income of Porsche owners is $511k, for a 911 it is $614k. When compared to other luxury brands Porsche seems to have the highest house hold incomes of them all by a large margin:

Porsche $511k

Jaguar: $277k

Mercedes: $219k

Audi: $217k

BMW: $216k

Lexus: $168k

Of course these are averages which can be skewed by outliers that earn millions a year. The numbers are likely based on new car purchases and not used. The average 911 will carry $15k - $25k in options which brings the MSRP to around $115k - $145k depending on which Carrera variant. GT cars are up to $200k+.

Pricing breakdown for cars in the Porsche family is:

Boxster/Cayman: $357k

911: $614k

Panamera: $568k

Cayenne: $530k

Macan: $469k

 

[Splenda88]

It's very different at community hospitals. The hospital admin provides amenities for mainly the cardiologists and orthopedic surgeons who bring in $$$. They want them to be able to park easily and make money. Fortunately us lowly cogs get to mooch off of the "productive" doctors.

We all bring some revenue somehow.


1. Cardiovascular surgery

• Average revenue: $3.7 million
• Average salary: $425,000

2. Cardiology (invasive)

• Average revenue: $3.48 million
• Average salary: $590,000

3. Neurosurgery

• Average revenue: $3.44 million
• Average salary: $687,000

4. Orthopedic surgery

• Average revenue: $3.29 million
• Average salary: $533,000

5. Gastroenterology

• Average revenue: $2.97 million
• Average salary: $487,000

6. Hematology/Oncology

• Average revenue: $2.86 million
• Average salary: $425,000

7. General surgery

• Average revenue: $2.71 million
• Average salary: $350,000

8. Internal medicine

• Average revenue: $2.68 million
• Average salary: $261,000

9. Pulmonology

• Average revenue: $2.36 million
• Average salary: $418,000

10. Cardiology (noninvasive)

• Average revenue: $2.31 million
• Average salary: $427,000

These 10 physician specialties generate the most revenue for hospitals

The amount of revenue physicians generate for hospitals is typically considerably more than their annual salaries, according to a recent survey by physician staffing firm Merritt Hawkins.

www.beckershospitalreview.com

 

[southerndoc]

My primary vehicle is a Ford Explorer... decked out with red lights.

 

[EMhawkeye]

None needed. Do you really think a bankrupt government is going to pay you more than what you make now?

Department of Veterans Affairs salaries: How much does Department of Veterans Affairs pay? | Indeed.com

The average Department of Veterans Affairs salary ranges from approximately $36,239 per year for Certified Medical Assistant to $204,576 per year for Medical Director.

www.indeed.com

That's 167K divided by 1400 hours = $119/hour

Average salary in Canada for EP's is 271k

 

[oldtown]

To each their own. I’ve never been able to justify an expensive car, no matter how much I make. But, I’m not a car guy.

Im doing quite well as a business owner currently, but I still drive a $24K (new price) base model car. I’m a self flagellator though, and maximizing income:car value ratio is a badge of honor for me. When I drive this one into the ground in a few more years, I do have my eye on the new Ford Bronco series though and may treat myself by paying over $30 K for a car.

 

[turkeyjerky]

It will be great under single-payer when we are paid $100/hr to see a minimum number of patients, meet "government quality controls", and have no backup or recourse. For all the ills of venture capital and crony capitalism, I'll take them over being a government employee.

Personally I’d take 1 pph at 100/hr plus govt benefits over 2.5 pph IC for 150/hr...

 

[doctalaughs]

There's a large shortage of neurologists that's been going on for a long time - that's not new. Some of the differences with us and other specialties is:

1. Reliance on history/exam over testing/imaging makes it difficult to "fake" your way through, which turns off midlevels
2. Not a lot of med students are interested in neurology because, let's face it - the subject matter is not for everyone!
3. We can't pound through 50 patients/day like derm can because so much of what we do relies on a thorough history/exam, so neuro is just not as lucrative to VCs

Dude, derm is 100% physical exam and I have no illusions that midlevels will not slowly take over via propaganda and corporate greed.

You can shotgun over-biopsy (some PE firms literally tell their derm PAs to make sure they biopsy at least 2-3 lesions on every single visit to increase collections) but that doesn’t mean you can competently pick out the melanoma on a patient with 200+ different lesions on their body. But that’s not the point —- sadly skills/competency has ZERO influence on this game. They would literally hire trained monkeys do our jobs as long as they were “nice” to customers and the money lost via lawsuits was less than the money gained by paying lower salaries.

 

[bravotwozero]

To each their own. I’ve never been able to justify an expensive car, no matter how much I make. But, I’m not a car guy.

