how can a family doc make it anymore?

[oldandtired]

If you guys are so worried about your income, why in gods name would you go into FP!!? Why work like a dog to make 200K in FP when you could work 40 hours and make that in Path, Optho, Anesthesia, etc.

All those med students who went into the "hot" field of FP in the mid 90s must be kicking themselves in the ass q 1 hour now. In the end, you get good at what you do and find it rewarding. After years of practice, the most important issue is lifestyle.

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[HamSandwich]

where can I find information about states with malpractice crisis vs. states where malpractice is dirt cheap. I know there are different parts of the country that are more litigious than others, but only from word of mouth. where are some good resources that will tell me where it is good to end up as an FP?

 

[CambieMD]

Ham,

there is a lot information out there about malpractice rates. Look at the AMA News.
Some states are very problematic. Florida, Pennsylvania and West Virginia are especially notorious. Floridas' rate are very high compared to the rest of the country. Rates everywhere are trending up.


CambieMD

 

[PACtoDOC]

Who I feel sorry for are all you who bash FP as if it is some terrible lifestyle and because you somehow think you will be impoverished by it. And Cambie, I don't know what synical truck you fell off of but my guess is that you are just a bitter urban FP who has no niche market for lack of creating it! The vast majority of this country is vast open land with rural architecture, and these places still severely need FP's. And as an FP in this part of the world, you can do just about anything you want. And for God's sake guys. Lets imagine the worst case scenario. You are an FP making 120K the rest of your life, working 8-5. That still places you in the top 1% of any rural area you live in in terms of lifestyle, pay, and respect. And the good thing about FP is that you get to know your patients as friends, and share with them the goods and bads of their lives. As an FP, you are truly a counsellor and comforter for people, and for that you will reap community rewards like you can never understand until you have practiced in this regard. But the better case scenario is that you do have a good way with people, you do enjoy what you do, and because of those things, patients will see this reflected in the care you give them, and one day you will wake up and wonder where all your patients came from. Then when you top out at about 250-300K and you can't see anymore patients, so you either stop taking new patients, hire a PA, or get a partner. In my last practice, the top doc made over 350K, the junior partners all over 200K, and the PA's all over 100K. I can see where people could dislike FP if they are not people persons, and if they only end up acting like a referral ***** because they lack the confidence or training to do the procedures they refer out, but give it a rest guys. As physicians in this country, whether you are FP or not, you will never be starving. I am floored at you Teufel....how can you state most primary care providers make an abysmmal salary?? You must be some sort of fascist republican or something. I mean when did you all get so snobbed out that 120K per year was some sort of meaningless existence? And most rural FP's make a ton more than that as I know from personal experience. I am 3rd in my class, and could easily get into most any residency I chose, but I am still doing FP because it is what I love, and what I am. The gaitkeeper model of healthcare may have failed, but that has nothing to do with FP failure. There will always be a need for FP's because specialists will always live in their own microcosm of a world and will never satisfy the needs of their patients other than to fix the one problem they came to them for. And just remember this Dr. Specialist.....it only takes a couple of FP's to start referring elsewhere before you realize that those FP's were the source of your income in an indirect way. I can think of at least one cardiologist, an entire gastro practice, and an EM group that all lost their contracts in our region because our practice alone stopped referring patients to them. Our patients did not like them, and we were the largest primary care group around. Without our referrals, they could not justify being in the area. When they left, new groups moved in and survival of the fittest started once again. Its funny how FP offices are loaded down with gifts and food at Christmas time from all our specialist colleagues.

 

[dksamp]

Hello,
I agree with PACtoDOC 1000%. Took the words right out of my mouth. I am a BIG proponent of doing what will eventually make you happy. It seems that Cambiemd if tired of FP and is looking to swith out of FP, WHICH IS FINE if changing specialties will make you happy. In an earlier post, Cambie said
"I plan to apply to Anesthesiology and ER in2005".

Both of those specialties are Great, and pay very well and have their advantages. I personally know of friends that finished their anesthesiology residency recently and STARTED OUT at $350,000+ per year. Back when I was applying for residency, I could have gone into anesthesilolgy (as I had had a few offers made to me back then). Ask me now if I would ever want to DO anesthesiology, I would reply with a resounding HELL NO!! Despite the $$, I would be MISERABLE, and I do NOT sacrifice my long term happiness for extra $$$. ON the other hand, as a private practice FP starting out, I am making barely a third of my anesthesia counterparts that are out of residency. But am I happy?? The answer is HELL YES. I am happier than a fat boy in a buffet, and THATS the honest truth. I am not missing any meals, and my bills are paid.
With regards to the demand of primary care docs and the NP/PA issue, I do NOT see them as a threat. When I was a resident, we used them to handle the overlow of patients that were not able to see me that day. The good thing about them is that they KNOW their role. I have yet to meet one that thought he/she could replace a PCP. They chose NP/PA because they did NOT want to have to deal with the same level of responsibility/liability and workload as MD's. Also remember that, PA's are NOT independent entities, and fall under the board of medicine. All PA's have to be under an MD and have to be able to
access to one. As for NP's, they all fall under the board of nursing, and while there may be "independent" NP offices around the country, they TOO know their role and their limitations. I have NEVER met a "renegade" NP that thought he/she was a replacement for an MD. WHile both NP's and PA's are comfortable with some of the more simple/moderate medical complaints, has anyone ever tried to get either one of them to see and manage a complex "train-wreck" patient?? or a patient with multiple medical comorbidities? GOOD LUCK. Thats when they will QUICKLY "pull rank" and remind you of their role. At least thats been my experience with NP's and PA's. People who complain about this "perceived" threat use it as a red herring to mask other underlying issues within themselves and their practice.
This is NOT the movie "Field of dreams" with Kevin Costner. The "Build it and they will come" mentality will only get you so far. Too many doctors forget that just having an MD alone and board certification is not enough. One has to MARKET themselves properly, stand out as unique, capture niche markets as I have previously described. One example is an FP a few miles north of me. He no longer sees sick people, and no longer does hospital admissions. He ONLY sees patients with VEIN problems and other cosmetic problems (all day every day). He received training in endoscopic laser therapy (EVLT) for varicose veins and now has a booming cosmetic practice. He also does the botox, laser therapy, and other cosmetic procedures. He hasn't seen a sick patient in a LONG time. He is a man with a good business sense and KNOWS how to market himself properly. Are there a plethora of dermatologists inthis area?? YES. Is he threatened/scared by this?? NO. The people you find most disappointed with any field are usually the ones who had unrealistic expectations entering that field.
SO in choosing your field, if you overconcentrate on the $$ and do not take into account the "happiness factor", you may have some $$ in your pocket, but you will be miserable. If you are willing to settle for that, then so be it.
To Cambiemd and the others who are going to switch specialties, best of luck with whatever you choose, and I hope it brings you LONG-TERM happiness. PEACE!!

