How much does a FM doctor make in Midwest

[deleted936470]

How long did you spend living in st louis?

3 yrs

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[efle]

3 yrs

I was similar, what couldn't you find that is offered by san diego or LA? I grew up in SoCal and expected St L to be a lot more different than it really was

 

[hallowmann]

There are places not on the coast where you don't have to deal with winter/snow again and they're pretty cheap, thinking the south specifically (in the middle part of the country). I wouldn't want to live there, but people can.

I agree. There are certainly nice places. I have family outside of Dallas and it's nice, but some aspects of the culture seems to have adversely affected their children in terms of poor self-image and forced "otherness". They've tried to form a community there to insulate a bit, but that's never what I've wanted to do, it's not how I grew up, and it's not really how I want my kids to.

This is not unique to the South. I wouldn't live in Sacramento either.

 

[deleted1005514]

I second the PNW. Most beautiful nature, no real winter in most of OR and WA, relatively very cheap to have a house on the fringes of a city like Portland.

I'm glad to hear this, my husband has been lobbying for us to eventually move to the Columbia River Gorge area...it is beautiful from pictures I've seen.

 

[Emmet2301]

I was similar, what couldn't you find that is offered by san diego or LA? I grew up in SoCal and expected St L to be a lot more different than it really was

I used to live in the way out suburbs of St Louis. It was good to settle down in but not great for a single person.

Not a big nightlife or bar scene.

 

[Emmet2301]

I agree. There are certainly nice places. I have family outside of Dallas and it's nice, but some aspects of the culture seems to have adversely affected their children in terms of poor self-image and forced "otherness". They've tried to form a community there to insulate a bit, but that's never what I've wanted to do, it's not how I grew up, and it's not really how I want my kids to.

This is not unique to the South. I wouldn't live in Sacramento either.

What do you mean? Was the otherness due to race/ethnicity or just not being from Dallas?

 

[hallowmann]

What do you mean? Was the otherness due to race/ethnicity or just not being from Dallas?

Race/ethnicity and faith. I easily pass, so I found people very friendly there, but not all my family has that ability.

 

[LeaveNoTrace]

Not discrediting you or anything, buddy, but I find this extremely hard to believe. The Kaiser “golden handcuffs “is not new. But 600k sign on bonus doesn’t even exist for psych in North Dakota, let alone CA.

I have numerous friends in CA, and even in remote and less desirable areas, the perks aren’t that great.

Do those half-million-dollar signing bonuses exist for psych anywhere in the US - like, say, rural Alaska?

 

[Postictal Raiden]

Do those half-million-dollar signing bonuses exist for psych anywhere in the US - like, say, rural Alaska?

That was my point. I doubt the existence of any position in any field in any place that offers 500k sign on bonus. Show me evidence.

 

[hallowmann]

Do those half-million-dollar signing bonuses exist for psych anywhere in the US - like, say, rural Alaska?

That was my point. I doubt the existence of any position in any field in any place that offers 500k sign on bonus. Show me evidence.

$200k exists and I've seen it, but there are usually a lot of strings. @Mad Jack was talking about a couple, so each of them had something like $250-$300k bonuses which together were $500-$600k. I don't find it that hard to believe, but the 10 year retention would be a major dealbreaker for me.

 

[efle]

I used to live in the way out suburbs of St Louis. It was good to settle down in but not great for a single person.

Not a big nightlife or bar scene.

Bingo. You want lots of good clubs and ways to meet girls. But most graduating residents in their 30s aren't looking for that, anymore.

Plus I promise the 'burbs of CA are also boring for single young people. That's just the nature of the burbs, not of which area of the US they're in.

 

[Splenda88]

What's wrong with the coastal states in the south ? Places like FL, GA, SC, NC and VA. Real estate is not too expensive and you don't have to deal with snow storm

 

[Drrrrrr. Celty]

What's wrong with the coastal states in the south ? Places like FL, GA, SC, NC and VA. Real estate is not too expensive and you don't have to deal with snow storm

Most of the people on this site are from CA, NY, or IL. So that influences things.

I can genuinely say personally after doing med school in the MW and currently living across the country that there are very few places I wouldn't live or thrive in happily. But Florida is one of them.