Im doing quite well as a business owner currently, but I still drive a $24K (new price) base model car. I’m a self flagellator though, and maximizing income:car value ratio is a badge of honor for me. When I drive this one into the ground in a few more years, I do have my eye on the new Ford Bronco series though and may treat myself by paying over $30 K for a car.

Ditto. Cant justify expensive cars, at least not until I hit FI. Going to milk that 2011 Mazda 3 for all it’s worth and then maybe get a used electric car afterwards. I will splurge more on vacations though, think that is worth it.

 

[Apollyon]

I will splurge more on vacations though, think that is worth it.

It's not what you have, but, what you do.

 

[wamcp]

Citation needed for basically that entire post.

OK. Look at Germany. They are a compulsory, universal multipayer healthcare system

In Germany, did you know a general practitioner sees 243 patients on average per week? If you work 5 days a week, that's 48.6 patients per clinic day. If you work 8 hours per day that’s 6 patients PER HOUR

German primary care in international comparison: Results of a survey of doctors | Request PDF

Request PDF | German primary care in international comparison: Results of a survey of doctors | Introduction: National health care systems differ markedly in organization and financing, in international comparison. In 2006 the Commonwealth... | Find, read and cite all the research you need on...

www.researchgate.net

Guess how much they get paid? 4000 euros/month to a maximum of 7000 euros/month in 12 years of practice. You then pay 40% of tax overall on that. THat means, after TWELVE YEARS as a physician, you get a measly sum of $54,902 USD of after-tax income per YEAR.

Income of medical doctors in Germany

www.ncbi.nlm.nih.gov

Did you know 40 percent of doctors in German municipal clinics work 49 to 59 hours a week? That one in five doctors had even higher weekly averages of 60 to 80 working hours, including all services and overtime? You add that up, that leaves only 40 percent of doctors working LESS than 49 hours a week. That is absolutely disgusting for how low they get paid.

Doctors in German municipal clinics to be on strike amid wage dispute - Xinhua | English.news.cn

www.xinhuanet.com

And finally did you know German doctors went on STRIKE as recently as April 2019? To demand a measly 5% pay raise, asking for caps on the number of hours they are forced to work, asking they be paid extra if forced to be on call, and asking for at least two weekends free per month

https://www.thelocal.de/20190410/wednesdays-doctor-strike/

Tell me...how is working and getting paid like a resident for your entire career under government healthcare... more favorable?

 

[GeneralVeers]

Personally I’d take 1 pph at 100/hr plus govt benefits over 2.5 pph IC for 150/hr...

You can have both. I'd quit.

 

[GeneralVeers]

Average salary in Canada for EP's is 271k

That's an anomaly. The only US comparison we have is the VA system. Bear in mind that's the VA having to compete with just enough pay to find physicians. When it's single payer, there will be no incentive to pay doctors enough to work. We are also in a situation of physician oversupply, unlike Canada.

 

[Splenda88]

Ditto. Cant justify expensive cars, at least not until I hit FI. Going to milk that 2011 Mazda 3 for all it’s worth and then maybe get a used electric car afterwards. I will splurge more on vacations though, think that is worth it.

What's that number for you?

I think there is a happy medium in term of driving nice car and trying to become FI ASAP.

 

[GeneralVeers]

I firmly believe you should enjoy life. What's the point in working a stressful job, and a lot of hours, and taking abuse from the hospital, patients, and nurses if you can't enjoy it? There is no reason that every EP can't have a nice house, nice car and take vacations AND still save up for retirement.

I have no kids, so who am I going to leave the money to anyway?

I believe in enjoying the money while you are young and able to do things. Why save money only to be old, infirmed and not be able to do anything with it? Don't want to wait until I'm 70, and probably shouldn't be driving anyway to have a nice car.

 

[oldtown]

I firmly believe you should enjoy life. What's the point in working a stressful job, and a lot of hours, and taking abuse from the hospital, patients, and nurses if you can't enjoy it? There is no reason that every EP can't have a nice house, nice car and take vacations AND still save up for retirement.

I have no kids, so who am I going to leave the money to anyway?

I believe in enjoying the money while you are young and able to do things. Why save money only to be old, infirmed and not be able to do anything with it? Don't want to wait until I'm 70, and probably shouldn't be driving anyway to have a nice car.

Like I said- to each their own. For me, a car gets me from point A to point B and nothing else. And, it is a depreciating asset. If I spent $100K on a car, any incremental pleasure derived from its creature comforts, status and performance (minimal in my case) would be far outweighed by regret and anger at myself over what that extra $75K spent will turn into in 20 years. Hoping to retire by 50 and not have to deal with medicine anymore, that angst is simply not worth it for me.

Cars do nothing for me. Some people are really into them. If one gets that much pleasure out of them, then have at it. But, it is certainly a good way to delay reaching ones retirement number.