-Derek Sampson, MD

Board Certified Family Physician

 

[Teufelhunden]

Originally posted by PACtoDOC
Teufel....how can you state most primary care providers make an abysmmal salary?? You must be some sort of fascist republican or something. I mean when did you all get so snobbed out that 120K per year was some sort of meaningless existence?

"Fascist republican" ???

Jeez...no need to resort to name calling just because we have different ideas of what a "good living" is. Listen, you and I obviously have different financial goals. I don't think that makes either of us right or wrong, and I definitely don't think it makes me "fascist."

BTW, as I continue in this process I'm actually starting to appreciate FP more and more, and actually found myself wishing I was back on my FP rotation. However, in the end, I'm not going to go through the same duration of education and training as my colleagues and then end up making only a fraction of their salaries. Hell, I have friends with 4-year degrees who make more that 120K/year. I'm sorry, but I'm not investing this much time and energy into my education to not be compensated proportionally for it.

Listen, the majority of the complaints I hear about FP are from FPs themselves. I meet FP after FP who discourages me from going into FP because there's no money in it.

Again, I know a lot of people, like yourself, do not prioritize financial goals as high as we (my wife and I) do. For one, we don't want to work until we're 65. Obviously, we'll get to early-retirement a lot faster earning 300K/yr than earning 150K/yr.

Anyway, I'm sorry that you feel you have to resort to ad hominem attacks just because we have different financial goals. Not to mention, we have our reasons for having such goals as there are other people in our family who will likely depend on us financially in the future, and we want to be able to provide such when that happens.

But hey, PACtoDOC, if you feel the need to call me a "fascist" because we differ in our financial goals, then whatever...

 

[PACtoDOC]

Teufel,

Sorry but you created your own hole when you stated that primary care docs make abysmal salaries. Don't ever run for Congress, because 99% of your constituents will despise you calling their salary abysmal. There is plenty of money to be made in FP. There is no reason an FP who is hard working, smart, and business-savy cannot make 250-300K per year if not more. You just have to market yourself correctly and put yourself in a place where you are needed by people. Of course FP's in the city and even suburbs are going to make less. They cannot get the extra 10% from medicare for working in an underserved area, plus, they are competing with IM, Peds, and other FP's. But Abysmal.....then I suppose you think the surgeon general, the chairman of the joint chiefs, and every flag officer makes an abysmal living as well heh? You chose your words, I simply placed you in the category most fitting once you chose them.

 

[neo]

Originally posted by dksamp

Here is my challenge to you......NAME ONE !!!
I challenge you to name the part of the country where it is impossible or FP's to get a job. Now, let me qualify that by saying that if you attach a bunch of impossible conditions to your employment such as...

1. I will only work for "$$$" salary...PERIOD
2. I want a practice with ZERO medicaid
3. I want to do x,y,z procedure (not taking into account the local politics of the area, which may prevent you from doing so)
4. I want to be made an offer. I don't want to lift a finger to look for anything.
5. Her ability to get along and "play well with the other kids"
6. previous licensure/legal/liability trouble
7. one's desire for one SPECIFIC area of the US with ZERO flexibility.

These and other factors may preclude one finding a job that they would want.

Durham, NC

btw, condition number 7 makes no sense

you want me to name a place where an FP cant find a job and then your condition number 7 is that i can't specify a place?

huh?

find me ONE FP job within 20 miles of south Durham and I will PERSONALLY pay you 100 dollars. Im dead serious.

two conditions.

1. outpatient only - shouldn't be too hard right?

2. salary of at least 115K - that's not asking for too much.


the person who is looking for a position is a board certified FP. graduate of US allopathic med school and residency. has GLOWING letters from her previous post where she was on clinical faculty at a US medical school FP department. has NEVER been sued, was adored by her patients and co workers at her old job.


should be easy to find a job for such a person right?

I will SERIOUSLY pay 100 dollars to ANYONE who finds a outpatient only FP job within 20 miles of south Durham. She would greatly appreciate help finding such a position and 100 dollars is WELL worth find a job.

She has talked to about 20 recruiters who are ALL VERY EXCITED to hear from her and tell her about the bazillion positions they have and then when she says in the Raleigh Durham Chapel Hill area, their responses are INVARIABLY "OH, GOOD LUCK THEN"


So whoever was talking big back there. prove me wrong, find a position within 20 miles of south durham that is outpatient only and makes 115K a year. i think most people would think that those are reasonable stipulations.

prove me wrong. please. i would be elated to be proven wrong.