 

[Drrrrrr. Celty]

I still find this conversation somewhat contrived. Even in LA I don't think the notion that a FM doctor and their partner ( Who likely will probably make at least 50k) is supposed to not be reaching a satisfactory living status. I mean, even for a suburbia house costing 1m the mortgage even with loan pay off probably will leave you with at least 3-7k disposable income and then after 10 years more.

Like my parent's income together even after my loan repayment is still significantly less than what my income would be if I was making 200k. And I lived very comfortably under their roof.

 

[SLC]

Yeah the midwestern house on a lake is only good if you're married, have 3 kids needing "good schools" and are resigned to aging into your dad-bod (god I hate that term). Otherwise it's a pretty lame way to live, there is only so many times a day you can pause and reflect on how big your crib is before the effect wears off and you start scratching your head about what else to do. Not saying working for half the money and twice the taxes in Socal is any better, but the midwestern mansion just isn't the optimal way to swing it.

Nope, Mountain West is the way to swing it. I’m within a few hours drive from Las Vegas, less than 2hrs from 5 red-rock national parks; 1hr from world class flyfishing in spring-fall, and world class skiing/snowboarding in winter.

A metro of about 2million is just up the road, when I need it.

And it’s as cheap as the Midwest here. I got 4,000 square feet for less than 400k. And I’m in the upper $200k range on salary less than 2yrs in.

 

[efle]

I still find this conversation somewhat contrived. Even in LA I don't think the notion that a FM doctor and their partner ( Who likely will probably make at least 50k) is supposed to not be reaching a satisfactory living status. I mean, even for a suburbia house costing 1m the mortgage even with loan pay off probably will leave you with at least 3-7k disposable income and then after 10 years more.

Like my parent's income together even after my loan repayment is still significantly less than what my income would be if I was making 200k. And I lived very comfortably under their roof.

Your parents bought the house at what price relative to it's current value though? 30%? A generation ago the situation wasnt nearly as extreme. An FM doc with loans would absolutely struggle to own a small home in the area I'm currently living.

 

[Splenda88]

Most of the people on this site are from CA, NY, or IL. So that influences things.

I can genuinely say personally after doing med school in the MW and currently living across the country that there are very few places I wouldn't live or thrive in happily. But Florida is one of them.

Why is that?

Bear in mind south FL is completely different than the rest of the state.

 

[67552931811]

What's wrong with the coastal states in the south ? Places like FL, GA, SC, NC and VA. Real estate is not too expensive and you don't have to deal with snow storm

Florida is a total dump, sans Clearwater/ Tampa/ St Pete

 

[JoaoMoutinho]

Nope, Mountain West is the way to swing it. I’m within a few hours drive from Las Vegas, less than 2hrs from 5 red-rock national parks; 1hr from world class flyfishing in spring-fall, and world class skiing/snowboarding in winter.

A metro of about 2million is just up the road, when I need it.

And it’s as cheap as the Midwest here. I got 4,000 square feet for less than 400k. And I’m in the upper $200k range on salary less than 2yrs in.

I think what you mean is that the area is horrible, the winters are horrible, everyone is conservative and horrible, fry sauce and red cream soda are disgusting, and that bar hopping is much more difficult in parts of the mountain west than in the rest of the country.


Ok, the last part might be the only one that's actually true (although I'm not a big red cream soda fan either), but let's let some things be hidden gems a little while longer.

 

[Splenda88]

Florida is a total dump, sans Clearwater/ Tampa/ St Pete

I wonder why so many are moving down there?

 

[Drrrrrr. Celty]

Your parents bought the house at what price relative to it's current value though? 30%? A generation ago the situation wasnt nearly as extreme. An FM doc with loans would absolutely struggle to own a small home in the area I'm currently living.

The house they bought is about... 150k more than what they bought it at I believe. If I bought an equivalent home I don't think my mortgage would break 3500 a month. Combine that with loans I'm still probably getting 4000 on hand after taxes. 4k a month of spending money is pretty decent.

 

[Drrrrrr. Celty]

Why is that?

Bear in mind south FL is completely different than the rest of the state.

I have lived in a lot of different spots in Florida. Flat tropical humidity is not my thing. I'm ok with South, but with Florida you're setting yourself up for hurricanes, not being able to walk outside for 70% of the year without becoming moist, and being around vacationers/snowbirds.

 

[Drrrrrr. Celty]

Florida is a total dump, sans Clearwater/ Tampa/ St Pete

Tampa is alright. Orlando was pretty good too.

