Getting overwhelmed about debt, location of work, and “low income”… rising M2 considering FM

[Latteandaprayer]

Family medicine is what drew me to medical school in the first place, and I’ve done shadowing and I really enjoy the idea of being an FM physician. I know it’s premature, but right now that’s where my heart is.

The issue is, I will be married most likely by the time I’m done with school (or shortly after), unless my relationship falls apart. My future spouse needs access to an urban area for his career goals. He’s already kind of putting it on hold for me. I don’t want to and can’t end up in a rural area. That means my income will be lower.

We’re also gay, and the prospect of living in the middle of nowhere is scary… it’s hard enough even in more liberal bubbles, I can’t imagine living in a place where we’re rejected by the majority. And we want kids, and I don’t want them to suffer because they have two dads. Yes I’m painting rural areas with a broad brush, but it’s just a consideration.

I will have about $300,000 in debt upon graduation, without financial support from my family (re: I’m gay and rejected). I have no savings, neither does my partner. If we relocate, that’ll be a cost for us to consider and bear.

Of course even the lowest paid FM is going to be making a lot relative to the average income. However, after taxes and loan payments, not much is left every year. My partner’s income is likely to be around $35-40k realistically.

I’m getting extremely overwhelmed, because everyone is like “you’ll be fine, just work in a swamp for 6 years and you’ll be rich!!” but that’s a lot to ask of my partner, and it’s not something I want.

I know you shouldn’t go into medicine for the money, and ultimately I’m not, I’m just genuinely worried I’ll be barely scraping by forever.

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[cj_cregg]

I guess the big question, which you don't necessarily have to answer here, is what is an acceptable lifestyle for you? Some people will be very happy with a nice but more "modest" home, car, etc. and a couple nice vacations a year, some people want more. Also depends where you want to live - I think you said previously in another post that you'd be fine living somewhere like Michigan in a more urban area, and Detroit or Ann Arbor is going to be much more affordable than NYC, LA, etc.

Average FM starting salary is about $230-240k, and it's not hard to make more if you're productive and are doing procedures and those sorts of things in the office. Many FM jobs offer generous loan repayment opportunities - even in urban areas if you're willing to work somewhere like an FQHC or another clinic that sees an underserved community. There are also state and federal (NHSC) loan repayment options for primary care docs working with underserved populations although there are some hoops to jump through.

 

[Latteandaprayer]

I guess the big question, which you don't necessarily have to answer here, is what is an acceptable lifestyle for you? Some people will be very happy with a nice but more "modest" home, car, etc. and a couple nice vacations a year, some people want more. Also depends where you want to live - I think you said previously in another post that you'd be fine living somewhere like Michigan in a more urban area, and Detroit or Ann Arbor is going to be much more affordable than NYC, LA, etc.

Average FM starting salary is about $230-240k, and it's not hard to make more if you're productive and are doing procedures and those sorts of things in the office. Many FM jobs offer generous loan repayment opportunities - even in urban areas if you're willing to work somewhere like an FQHC or another clinic that sees an underserved community. There are also state and federal (NHSC) loan repayment options for primary care docs working with underserved populations although there are some hoops to jump through.

Nice is all I want. I don’t want two BMWs and a million dollar house, I just want to be comfortable and have enough room for everyone and a couple dogs. A vacation or two would be nice, I don’t need to go to the Bahamas each time though.

 

[VA Hopeful Dr]

Nice is all I want. I don’t want two BMWs and a million dollar house, I just want to be comfortable and have enough room for everyone and a couple dogs. A vacation or two would be nice, I don’t need to go to the Bahamas each time though.

I'm FM in a fairly small town in SC. My wife has a partner who is a lesbian, married with kids. Haven't heard of them having any issues around them being gay or having kids that have 2 mommies. She's pulling in probably 350k. The wife was a school nurse but is now a stay-at-home mom to their three kids. They have a decently comfy life.

 

[cj_cregg]

Nice is all I want. I don’t want two BMWs and a million dollar house, I just want to be comfortable and have enough room for everyone and a couple dogs. A vacation or two would be nice, I don’t need to go to the Bahamas each time though.

In that case, in all likelihood you'd be fine with a FM attending salary unless you're wanting to live in a much higher COL area.

 

[FrustratedFamDoc]

I live and practice in Georgia. I guess it's considered deep south? My area is pretty conservative, and for the most part, people don't really care, at all, what your orientation. Seriously, no one cares. I have many gay patients and couples who work, live and are happy in my community.