 

[neo]

Originally posted by SupportingOccam
I think you're referring to the article(s) written by FP doc Gordon Moore. You can search the www.aafp.org for the articles. A couple links are:


http://www.aafp.org/fpm/20020200/29goin.html

http://www.aafp.org/fpm/20020300/25goin.html

The AAFP site has many articles archived free online for those interested in researching various dynamics, particularly business, in family practice...a good resource.

man, those are GREAT articles. anyone know links for more specific info on opening these kinds of practices?

 

[Teufelhunden]

Originally posted by PACtoDOC
Teufel,

Sorry but you created your own hole when you stated that primary care docs make abysmal salaries. Don't ever run for Congress, because 99% of your constituents will despise you calling their salary abysmal. There is plenty of money to be made in FP. There is no reason an FP who is hard working, smart, and business-savy cannot make 250-300K per year if not more. You just have to market yourself correctly and put yourself in a place where you are needed by people. Of course FP's in the city and even suburbs are going to make less. They cannot get the extra 10% from medicare for working in an underserved area, plus, they are competing with IM, Peds, and other FP's. But Abysmal.....then I suppose you think the surgeon general, the chairman of the joint chiefs, and every flag officer makes an abysmal living as well heh? You chose your words, I simply placed you in the category most fitting once you chose them.

Hey, I agree that some FPs can earn substantially more. But sadly, the mean tells the story. Listen, most FPs I know have expressed to me their dissatisfaction with their level of compensation. As for me, I agree that salaries in the low six-figure range are abysmal. Listen, a lot of people don't prioritize income very highly, and may express deep satisfaction with their jobs despite the pay. However, I personally have long-term goals that require I earn significantly more that 120K/yr.

Again, my use of the word 'abysmal' describes how I would feel about that as my potential future salary. I certainly didn't mean it as a label for other people. Heck, there's someone out there earning 23K/year who's perfectly happy and content. I wouldn't label that as an abysmal salary for them, because obviously it isn't -- they're happy with it!

Sorry if I offended anyone. I was just expressing how I feel about FP salaries. And believe me, a lot of people I know share this same view. I can't tell you how many people I've talked to who generally love primary care, but would never do it because of the low pay.

Again, it just seems silly to me to spend 11-12 years of education just to make as much as someone who has a 4-year degree. I just wanted to be compensated proportionally for the years I've invested in my education.

For example, here's three examples of what I'm talking about. Here's the education level, job and income of three of my best friends:

1) B.S. Exercise Science, Personal Trainer, $100K/yr

2) B.S. Accounting, VP & CFO, >120K/yr

3) B.S. Liberal Studies, Pharm Rep, >150K/yr

You see what I'm talking about? So, why would I suffer through 3X the amount of schooling as my friends, only to make the same amount? That's what my point is. It simply seems foolish to invest all those additional years of education, just to (in the end) earn the same as my friends with 4-year degrees. In fact, I'm sitting here thinking to myself, and I can only think of a handful of my friends (in their early 30s) who make less than six-figures!

I didn't even begin to mention the stress, the hours, the debt! All things which we, as physicians, endure to a much greater extent than most other professions. What's wrong with wanting to be compensated accordingly for these things?

 

[PACtoDOC]

There is nothing wrong with that Teufel. Your comparrison of incomes seems a bit on the "best case scenario" side. My bet is people will agree with me that your friends each make well above the average for their 4 year degree, and my next bet is that they were either the best in their field or they are lucky and experienced. Here are the salaries of my friends whom I have.

Doug- FBI Agent- 76K for about 50 hours a week
Laura- Police Officer- 38K
Jim- Attorney 86K
Tom- Army Major, 62K
Nate- Scherring Rep- 70K
Seth- Roche Rep- 56K
Bob- Neurologist- 160K
Bobby- Podiatrist- 210K

Only two of these people rank above the abysmal salary range that you laid out, which is what got my goat. The one thing about every specialist I ever met while practicing is that they all get bored doing the same damn thing day in and day out. Endocrine guys see about 6 major conditions and thats about it. Same with GS, same with derm, same with CV surg....same with ENT...etc....
If you want to see something quite interesting, head to the FP program website at ETSU in Kingsport, Tn. They have a 2nd year resident who is a US grad, who came to the program after completing his GS, and CVS residency/fellowship only to want more of a relationship with his patients. And my next question is why do you guys who bash FP bother hanging out on this thread. You don't see us going into the specialty threads bashing them? And your double blind placebo controlled study of talking with a few FP's you had the dispriviledge of rotating with does not constitute a cross-section of the average FP.

 

[Teufelhunden]

Originally posted by PACtoDOC
And my next question is why do you guys who bash FP bother hanging out on this thread. You don't see us going into the specialty threads bashing them?

Hey, I'm by no means an FP-basher! I think it's a crime FPs are compensated so poorly, as I think their role in health care is just as important as anyone else's. Peronally, I'd love to do FP and am still considering it (for a lot of reasons you mentioned, variety being my #1). I'm constantly on this forum to get info - looking for good news, mostly. At some point, I'm hoping the pendulum will swing back the other way, and FPs wil start doing well (financially) again.

Originally posted by PACtoDOC
And your double blind placebo controlled study of talking with a few FP's you had the dispriviledge of rotating with does not constitute a cross-section of the average FP.

Actually, most of my feed-back about FPs comes via my friend who's a pharm rep. He's deals mainly with oncologists now (he sells Gleevec), but he spent much of his early career peddling Prilosec, Allegra, etc to FPs. Anyway, through his 100s of interactions with different FPs, his advice has consistently been "Don't do FP, they're all miserable!"

It's hard to ignore that kind of advice. He said that a majority of them would NOT have done it given the chance to do it over again. They bitched and complained about all the usual culprits: insurance, malpractice, paperwork...and of course, their crappy compensation (especially in the light of loan debt).

 

[Teufelhunden]

Originally posted by PACtoDOC
Here are the salaries of my friends whom I have.