But again, Hot, Wet, and Flat.

 

[SLC]

I think what you mean is that the area is horrible, the winters are horrible, everyone is conservative and horrible, fry sauce and red cream soda are disgusting, and that bar hopping is much more difficult in parts of the mountain west than in the rest of the country.


Ok, the last part might be the only one that's actually true (although I'm not a big red cream soda fan either), but let's let some things be hidden gems a little while longer.

João Moutinho eh? Great footballer!

 

[efle]

The house they bought is about... 150k more than what they bought it at I believe. If I bought an equivalent home I don't think my mortgage would break 3500 a month. Combine that with loans I'm still probably getting 4000 on hand after taxes. 4k a month of spending money is pretty decent.

Lmao my man, you cannot get a decent family home for 3500/mo in the expensive parts of CA

Zillow says a 1500 square foot 3bedroom in my area code is more than double that

You're probably not in one of the parts of the state that are described as "too expensive for a primary care doctor"

 

[Mass Effect]

What's wrong with the coastal states in the south ? Places like FL, GA, SC, NC and VA. Real estate is not too expensive and you don't have to deal with snow storm

NC and VA get snow (even blizzards occasionally), but nowhere near their counterparts in the rest of the country. GA and FL get snow on very rare occasions.

 

[Splenda88]

Tampa is alright. Orlando was pretty good too.

But again, Hot, Wet, and Flat.

It's actually on of the things I like about Florida. The roads are well maintained because it's flat.

 

[Splenda88]

NC and VA get snow (even blizzards occasionally), but nowhere near their counterparts in the rest of the country. GA and FL get snow on very rare occasions.

I know but not like places in the midwest and northeast...The midwest and the northeast (especially NY/NJ) are not my cup of tea.

 

[Mass Effect]

I still find this conversation somewhat contrived. Even in LA I don't think the notion that a FM doctor and their partner ( Who likely will probably make at least 50k) is supposed to not be reaching a satisfactory living status. I mean, even for a suburbia house costing 1m the mortgage even with loan pay off probably will leave you with at least 3-7k disposable income and then after 10 years more.

Like my parent's income together even after my loan repayment is still significantly less than what my income would be if I was making 200k. And I lived very comfortably under their roof.

Wait til you're an attending and you'll see that 200K shouldn't get you the million dollar home if you're paying taxes (including property taxes), paying off loans, paying for a family, AND buying a 1 m home. I don't know about CA state taxes, but for some, 200K = around 11K a month. Paying a huge chunk to mortgage for a house you can buy for half the price other places is not a smart financial move.

I'm sure you can find affordable homes in LA, but thinking you'll buy a million dollar home with your 200K first-job paycheck is a huge mistake.

 

[Splenda88]

A 3.5k/month 30-yr mortgage would give me a headache

 

[Mass Effect]

I second the PNW. Most beautiful nature, no real winter in most of OR and WA, relatively very cheap to have a house on the fringes of a city like Portland.

I think a lot of the coastal love comes from lack of exposure. My friends who went to college in LA/SF/San Diego stayed there to work. My classmates who grew up and went to college all in the big New England metros, same thing, they all want to match Boston and NYC and Philly.

If they'd spent a few years somewhere like Durham, Nashville, Atlanta, Austin, St Louis, Minneapolis, etc I think a lot of them would have been a lot more flexible about it. They talk about the Midwest and South like wastelands devoid of yuppies or things for yuppies to do. Really you can find all the usual entertainment in any cities that big, and when you drive a short while away from the city centers, you'll get 5x as much house per dollar.

Just as point of clarification, NYC and Philly are not part of New England.

 

[efle]

Just as point of clarification, NYC and Philly are not part of New England.

Yeah it's just that Manhattan ivory towers and Penn are the next best option if Harvard doesnt work out

 

[RangerBob]

What's wrong with the coastal states in the south ? Places like FL, GA, SC, NC and VA. Real estate is not too expensive and you don't have to deal with snow storm

Ocean is on the wrong side.

 

[Mass Effect]

Yeah it's just that Manhattan ivory towers and Penn are the next best option if Harvard doesnt work out

Not necessarily. There's a little known school tucked away in heart of New England, only a couple of hours drive from Harvard. Its name would be Yale.

 

[IntheClouds4ever]

Could you tell my more about when to pay off loans, when it's a good idea to only pay interest etc.?