The things that do matter: board certified without any red flags, be able to connect with your patients, good colleague, truthful, don't complain, nice to your patients and do your best to practice good medicine. People will flock to your practice.

That's pretty much it.

Debt is a big deal. There is no getting around that and FM is on the lower end of the spectrum. As much as I love what I do, with midlevel advancement in to all primary care, it will put a downward pressure on salaries (I know I'm going to catch hell for that). Take that for what it's worth. Surgical fields are better insulated from this.

If you live very modestly, in an apartment without having the expense of a child, you can have those loans paid off within a few years. Also, PAY YOUR INTEREST EVERY MONTH WHILE IN RESIDENCY OR ELSE IT WILL CAPITALIZE.

 

[VA Hopeful Dr]

I live and practice in Georgia. I guess it's considered deep south? My area is pretty conservative, and for the most part, people don't really care, at all, what your orientation. Seriously, no one cares. I have many gay patients and couples who work, live and are happy in my community.

The things that do matter: board certified without any red flags, be able to connect with your patients, good colleague, truthful, don't complain, nice to your patients and do your best to practice good medicine. People will flock to your practice.

That's pretty much it.

Debt is a big deal. There is no getting around that and FM is on the lower end of the spectrum. As much as I love what I do, with midlevel advancement in to all primary care, it will put a downward pressure on salaries (I know I'm going to catch hell for that). Take that for what it's worth. Surgical fields are better insulated from this.

If you live very modestly, in an apartment without having the expense of a child, you can have those loans paid off within a few years. Also, PAY YOUR INTEREST EVERY MONTH WHILE IN RESIDENCY OR ELSE IT WILL CAPITALIZE.

Lots of PCP jobs come with some decent loan repayment. Lots of non-profits so can do loan forgiveness programs as well.

Or pick up a weekend of UC shifts per month, that's usually good for a couple grand per weekend to pay down loans.

 

[Latteandaprayer]

I live and practice in Georgia. I guess it's considered deep south? My area is pretty conservative, and for the most part, people don't really care, at all, what your orientation. Seriously, no one cares. I have many gay patients and couples who work, live and are happy in my community.

The things that do matter: board certified without any red flags, be able to connect with your patients, good colleague, truthful, don't complain, nice to your patients and do your best to practice good medicine. People will flock to your practice.

That's pretty much it.

Debt is a big deal. There is no getting around that and FM is on the lower end of the spectrum. As much as I love what I do, with midlevel advancement in to all primary care, it will put a downward pressure on salaries (I know I'm going to catch hell for that). Take that for what it's worth. Surgical fields are better insulated from this.

If you live very modestly, in an apartment without having the expense of a child, you can have those loans paid off within a few years. Also, PAY YOUR INTEREST EVERY MONTH WHILE IN RESIDENCY OR ELSE IT WILL CAPITALIZE.

Either way, my partner is interested in California or staying in Michigan, and so am I. That’s where we have our eyes set. And since he’s already putting his career on hold somewhat (he wants to wait to really start building it and establishing ties for when I go to residency because it’s more likely we’ll settle in that area anyway), I don’t want to keep making him sacrifice for me. Both of us are not interested in living in rural areas.

 

[FrustratedFamDoc]

You don't have to live rural to make a decent income. Just be aware that you may encounter higher living expenses in urban areas and if you are looking at the expense of a child, your loan repayment goals may be delayed. There are always extra shifts to pick up at urgent cares as VA mentioned.

Without trying to get too personal, your personal relationships better be solid as bedrock before starting residency. It tests, and destroys many relationships.

 

[AMEHigh]

I live in a one of the highest cost of living cities in the US and it’s fine. You just have to figure out your priorities. I know people are chiming in about other cities, but no I would not be happy in most other places in this country outside of a few large cities. So I deal with my salary for the benefits of the other reasons I enjoy living here.

I have no desire to own a McMansion, so that’s not appealing to me about other cities. I love that I have access to multiple international airports within a very short distance (although I haven’t really traveled much since covid) and I love the availability of different jobs in this city, especially as a FM doc. So many different opportunities and practice environments.

 

[VA Hopeful Dr]

I live in a one of the highest cost of living cities in the US and it’s fine. You just have to figure out your priorities. I know people are chiming in about other cities, but no I would not be happy in most other places in this country outside of a few large cities. So I deal with my salary for the benefits of the other reasons I enjoy living here.

I have no desire to own a McMansion, so that’s not appealing to me about other cities. I love that I have access to multiple international airports within a very short distance (although I haven’t really traveled much since covid) and I love the availability of different jobs in this city, especially as a FM doc. So many different opportunities and practice environments.