Doug- FBI Agent- 76K for about 50 hours a week
Laura- Police Officer- 38K
Jim- Attorney 86K
Tom- Army Major, 62K
Nate- Scherring Rep- 70K
Seth- Roche Rep- 56K
Bob- Neurologist- 160K
Bobby- Podiatrist- 210K

I guess I just have more successful friends that you - j/k

 

[PACtoDOC]

Your drug rep and exercise physiologist friend are both in the top 1% of their field if they make that much money. Funny enough, the only thing a drug rep sees in an FP office is what we want them to see, and they generally serve the purpose of 1) person to release steam to, and 2) professional caterer. They don't honestly know much about the ins and outs of FP or medicine in general. You want to talk about a job no one would want, well drug reps are high up on the list. And here is a little opinion that will not buy me a bunch of friends on this forum, but it is true. We all know that many FP's are in fact FP's because they could not get a better residency. So when you litter a profession with below average physicians, you tend to end up with some that are not great doctors, are not motivated (or they would have done better in the first place in school), are not happy, and resent what they do. Truth is, the FP's I know that came from the top portion of their class are the ones that often are happier, are more successful, and make the most. This is because they are motivated to pursue their dream of being an FP, and are not consumed by the fact that they got stuck in the profession. So you can't really average out and generalize across the board about FP's and say that they all make abysmal salaries. You can do just as well as almost any other field without killing yourself if you are good at what you do.

Case in point. Two of my buddies who are former colleagues were both top 10% die hard FP wannabes in med school. One went to a rural area under a contract starting out at 120K. He soon surpassed his guarantee and before long he had all the bargaining power because he was excellent, patients loved him, and he was very efficient. He sees 30-50 people per day and works probably 55 hours per week. He makes 300K per year, plus his PA makes him another 100K.

2nd case- Buddy who went FP and is so rural that he does his own appy's, c-sections, colonoscopies, lap chole's, hystos, and still sees patients 3.5 days a week. Between he and his PA, they bring in 1,000,000 in collections and net more than half of that. Like any field, you have to work hard and be business savy to do well. You can easily get sucked into a specialty group out of residency in any field and find yourself making much less because you are new, you are not a partner, and because patients might not like you very well. Its just the way it works.

 

[dj_smooth]

Sorry to butt in on this conversation, but just how rural is your friend (i.e. where is he practicing?). I am just trying to figure out if rural docs are making more because I see articles all the time on the internet about how much lower rural docs make. I'd love to go rural myself and do all the appys and choles too; are these opportunities difficult to find? I've posted on another thread about where to get those types of training opportunities and I keep getting the same answer (Ventura County FP). There have got to be other places to do that stuff, right? I'm also wondering how long those priviledges will be granted by hospitals...malpractice must be healthy for them.

 

[HamSandwich]

djsmooth,

i rotated on the blackfeet res in browning, montana. the FP docs did C/S, lap appys, lap choles. the one guy went to WY for residency and pulls in ~250K. it is cold there however and very rural. nearest MickeyD's is 30 miles, same with the nearest non scuzzy grocery store.

 

[chillin]

A Drug Rep. making 150,000??? I think he must be smoking that Gleevec he's pushing. Why would any drug company pay someone that much when they can train any zip off the street with a four year degree and half a brain to kiss some doc's butt to push their drug. I've dealt with enough drug reps in my day to know they probably manipulate their salaries as much as they manipulate their drug's clinical trials.

 

[CambieMD]

Hello to all. This thread seems to generate a lot interest and comments. That's good. I merely post my opinions and observations . I am not attempting to generate controversy. I do not expect everyone to agree with me. There is no need for anyone who does not agree with me to send negative responses aimed at me or anyone else with whom they do not see eye to eye. Such actions do not serve those who browse this forum for a multitude of opinions. Name calling is completely uncalled for. Let's share our views in as civilzed a fashion as possible.

CambieMD

p.s.

Also known as the Maharaji-Cynic. The all hating one.
(Rush fans may get it. That was suppose to be a joke)

 

[chillin]

Originally posted by CambieMD
I can see that Dr. Sampson put a lot of work and passion into his post. I can see that he is enjoying himself.

Like that isn't a snide remark.

 

[Teufelhunden]

Originally posted by chillin
A Drug Rep. making 150,000??? I think he must be smoking that Gleevec he's pushing. Why would any drug company pay someone that much when they can train any zip off the street with a four year degree and half a brain to kiss some doc's butt to push their drug. I've dealt with enough drug reps in my day to know they probably manipulate their salaries as much as they manipulate their drug's clinical trials.

Yeah, it's insane. Most of that isn't his base salary. Most of his income is in the form of bonues. For example, last year he was Norvartis Oncology's Sales Person of the Year. So, he is definitely doesn't represent the norm in that field.

This guy is my best friend, and I know for a fact he isn't bull****ting me...I've seen the bonus checks...I agree that it's crazy that they get paid so much. I love him like a brother, but it pisses me off to no end that he is so well compensated for what he does. Here's a guy with a liberal studies degree...former college football player...partied all through school...and making a killing.

Anyway...yeah...I'm a little jealous as I just looked at my bank account online....$34.15.

Damn...and there's still checks that haven't cleared

 

[neo]

if people havent figured out that medicine, any kind of medicine not just FP, is NOT the field to go into for money, well.. then they've deluded themselves.

If money is your major motivation for entering medicine, you're going to be sorely disappointed and bitter.

Medicine isn't just a job, or at least it shouldn't be. The decisions you make can kill or save people. To say its stressful is a gross understatement.