I'm matriculating this fall and the total cost of attendance from the financial aid office freaked me out a bit since I've never taken out loans before.

don’t worry about the cost unless your taking out more than 60k/year.

most residents will go into REPAYE plan after graduating which means half of the accrued interest during residency is paid by federal government.

280k in loans means 1400/month in interest.
1400/month x 36 = 50,400 and still at 280k in loans

saving 1400/month x36 in a high interest savings account with 1.8% interest = $52k With loan growing to $305k with half interest paid by government. Then $305-52= $253k plus you’ll have an emergency fund for any catastrophic event during residency. Go into REPAYE, pay minimums, then pay back after residency.

 

[Drrrrrr. Celty]

Lmao my man, you cannot get a decent family home for 3500/mo in the expensive parts of CA

Zillow says a 1500 square foot 3bedroom in my area code is more than double that

You're probably not in one of the parts of the state that are described as "too expensive for a primary care doctor"

700k probably will get you a decent family home in Cali too. Unless you're literally aiming on buying a house in La Jolla or something then sure, you'll probably be pulling 5k to 6k over 30 years.

 

[Drrrrrr. Celty]

A 3.5k/month 30-yr mortgage would give me a headache

I mean a 15 year mortgage for a 700k home would end up being something like 5250 to 5500 a month. But on the same page it would probably limit your playing money down to like 2-3k a month if you're paying off loans over 5 to 10 years too. A tighter fit for sure.

 

[Drrrrrr. Celty]

It's actually on of the things I like about Florida. The roads are well maintained because it's flat.

Call me crazy, but palm trees pretending to be christmas trees are disgraceful.

 

[Link0358]

As a personal finance question, how expensive of a home could an FM reasonably afford after they finished paying off all of their loans?

 

[Chibucks15]

As a personal finance question, how expensive of a home could an FM reasonably afford after they finished paying off all of their loans?

Depends on COL, taxes, etc. Use one of those "how much home can I afford" things you find on google. That's what I'm doing before residency to see if buying a house is feasible in the location(s) I'm hoping to get

 

[Drrrrrr. Celty]

As a personal finance question, how expensive of a home could an FM reasonably afford after they finished paying off all of their loans?

Entirely depends on how much you're earning.

Lets go off of the average FM doctor 5 years out of residency and say it's like 250k. 250k at the local and state tax level probably amounts to around 33-45% of your income removed. So that becomes 140-175k. Divided by 12 thats around 11.5k to 15k a month. From there it becomes an issue of 15 year v.s a 30 year mortgage.
A 1million dollar home on a 30 year is 5k a month, on a 15 around 8k. Throw in car payments, other subscriptions, food, etc. And you'll basically the bottom line. That being said, work an extra shift or two a month at UC or something and you've got some more playing money.


So if you're a single income household and you're on a 30 year loan then you'll be making enough to live within your means. If you have a partner/spouse who makes at least 50k and you'll be able to probably be putting in money into the bank for savings, 401k, and able to go on vacation a couple times a year.

 

[Splenda88]

It would be irresponsible for anyone to buy 1 mil dollars home on 250k/yr income IMO.

 

[Link0358]

It would be irresponsible for anyone to buy 1 mil dollars home on 250k/yr income IMO.

Yeah looking at the math, it’ll be hard to make it work if you also want to put money aside for retirement, vacations etc.

Having a second income would definitely change things though.

 

[ciestar]

Yeah looking at the math, it’ll be hard to make it work if you also want to put money aside for retirement, vacations etc.

Having a second income would definitely change things though.

We’ll have two incomes and have zero intentions of buying a house of that cost...

 

[Splenda88]

Yeah looking at the math, it’ll be hard to make it work if you also want to put money aside for retirement, vacations etc.

Having a second income would definitely change things though.

A 15-yr mortgage payment should be 25-30% of you take home pay. If you take home pay is 12k/month, you mortgage should be ~3k max.

Remember that most of us will also have 300k student loan to pay back... This is another ~3k/month payment for 10 yrs.

You only have 6k/month left to pay other bills (e.g. utilities, health and life insurance, car payment etc...) and invest in your retirement.

It's safe to say I won't be living in these expensive cities that you guys talk about in this thread. I went into medicine because the job is intellectually stimulating and also to make enough money while having a good lifestyle. I don't want to keep working residency hours after I am done with residency in order to keep up with my bills. That is crazy!

