Pediatric Salaries

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stophon4

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Hey All,

3rd year med student here hoping to learn more about compensation in pediatrics. I loved my peds rotation but, like so many others before me, I am concerned about salary. I will have 300k in debt, and even more worrisome, I am geographically bound to a large, very populated city. To leave a little bit of identity ambiguity, let's just say it is either LA, Boston or Chicago.

I consistently read on these forums that no one should expect to make over 200k as a pediatrician, but I just got access to the 2015 MGMA report (and I am told it is the most accurate), and the report is much more optimistic. It says that even though a normal starting salary is 160k (comparable to what has been stated on this forum), the median mid career compensation of general pediatrician is between 220k and 260k.

So can any older pediatricians level with me here? What should I expect to make when I'm 40? 180k or 250k? These are very different numbers. If the typical mid career pediatrician really is making 250k, as the MGMA report says, then I really don't think there is anything to complain about in peds!

And with an average work week of 47 hours, is peds the new derm? Just kidding, thanks for the replies everyone!

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By mid-career, it should be closer to 250K than 180K - if you have regular full-time hours. But lots of variability depending on type of practice and methods of compensation.
 
What about for academic centers and subspecialties like PICU? My sense is that most pedi subspecialties exist at major academic centers and per Careers In Medicine, academic peds salaries are mostly pretty fixed around 150-200 (150 for things like nephro/heme onc and 200 for critical care type stuff). Is that pretty true?
 
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What about for academic centers and subspecialties like PICU? My sense is that most pedi subspecialties exist at major academic centers and per Careers In Medicine, academic peds salaries are mostly pretty fixed around 150-200 (150 for things like nephro/heme onc and 200 for critical care type stuff). Is that pretty true?

No. It might be true for academic centers very close to Fenway Park, Yankee Stadium and perhaps a few others, but not for those closer to Big Ten and SEC schools among others. As far as the OP is concerned. It is really hard to make meaningful generalizations when you are still 5 years from practicing and there are so many practice variables. I know you'd like to use a fixed number to make a career decision, but it just isn't possible. Number of hours also depends a lot on how the practice is set up especially related to call coverage.
 
For primary care pediatrics a 160k starting salary seems a bit high, especially for a major city. 100-150k is more realistic imo, but it absolutely can be higher for less desirable locations. Don't know about further on in the career; I just know salaries from hearing about PGY3s getting job offers.

For pediatric subspecialties the salary varies wildly by speciality and obviously within each specialty as well. If income is a critical factor in deciding your speciality, yet for some crazy reason you still want to do pediatrics, then I would strongly consider neonatology. Neonatologists tend to universally have reasonably high incomes. Other potential well-paid pediatric specialities include emergency medicine, intensive care, gastroenterology and cardiology. Of course all of these fields will see substantially lower incomes than their adult counterparts, and again salary depends on location and academic vs. private practice. If income, lifestyle and being in a pediatric-field are all hugely important factors to you, then an excellent option is pedi emergency medicine. It has a much better lifestyle than the other specialities I mentioned, imo. Plus they certainly deal with interesting medicine on a day-to-day basis. Just a thought.
 
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If I can get above 200k by mid career in outpatient pediatrics in one of the major cities I listed above, then I will be thrilled. I don't know if that's asking too much. I just like kids and I want to be able to spend time with my family while also being able to put my own kids in great schools.
 
As a second year interested in peds but with the knowledge of a second year..
What about pediatric fellowships from a non-pediatric residency specialty? Such as pediatric anesthesiology or pediatric surgery? What are resident's (or anyone who would know) impressions on their salaries/lifestyle/competitiveness ?
 
As a second year interested in peds but with the knowledge of a second year..
What about pediatric fellowships from a non-pediatric residency specialty? Such as pediatric anesthesiology or pediatric surgery? What are resident's (or anyone who would know) impressions on their salaries/lifestyle/competitiveness ?

It is best to ask these - and they are often discussed, on the relevant subspecialty forums, or, since you are a med student on the allo forum. There are many specialties dealing with children that don't start with a pediatric residency or are a blended residency and each is different in all of these things.
 
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@oldbearprofessor I just looked all through past threads on the topic - I'm sorry I didn't do that before asking (rookie mistake). Thanks for the advice!
 
As a second year interested in peds but with the knowledge of a second year..
What about pediatric fellowships from a non-pediatric residency specialty? Such as pediatric anesthesiology or pediatric surgery? What are resident's (or anyone who would know) impressions on their salaries/lifestyle/competitiveness ?

In general, pediatrics pays less than it's adult counterpart. This is in part due to the fact that a large portion of children are covered under medicaid, which pays less than medicare. This, I imagine, extends to pediatric surgical specialties, pediatric Emergency, and pediatric anesthesia. But, these are also very in demand fields, in some cases considered very elite (pediatric surgery), so I imagine the salaries vary widely based on where you are. They all will pay better than general pediatrics because they are more procedure based.
 
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That's so depressing, well scratch peds off the list.
What I don't get its that if you look at any of the published salary reports, Medscape, MGMA, Doximity, etc., Peds, FM and primary care IM are all within maybe 10k of eachother. But if you go on the FM forums here people throw out ballpark estimates much higher than the reported averages, whereas here on the Peds forum people throw out numbers much lower than the reported averages.
 
What I don't get its that if you look at any of the published salary reports, Medscape, MGMA, Doximity, etc., Peds, FM and primary care IM are all within maybe 10k of eachother. But if you go on the FM forums here people throw out ballpark estimates much higher than the reported averages, whereas here on the Peds forum people throw out numbers much lower than the reported averages.