I agree that drug reps making 150K is very very unusual but FPs making 300K are also unusual. you guys are both citing the best case scenarios for each job to support your side of the argument. The facts are that physician compensation is down. Ask any physician who worked in the 80s. And this trend is not likely to change any time in the future because insurance companies dont want to pay more and medicare and medicaid are driven by public opinion and the vast majority of americans still believe that doctors are overcompensated and that that is the reason that healthcare costs are out of control and will push to limit physician compensation further. one of these days, the public will realize the truth and what the real reasons for the dysfunction of healthcare in this country are but i dont see that happening until there is pretty close to a collapse of healthcare system. people wont think there is anything wrong until they cant see doctors anymore because fewer and fewer people want to be a doctors. until then, they are gonna believe the rich doctor myth and feel like our salaries must be the driving force behind their increasing health insurance premiums.


and no replies about jobs in durham, nc? well, my friend has now been actively looking for over 6 months. talked to recruiters, every hospital chief of staff in the area, and called up at least 30 different FP practices in the area. they all tell her, "yeah, its bad around here, if we knew of any jobs, we would've told the 5 to 10 other people who've called us before in the past month" so if anyone stumbles onto any info, send it my way, we'd appreciate it.

 

[Teufelhunden]

Originally posted by neo
if people havent figured out that medicine, any kind of medicine not just FP, is NOT the field to go into for money, well.. then they've deluded themselves.

Well, this I simply can't agree with. If you don't believe me, check out the Job Almanac. Physician consitantly ranks as the #1 paying profession in the U.S. Name another degree that virtually guarantees it's grads a 6-fig income?


Only MBAs and JDs from the very top schools are guarnateed those type of salaries, whereas grads from the bottom-tier medical schools are still going to make good livings.

My sister graduated Magna Cum Laude from a Tier-2 law school, and is starting at $61K/year. She's thrilled! Over half of her class didn't even have jobs upon graduation. Tell me the last time you heard of half of a medical school class not being able to find jobs?

Anyway, the numbers simply don't lie. Physicians, as a group, make more than any other profession (as a group). Again, if you don't believe me, check out the Job Almanac or the Bureau of Labor Statistics website.

 

[neo]

yes, as a group. but, physicians are a small group and as a group are highly intelligent and hardworking. if this same group went into another field, they would make more money with less work, less stress, and less education.

 

[Adapt]

It all comes down to how greedy you are. If you're greedy, don't go into FP because you will be disappointed.

 

[Teufelhunden]

Why label it as greed? If someone's life goals include making a lot more than 150K/year, you're just gonna go ahead and unfairly label that as "greed?"

What if someone wants to retire at 50 so they can enjoy life, spend more time with their family, volunteer, read every book they never had time to, learn to play the cello...this is greed?

What if someone wanted to raise enough capital (on their own) to open the restaurant they've always dreamed of? Pure greed, huh?

What if there's other people in your extended family who are less fortunate, who you really want to be in a position to, say, send all 4 of your nieces and nephews to college? Greed again?

Anyway, I think it's unfair of you all to make assumptions about people, and start throwing around derogatory adjectives like "greedy" just to describe someone with different goals than you.

 

[Adapt]

I'm sorry Teufelhunden but your statements show your greediness.

I'm not saying that specialists are greedy. They probably went into their fields because they really enjoyed it.

However, you explicitly said you like FP but wouldn't do it because of the money.

To the average person, 120K is a lot of money. I was talking to my roommate who is computer sci and he was saying that 120K is a really good salary and for people that think it' not, well then they're greedy.

You said PCP's make abysmal salaries. YOU'RE SAYING THAT 120K AT THE MINIMUM IS AN ABYSMAL SALARY. Wake up man. That's greed.

Don't give me this nonsense about how you're goals are higher in terms of what you make so it's not being greedy. Money won't buy you happiness.

A 120K salary along with your wife's salary could easily put you over 200K a year which is more than enough to comfortably raise a family.

Don't get mad if people view you as greedy. Greedy is just a term. I'm not saying it's bad to be greedy, but that is the definition of greed.

greed - An excessive desire to acquire or possess more than what one needs, especially with respect to material wealth

You certainly could live comfortably with a 120K salary and your wife's. But you want more. That equals greed.

 

[chillin]

Greed: excessive desire, especially for wealth. Yeah, I'd say he's being greedy. The bottom line is money will only buy material possessions. Having nice things doesn't change you much, and any enjoyement they bring doesn't last all that long, especially if your unhappy in other areas of your life. So the best thing is to focus on what you enjoy doing. The money will come.

 

[Teufelhunden]

Originally posted by chillin
Having nice things doesn't change you much, and any enjoyement they bring doesn't last all that long, especially if your unhappy in other areas of your life.

Yeah, well I'm not unhappy in other areas of my life. So you're telling me that finally acquiring all the things we've always wanted, like a nice home, won't bring us even more happiness?

Originally posted by chillin
So the best thing is to focus on what you enjoy doing. The money will come.

Totally off subject, but this is total crap. Doing what you enjoy doing won't ensure "the money will come." I have plenty of old friends who "do what they enjoy" and many of them are flat broke.

Hell, there's a ton of things I enjoy doing more than medicine...unfortunately, none of them translate into well-paying jobs.

 

[Teufelhunden]

Originally posted by Slickness
You certainly could live comfortably with a 120K salary and your wife's. But you want more. That equals greed.

I'm so glad you're here to define greed for all of us.

Perhaps someone making 60K/year thinks you're greedy for wanting to make 120K/year.

Then, it's very likely that someone making 30K/year would thing the guy who wants to make 60K/year is greedy.

You see where I'm going with this.

It's funny how you talk about "desire to acquire or possess more than what one needs." I would say that a 120K/year salary FAR exceeds one's basic needs.

In fact, according to your definition, anyone making a dime more than what is required to provide adequate shelter and nutrition is greedy.

BTW...who the heck are you (or anyone else for that matter) to define for me what my family's needs are? Aren't I free to make that determination for myself? How do you know what would make us "comfortable?" How can you assume to know what other people's definitions of "comfort" are? Isn't that a decision individuals can make for themselves?