I feel like the potential of having to use Newark to travel is a con, not a pro.

 

[AMEHigh]

I feel like the potential of having to use Newark to travel is a con, not a pro.

Hahaha

 

[smq123]

I live and practice in Georgia. I guess it's considered deep south? My area is pretty conservative, and for the most part, people don't really care, at all, what your orientation. Seriously, no one cares. I have many gay patients and couples who work, live and are happy in my community.

The things that do matter: board certified without any red flags, be able to connect with your patients, good colleague, truthful, don't complain, nice to your patients and do your best to practice good medicine. People will flock to your practice.

That's pretty much it.

To be fair to the OP - I feel like straight people say stuff like, "I live in a conservative area but no one cares if you're gay here!" in order to convince themselves that their neighbors aren't bigoted a-holes. Because no one wants to believe that they're surrounded by narrow minded racist homophobes. It's an easy belief to keep up because most acts of macro-aggression aren't really tolerated anymore, and if you're not a minority, then you tend not to notice the micro-aggressions. But if you're part of a minority, and your neighbors (who might not say anything derogatory out loud) vote for state and local officials who actively try to make the lives of LGBTQ people more difficult (coughcough GREG ABBOTT coughcoughcough RON DESANTIS coughcough) then....that can be difficult to overlook.

Either way, my partner is interested in California or staying in Michigan, and so am I. That’s where we have our eyes set. And since he’s already putting his career on hold somewhat (he wants to wait to really start building it and establishing ties for when I go to residency because it’s more likely we’ll settle in that area anyway), I don’t want to keep making him sacrifice for me. Both of us are not interested in living in rural areas.

Urban California, like almost any major city on either of the coasts, will be challenging - salaries will be lower, cost of living will be much higher, decent jobs may be somewhat harder to find. Especially in California, which has a significant tax burden.

If you and your partner are ok with staying in Michigan, or somewhere sort of Michigan-adjacent (Minneapolis/St. Paul, Milwaukee, Madison, Chicago), then you will be far better off, both in terms of salary and cost of living.

As an FYI - you mentioned in your post the concern about relocating. Almost all jobs, even ones in FQHCs, pay for relocation costs. At least, they pay for moving; some may offer a sign on bonus that helps pay for other costs of relocation.

Don't try and google salaries in the area where you want to live - salary is still considered a "dirty word" for physicians, especially in primary care, and so what you see on google is almost certainly inaccurate. The only way to find out exactly what people are making is to ask them directly, keeping in mind the environment in which they work (an FQHC is going to be different from private practice which is going to be different from an academic job).

As long as you and your partner don't fall into the usual financial traps that trip doctors up, you'll be fine. I should point out that they're common financial traps because a lot of people fall into them, and doctors are notoriously terrible with money at baseline. But if you know what they are ahead of time, and come up with a strategy how to avoid them, then you'll be ahead of the game.

 

[Latteandaprayer]

To be fair to the OP - I feel like straight people say stuff like, "I live in a conservative area but no one cares if you're gay here!" in order to convince themselves that their neighbors aren't bigoted a-holes. Because no one wants to believe that they're surrounded by narrow minded racist homophobes. It's an easy belief to keep up because most acts of macro-aggression aren't really tolerated anymore, and if you're not a minority, then you tend not to notice the micro-aggressions. But if you're part of a minority, and your neighbors (who might not say anything derogatory out loud) vote for state and local officials who actively try to make the lives of LGBTQ people more difficult (coughcough GREG ABBOTT coughcoughcough RON DESANTIS coughcough) then....that can be difficult to overlook.



Urban California, like almost any major city on either of the coasts, will be challenging - salaries will be lower, cost of living will be much higher, decent jobs may be somewhat harder to find. Especially in California, which has a significant tax burden.

If you and your partner are ok with staying in Michigan, or somewhere sort of Michigan-adjacent (Minneapolis/St. Paul, Milwaukee, Madison, Chicago), then you will be far better off, both in terms of salary and cost of living.

As an FYI - you mentioned in your post the concern about relocating. Almost all jobs, even ones in FQHCs, pay for relocation costs. At least, they pay for moving; some may offer a sign on bonus that helps pay for other costs of relocation.

Don't try and google salaries in the area where you want to live - salary is still considered a "dirty word" for physicians, especially in primary care, and so what you see on google is almost certainly inaccurate. The only way to find out exactly what people are making is to ask them directly, keeping in mind the environment in which they work (an FQHC is going to be different from private practice which is going to be different from an academic job).