 

[Cranjis McBasketball]

I think what you mean is that the area is horrible, the winters are horrible, everyone is conservative and horrible, fry sauce and red cream soda are disgusting, and that bar hopping is much more difficult in parts of the mountain west than in the rest of the country.


Ok, the last part might be the only one that's actually true (although I'm not a big red cream soda fan either), but let's let some things be hidden gems a little while longer.

I could literally drink fry sauce

 

[InternistDO]

If you make 250k as a married couple in a high cost of living area (lets say Los Angeles), assuming you are being responsible and maxing out you and your spouse's 401k, you'll make about $155,000 after tax/retirement contributions, or $12,900 a month. If you're debt free, the 30% rule puts your maximum mortgage at about 4000 a month, which seems a bit high for me since it's not accounting for property taxes and the like, but puts your maximum 30 year mortgage at about 800,000, which is a million dollar house if you correctly put a 20% downpayment.

To me that seems a little high though, I don't think I'd want to go above 750,000. And all of this is assuming you've paid your loans off.

Obviously a lower tax state would let you stretch that number higher--you'd take home about 1000 more a month in FL as opposed to CA for example.

 

[Splenda88]

If you make 250k as a married couple in a high cost of living area (lets say Los Angeles), assuming you are being responsible and maxing out you and your spouse's 401k, you'll make about $155,000 after tax/retirement contributions, or $12,900 a month. If you're debt free, the 30% rule puts your maximum mortgage at about 4000 a month, which seems a bit high for me since it's not accounting for property taxes and the like, but puts your maximum 30 year mortgage at about 800,000, which is a million dollar house if you correctly put a 20% downpayment.

To me that seems a little high though, I don't think I'd want to go above 750,000. And all of this is assuming you've paid your loans off.

Obviously a lower tax state would let you stretch that number higher--you'd take home about 1000 more a month in FL as opposed to CA for example.

I guess I am too conservative... Anything >500k is still high for me.

 

[qwerty89]

I'm sheltering in place in an expensive part of California right now, in a rent controlled studio apartment with a murphy bed that costs $30,000/year. In the Midwestern city I used to live in, I rented a similar size studio for several months that was $5,000/year. And I'm not talking about being out in the sticks - a real city with plenty of restaurants, movie theaters, recreation etc. A college town type area too, plenty of educated and like minded people around.

As nice as the weather in SoCal is, financial independence a decade sooner at the same QoL is much nicer. When I visit the bay and SoCal there's really not much to do that can't be done in a midwest city.

Former Californian here. You don't even have to go to the frigid upper midwest to do that. Simply moving to a major Texas city/suburb is just fine. Still get the decent winters and diversity and great food options but its got no income tax and has a great malpractice climate. Downside is that the salaries are probably lower than what you might expect if you actually live in the major cities themselves.

Want to live near Dallas? How about Flower Mound? Decent suburb. With beautiful homes!
Want to live near Houston? How about Sugar Land? Also a decent suburb. Gorgeous affordable homes.

Or live in Woodland Hills near Los Angeles. With a beautiful hom...er...condos. (also don't look at the HOA fees).

Pretty much everything (but property tax and sometimes sales tax, slightly) is cheaper outside of CA. Vehicle registration fees? You want to buy a luxury Tesla Model S? Cool! Great car! For $80,000 you are looking at well over $750 a year in fees. That would be around $100 in TX.

 

[Splenda88]

Former Californian here. You don't even have to go to the frigid upper midwest to do that. Simply moving to a major Texas city/suburb is just fine. Still get the decent winters and diversity and great food options but its got no income tax and has a great malpractice climate. Downside is that the salaries are probably lower than what you might expect if you actually live in the major cities themselves.

Want to live near Dallas? How about Flower Mound? Decent suburb. With beautiful homes!
Want to live near Houston? How about Sugar Land? Also a decent suburb. Gorgeous affordable homes.

Or live in Woodland Hills near Los Angeles. With a beautiful hom...er...condos. (also don't look at the HOA fees).

Pretty much everything (but property tax and sometimes sales tax, slightly) is cheaper outside of CA. Vehicle registration fees? You want to buy a luxury Tesla Model S? Cool! Great car! For $80,000 you are looking at well over $750 a year in fees. That would be around $100 in TX.

Dallas is great place to live IMO.

That home in Flower Mound is beautiful but a little pricey...