You say money can't buy you happiness. Well, that's complete b.s. Sure, I'll agree that money alone can't make someone happy. However, for people who already have their other needs met (e.g. love, family, friends), money can sure provide additional happiness.

Some of the best times of my life were vacactions my wife and I took, all of which require money. My wife and I have a wonderful time when we go out to dinner...which costs money.

Most people are immensely happy when they can finally afford to buy the home of their dreams. Are you saying home ownership can't make you happy?

This argument is insane. I'm not trying to define for you what happiness is. I'm not trying to impose my beliefs as to what is and isn't a comfortable lifestyle on you or anyone else. I think everyone defines that for themselves.

But, for some reason, some of you still feel the need to call names and label me as "greedy."

 

[Adapt]

I would be happy with 120K. You think that's abysmal. Sorry buddy that's greed.

Who cares though. If you think getting that extra 200K will give you "additional" happiness then by all means do it.

 

[Teufelhunden]

Originally posted by Slickness
I would be happy with 120K. You think that's abysmal. Sorry buddy that's greed.

Someone who's happy making 60K could say the same thing about you.

Originally posted by Slickness
Who cares though. If you think getting that extra 200K will give you "additional" happiness then by all means do it.

I will, thanks!

 

[chillin]

When I lived in South America people didn't have jack crap, but they seemed to be pretty happy about things. They just sat around and drank tea and talked all day. Anyway, this society spends way too much time comparing possessions. Big is better. This brand is better. Joe makes so much more than whoever. But then you have some grumpy, stressed out, overworked surgeon who may have a lot of crap but is miserable and divorced. I'm not saying that you can't be a surgeon and not be happy because enough of them are, but a lot of people choose a path directed towards prestige and money. These same people are often bit. Go for the profession that fits you the best. If it happens to be surgery, anesthesiology, radiology great.

 

[Foxxy Cleopatra]

$60K wouldn't be bad at all for someone who lives a nice, modest lifestyle that isn't 100-200K in educational debt.

Every time I think that I acquired one tenth of a million dollars in debt solely on medical education loans, $200K/year salary no longer seems greedy, especially after working my tail off for less than $7/hr as a MD resident.

 

[CambieMD]

Hello to everyone,

the confrontational tone of this thread continues, unfortunately. The name calling is counteproductive. What ever happened to etiquette. I am not talking about political correctness. A forum is useless if eveyone agrees. Simply labling a poster as cynical or greedy is an oversimplification and is not in step with our level of training. Ok the patient is in CHF but why? The pt is in resp. failure secondary to what? What exactly does a particular set of lab results mean. What is the differential DX.

The issues faced in FP and other areas of medicine are very complex. The reasons for a particular view may be based on several factors that are not necssarily unique to FP but endemic in medicine in general.

That said, I stand by what I have said. I will not take the time to address assumptions that have been made about me.

We exist in a free market and the value of goods and services are determined by certain variables found within the market place.

Work effort more than anything else colors the desireability or lack thereof of a certain task or pursuit. How much is put into a system for a return, any return. I am an information junky. To me when you view it in terms of that, words like greedy or cynical have little meaning. What does the data say. The dialogue should come in the differing interpretations of the data. Read some residency reviews. I sometimes wonder if both guys are talking about the same program.

CambieMD

p.s.
I was a microbiologist in a prior life.

 

[Teufelhunden]

Originally posted by CambieMD
Work effort more than anything else colors the desireability or lack thereof of a certain task or pursuit. How much is put into a system for a return, any return.

This very eloquently states one of my main points I've been trying to express. As third and fourth year medical students, we're in a unique process of having to commit to a medical field, a decision that is ultimately made based upon multilpe factors.

One enormous factor for many people is ROI (Return On Investment). If you're intersted in internal medicine, it might be hard to stomach that your ROI will be fraction of what other specialties will garner.

When investing financially, people of course look at potential ROI to guide their investment decisions. Why then, should we not also be able to look at ROI when making a decision that involves not only the investment of thousands upon thousands of dollars, but also the investment of time -- 11-15 years.

Many will argue that time is our most valuable resource. And as physicians, we invest more time than almost any other profession. Not only do we invest that time, but many of us also make enourmous sacrifices in order to make that investment...sacrifices in our personal and family lives that is sometimes inevitable, especially in certain specialties.

So, why again should we not consider ROI as an important, if not THE most important, factor? When you put it on paper, the ROI for FP, IM, Peds, etc. is very poor when compared to some other fields that require the same time investment.

So, when I said that FP pay was abysmal, I meant that in relative terms, i.e. relative to the ROI of other medical fields. Compare the ROI of FP and Rads and tell me that the FP's ROI isn't "abysmal."

If faced with a similar comparison in your investment options, the choice would be a no-brainer.

Of course, ROI is far from the only factor in deciding one's career choice in medicine. Of course, your particular interests play a large role in deciding, as does lifestyle. Again, there are many aspects of FP that I think I'd enjoy (variety being #1, lifestyle #2), however it's hard to get past the relativelty poor ROI it presents as compared to other fields.

 

[dksamp]

Hello,
WOW..It seems that this thread has taken a life of its own. A LOT of good points made by all sides. Now, I'm gonna throw some more $0.02 in the mix:

PACTODOC...you made a VERY valid point which I forgot to bring up in my previously long diatribe. There IS a difference in ones perceptions of family practice depending on whether you REALY wanted to do FP vs. getting into FP by default (i.e. couldn't get into any other residency so it was chosen or washing out of another speciality and winding up in FP/GP). I have found that those who truly WANTED to do FP tend to be the most satisfied with their choice and tend to do VERY well in their practice. HOWEVER, those that went into FP with lukewarm enthusiasm and had unrealistic expectations on top of that are the ones that wind up miserable, unhappy and eventually leaving.