As long as you and your partner don't fall into the usual financial traps that trip doctors up, you'll be fine. I should point out that they're common financial traps because a lot of people fall into them, and doctors are notoriously terrible with money at baseline. But if you know what they are ahead of time, and come up with a strategy how to avoid them, then you'll be ahead of the game.

Thanks for the detailed response

I’m sure you’ll get flack for your first paragraph… but yes. That is exactly it. I’m sure no one has witnessed a direct attack on a gay couple, I’m sure no one hears the f slur thrown around as much. But the homophobia is there. Even in more liberal areas (where I am rn), people look. People treat you differently (I get asked a lot of questions that make me feel like an alien). I’m also noticeably not white. I don’t get called anything derogatory, but again the subtle racism can be there.

I grew up in a household that makes less than $20,000 a year including food stamps. At our best we made $35,000 a year for a couple years in my teens. To me the life I want is a nice house (not rotting away in an area where gunshots are heard once a week, house burn down every couple years, and cops make their rounds every night). I want to be able to “splurge” on excess, like nice coffee or jackets not from the Salvation Army. I want to go on a vacation once a year. We went on day-trip vacations to Chicago once a year, and would basically walk around with homemade sandwiches and—as a treat—something from Starbucks.

I’m not complaining, but I don’t want to keep living that life forever. Hence why I’m worried about what my quality of life might look like.

I know I’m spiraling and thinking too far in advance, but I want to make sure I won’t be screwed.

 

[smq123]

Thanks for the detailed response

I’m sure you’ll get flack for your first paragraph… but yes. That is exactly it. I’m sure no one has witnessed a direct attack on a gay couple, I’m sure no one hears the f slur thrown around as much. But the homophobia is there. Even in more liberal areas (where I am rn), people look. People treat you differently (I get asked a lot of questions that make me feel like an alien). I’m also noticeably not white. I don’t get called anything derogatory, but again the subtle racism can be there.

I grew up in a household that makes less than $20,000 a year including food stamps. At our best we made $35,000 a year for a couple years in my teens. To me the life I want is a nice house (not rotting away in an area where gunshots are heard once a week, house burn down every couple years, and cops make their rounds every night). I want to be able to “splurge” on excess, like nice coffee or jackets not from the Salvation Army. I want to go on a vacation once a year. We went on day-trip vacations to Chicago once a year, and would basically walk around with homemade sandwiches and—as a treat—something from Starbucks.

I’m not complaining, but I don’t want to keep living that life forever. Hence why I’m worried about what my quality of life might look like.

I know I’m spiraling and thinking too far in advance, but I want to make sure I won’t be screwed.

I don't think that you need to apologize - I understand. If it's not financially going to work out, and you need to pivot to another specialty, then you need to start doing activities geared towards those specialties. It makes sense.

I can assure you that, short of doing something financially catastrophically idiotic, you will have a very comfortable life as a family doctor. Even if you do something financially kinda stupid, you won't be living like you did as a child. Getting a Maserati or a Tesla might be difficult, but it sounds like that's not what you're looking for anyway.

I am happy to discuss hard numbers via PM - please PM me if you're interested. But I can assure you that you'll be fine.

 

[FrustratedFamDoc]

Last post on this as I don't want to derail a good thread.

I'm a minority and my sister is gay. She has lived in some of the most backwoods western NC, eastern TN and southern VA areas that you can imagine. She openly lets people everywhere know she is gay with what she wears and the stickers on her car. I've lived in small, medium and large cities as well as several islands in the Caribbean (parents are native Jamaican). I've been asked my entire life "what are you" and my sisters have as well. Just imagine fitting in everywhere, yet nowhere at the same time. I don't even know what "race" box to check. Is there an everything option? That'll mess with your head. My dad grew up as a 3% minority in Jamaica. Both parents moved here with a heavy Jamaican accent... that'll surely stick out in the south.

I have a good grasp on what not being liked, respected and accepted feels like because you don't really look like... ANYBODY else. Middle school was awesome... and I was in the band. Thanks mom. At least I had the chance to go through elementary school and make friends. My sisters were dropped right in to 7th grade... ouch.

Having such a unique family background, we were taught from the first day that we could remember that what you look like/race (hell, we didn't even know what we were or what box we were supposed to check. All I guess?) /etc.. didn't matter. And they actually meant it. We have all done very well for ourselves. Education and career is what actually mattered most. It's easier to be mad when you're broke.