TEUFELHUNDEN...I fully can appreciate your aspirations for early fast financial success, however, the tone of your posts concern me. One question (just curious)...
Which med school do you go to and what year are you??
In all your discourse about picking a medical specialty, all I see are statements about your financial aspirations. Nowhere do I see you mention anything about patient care, or why you would fit in best within a particular specialty, or specific things about a specialty that would be appealing to you. All I see you talk about is your financial goals, and how the specialty has to fall in line with that. There is NOTHING wrong with making a lot of money, I am not a socialist, however, it seems that you would be better off becoming a stockbroker instead of a physician. You would achieve your financial goals much quicker and make lots more $$$ with LESS headache.
If your goal is a high-paying specialty, I hope you have kick-ass board scores to back that up get you in those specialties. The cushy lucrative specialties require 90+ on your boards and A.O.A. membership (if U are a US grad).
Let me share with you my observation as a private practicioner. Those that seem to have $$$ foremost on their mind tend not to do that well in private practice, cause they put it before patient care, and often are the ones that wind up getting sued. Don't get me wrong, there is nothing wrong with making $$$ and LOTS of it, however you will find as you get older that NO $$ can replace personal happiness. There are jsut as many surgeons making 300k+ who hate what they do, and it shows in the patient care. If I had a consultant whose main concern was the $$$ before patientn care, there is no way in hell I would refer patients to that practitioner. Just something to think about.

CAMBIEMD...Could you please share with us what part of the US are you practicing in, and if you had any offers made to you yet in another specialty for retraining??

The problems of medicine in terms of the reimbursement are felt ALL ACROSS THE BOARD, not just in primary care. The individual in question has to do what they used to say in the marine corps..
IMPROVISE...ADAPT...OVERCOME...you gotta be willing to be flexible to go along with the multitude of changes going on today. Pedicatrics is the lowest paying specialty per capita, and yet, many people choose it and are quite successful at it because it fits them best and they know how to adapt.

ENOUGH of my rambling...best of luck to everyone in WHATEVER you choose. PEACE!!!!!

-Derek

 

[Teufelhunden]

I've only addressed financial aspirations because I was challenged on my description of FP salaries as "abysmal." That struck a nerve with a few folks, and I've been playing defense ever since.

I went into medicine for many reasons. In no particular order:
*intellectually stimulating
*interest in biomedical science
*wanted a job where I felt I contributed in a positive way to society
*financially rewarding

I'm one of those people who's interested in a lot of different fields, and feel that most medical fields would be personally rewarding as I'd be taking care of patients, whether that be directly or indirectly.

So, as most fields would be fulfilling and rewarding...the deciding factor really becomes financial. Again, I wouldn't enter a field solely for the money. If podiatry paid $1,000,000/year, I wouldn't have gone to podiatry school. Feet just aren't my thing. My point being: financial compensation is only something that helps me choose from specialties I have an inherent interest in.

As far as your saying that you have to be >90 percentile on boards, AOA, etc. in order to get into financially lucrative fields, I mostly agree. However, there are some fields, especially IM subspecialties like GI and Cards, that aren't really hinged on step 1 scores (most fellowships could care less what your step 1 score was).

With that said, I'm a DO student (OUCOM) with woefully average board scores (51%). So, you're right...being financially successful is probably a long-shot for me. But, I'm not about to throw in the towel now. I'm doing very well on my clinical rotations, so who knows....there may be some hope for me yet (?)

As an aside, becoming a stockbroker is by no means an instant route to financial success. Very few in that field make any real money. I think the average stockbroker makes a little over 50K/year.

People who say not to go into medicine to get rich are just being silly. The numbers don't lie. Again...check the Job Almanac and Bureau of Labor Statistics....doctors are the highest income earners in the U.S., as a profession.

Of course there are exeptions...but the mean salaries of MBA and law grads don't even come close to the mean salaries of physicians.

Hell, my sister graduated near the top of her class in a Tier 2 law school. She got a job making slightly over 60K, while the majority of her class is still looking for jobs.

My friend just got her MBA and is struggling to find a job.

When's the last time you heard an MD or DO who couldn't find work ???

 

[PACtoDOC]

Hey Teufel,

Wow, I would have thought from listening to you that you were certainly top 5% score wise. I'll sell you my scores for an abysmal amount, since I won't need them going into FP!

 

[Teufelhunden]

Originally posted by PACtoDOC
Hey Teufel,

Wow, I would have thought from listening to you that you were certainly top 5% score wise. I'll sell you my scores for an abysmal amount, since I won't need them going into FP!

Yeah, unfortunately for me, all the motivation in the world can't seem to overcome my innate inability to rote memorize and regurgitate on a bubble sheet.

It's a shame...you're right...you won't be needing your scores to get into FP...you should be able to sell some of your 'extra' points to me.

 

[Teufelhunden]

Before everyone jumps in with a "Let's make fun of Teufel's board scores" post, let me just say that I am fully aware of the challenges ahead of me in procuring a competitive residency.

I will say, however, that there are examples left and right, of people who 'made it' with average scores. My friend's cousin is a DO who scored <50th percentile, and is a plastic surgeon making over 750K/year.

So, like I said before, I'm not throwing in the towel yet. There are a lot of fields that are fellowships that branch off of relatively easy-to-get-into residencies, i.e. IM and Surg subspecialties.

Also, I'm Navy, which might work for me in this process, as the Navy match takes prior service into consideration (which I have). From what I was told at OIS, the Navy actually assigns point values to various things in their match process. For example, you get a certain number of points for your board scores, class rank, etc. Well, prior service is worth a similar amount as board scores, so that may end up saving me in the end.

Also, since I'll be applying to residency after a GMO tour, I will have completed all three steps of the boards, completed my internship as well as a 2-3 year GMO tour. That will give Navy residency programs a lot more to look at in evaluating my application, and hopefully de-emphasize my crappy Step 1 score.

Not to mention...you can re-apply for a residency after the completion of residency. A recent example of this: One of our IM docs at my hospital - in his mid to late 40s - just got accepted into a Derm program. My FP preceptor knows him well, and said that he was just sick and tired of IM...the crappy hours, the sh|tty pay. He actually figured out that the money lost while being a resident for 4 more years...he'll actually earn it back in his first year of derm practice!

 

[CambieMD]

Hi everyone,

the posts here have been good for the most part.

Webster defines greed as excessive or reprehensible acquisitiveness. Ones desire to be financially secure doesn't constitute greed. I am speaking on behalf of Teufelhunden.
By the way, what are you thinking about doing, Teufelhunden.

I am located east of the Mississippi River. I have used the past year to do research into what I may want to do. I will be applying next year.

Teufelhunden, if you are interested in a very competitive specialty start networking now. The bottomline is that you are applying for a job. I can tell you, your board scoreswill not help your program if you are a pain to work with. Get to know well known folk in the area that you are interested in.

Retention is an issue in medicine. How do you keep someone interested after they get their feer wet . I know of a guy who went straight to law school after he completed residency. (More loans EEEK!!)

CambieMD

 

[neo]

Originally posted by Teufelhunden

When's the last time you heard an MD or DO who couldn't find work ???

well, about one page back on this thread...

again, if anyone has any info. we'd be very appreciative.

 

[PACtoDOC]

Has she checked with the physician recruiters at all the local hospitals? Are none of them willing to give her a guarantee the first year so that she can practice wherever she wants? You would think almost any practice with enough space could accomodate your wife if she got this guarantee, or hell, even take out a loan and open up a very small clinic and slowly expand. This might have to be done if you are intent to stay in the area.

 

[neo]

talked to all the hospitals in the area. they all tell her that if anything there are too many primary care doctors in the area. with a population of less than 1 million in the entire raleigh durham, chapel hill area and two major medical centers in the area Duke and UNC chapel hill. and with most of the residents wanting to stay in the area after graduation, there is a huge glut here. every practice she's called tells her that if anything, they can barely support the physicians they currently have and say that many practices have closed recently due to the combination of low revenue and increasing malpractice rates (NC is one of the malpractice crisis states)


and while im at it, some people in this thread seem to think that a MD or DO is the path to riches and the easy life.

play with some online financial planning calculators

I have several friends who are in the tech industry or in business and they make an average of 90K a year. a large sample size and i'm sure that if someone who is as intelligent and goal oriented as your average medical student chose another field they would make at least that much. so lets assume an average of 80K a year to make calculations simple and err of the conservative side. after taxes, 60K a year. so.. starting at age 22 which is when the person finished college and starts his job. lets says for the next 8 years he lives like a med student/resident on about 26K a year and saves the rest for retirement. then lets say that for the next 20 years, he ramps up his lifestyle to live on 48K after tax dollars which is a pretty comfortable life and saves the rest. at the age of 50, he will have a retirement worth about 6 million dollars.

now, if you go to med school. you start saving after residency so you start at age 30. if you live the same lifestyle.... 48K a year after taxes.... you will need to save 6.5K a month to have the same nest egg because you will only be able to put 2-3K of it a month in tax deferred accounts and you will be hit hard with taxes on the rest of the investment. add to that your average MD loan debt of 1K a month... you will need 80K a year more income after taxes than your buddy who is a programmer for microsoft or ebay. so if your buddy is making 90K a year, you're gonna need to make at least 200K a year to make the same amount of retirement while living the same lifestyle financially.

this is not taking into account that as a doctor you are going to work more hours, more inconvenient hours, have more stress, etc.

the average physician according to the bureau of labor statistics that someone was citing makes 105K a year (this has got to be wrong but that's what they say) http://www.bls.gov/ncs/ocs/sp/ncbl0539.pdf
i'd say the average physician makes closer to 160K a year since the average PMD makes about 130K and the average subspecialist makes 250K and there are a ton more PMDs than subspecialists.

of course there are doctors that make 1 million a year. but then again, i have a friend who retired at the age of 30 after working for 8 years with paine webber and is worth 4 million now. so anecdoctal stories = worthless

this is why if you go into medicine for the money, you are going to be a very bitter person.

go into medicine because you love medicine and you find it fulfilling and you will be happy with the money you make and with your life.

go into medicine because you think its the path to a good life and riches, you're going to be kicking yourself.

 

[deleted6669]

why doesn't your friend just accept that there are no fp jobs there and move elsewhere?

 

[neo]

good question.

her husband just started residency in the area.

 

[CambieMD]

Hi Neo,

has your friend loked at correctional institutions. They tend to always need someone. I have a friend who works for a correctional institution and loves it. Safety isn't as big an issue as most people think. The environment is very regulated. Mental institutions often need docs to manage the "clients" medical problems. These options should be explored if they haven't been up to this point.

The suggestion that your friend explore a hospital guarentee is not a good one. The hospital may front her salary for a year but they will require that she hangs around for a few years as terms of their agreement. She needs something with few strings attached. Locum Tenens should be looked into, also. Starting a practice in an area that is overpopulated with very well trained US grads is not a good idea. Now she will be saddled with a commercial business loan. Some business loans mature in six years. My thinking is something quick with no strings or as few a possible would be best.



CambieMD


CambieMD

 

[Voxel]

How about urgent care centers or more rural ERs in NC?

 

[flga]

I would just like to know what exactly an Urgent Care Center is? Is it basically a walk in clinic??

 

[HamSandwich]

i hope this link comes thru....check out the physicians per capita. you can do it for any city/state

http://www.bestplaces.net/html/ccheal.asp?lstat=NC&lcity=3712000&rstat=NC&rcity=3711800