Doximity has peds in the 220k range. The problem with peds and I have said this before, is that it is full of women, and women are passive in salary negotiations and do not know their worth. This directly affects how much male pediatricians can make, because they do not have much bargaining power when the female peds resident that interviewed before them agreed to work for 130k. Physicians should never make less than nurses, that's just sad.
 
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Doximity has peds in the 220k range. The problem with peds and I have said this before, is that it is full of women, and women are passive in salary negotiations and do not know their worth. This directly affects how much male pediatricians can make, because they do not have much bargaining power when the female peds resident that interviewed before them agreed to work for 130k. Physicians should never make less than nurses, that's just sad.

And this is why there should be more transparency in salaries. One of my former chiefs took a job as a Hospitalist and told us all that she couldn't tell us her salary per her contract. But it makes it so much more difficult to figure out what I should be seeking when looking for a job.
 
And this is why there should be more transparency in salaries. One of my former chiefs took a job as a Hospitalist and told us all that she couldn't tell us her salary per her contract. But it makes it so much more difficult to figure out what I should be seeking when looking for a job.
Is this unique to peds though?
 
The problem with peds and I have said this before, is that it is full of women, and women are passive in salary negotiations and do not know their worth. This directly affects how much male pediatricians can make, because they do not have much bargaining power when the female peds resident that interviewed before them agreed to work for 130k.

With all due respect, I find these generalizations both inaccurate and inappropriate explanations of salary issues in pediatrics. You are entitled to your view, but forum readers should not accept them as the unquestionable reasoning for somewhat lower salaries in pediatrics than other fields.
 
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I'm more than a little disturbed that people are spending this much time on figuring out salaries before choosing a specialty/subspecialty. I don't think I'm "old school" (hope I'm not), but I still think medicine should only be practiced by those with a calling, and who are unequivocally selflessly devoted to their chosen field.

(descends from soap box...)
 
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I'm more than a little disturbed that people are spending this much time on figuring out salaries before choosing a specialty/subspecialty. I don't think I'm "old school" (hope I'm not), but I still think medicine should only be practiced by those with a calling, and who are unequivocally selflessly devoted to their chosen field.

(descends from soap box...)


Do you have 300k in loans? Times have changed. One of the reasons I try to keep my views to myself around attendings that grade me, you never know if they are one of those " you should be willing to starve and work for free. This is a calling!" types, or one of those " Medicine is a job, I like it but its not my entire life" types.
 
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With all due respect, I just want to defend our reality.

An average student with 200k in student loans accruing interest at 6.8% (current Unsubsidized Stafford) over 6 years of residency and fellowship while making IBR payments will leave fellowship owing $312,000 (per AAMC's MedLoans calculator).

$312,000 on a 10-year repayment plan is 3,600 per month. On a 15-year repayment plan it's 2,700 per month (x 12 months) = 32,400 per year in student loans for the first 15 years of one's career (for a total educational cost of ~$500,000.)

$150,000 salary (ballpark pediatric subspecialty per Careers in Medicine) after taxes is $97,000. Subtracting student loans, this is $65,000. Anyone finishing fellowship at ~33-35 needs to urgently begin at minimum probably 15% retirement savings ($22,000 per year), for a take-home income of $43,000.

It's hard to listen to a calling when you're talking about paying rent, expenses, childcare, and saving for college on $43,000. We are the first generation with this size loan and no deferral through training.

The reality, as far as I can tell, is that most pediatric applicants now have a high-earning partner, a loan-forgiveness program (nobody is counting on PSLF), or somehow took out less than the average medical school debt. It can't just be about a calling.
 
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With all due respect, I just want to defend our reality.

An average student with 200k in student loans accruing interest at 6.8% (current Unsubsidized Stafford) over 6 years of residency and fellowship while making IBR payments will leave fellowship owing $312,000 (per AAMC's MedLoans calculator).

$312,000 on a 10-year repayment plan is 3,600 per month. On a 15-year repayment plan it's 2,700 per month (x 12 months) = 32,400 per year in student loans for the first 15 years of one's career (for a total educational cost of ~$500,000.)

$150,000 salary (ballpark pediatric subspecialty per Careers in Medicine) after taxes is $97,000. Subtracting student loans, this is $65,000. Anyone finishing fellowship at ~33-35 needs to urgently begin at minimum probably 15% retirement savings ($22,000 per year), for a take-home income of $43,000.

It's hard to listen to a calling when you're talking about paying rent, expenses, childcare, and saving for college on $43,000. We are the first generation with this size loan and no deferral through training.

The reality, as far as I can tell, is that most pediatric applicants now have a high-earning partner, a loan-forgiveness program (nobody is counting on PSLF), or somehow took out less than the average medical school debt. It can't just be about a calling.
Sadly, tons of my classmates will have almost double that. I will graduate with about 300K myself. Tack on interest from a 3-year res and 3-year fellowship: yikes...

I also think the "average" of 200k is misconstrued because there are a plethora of med students who are having their school paid for. This significantly brings down the average. Personally, everyone I know will either be 300K+ in debt upon graduating or 0-- due to family paying their way.

I love peds and it was a signicant reason I went to med school in the first place. But, coming out of fellowship at 35 with about 1/2 a mil in debt?.....smh......
 
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I'm more than a little disturbed that people are spending this much time on figuring out salaries before choosing a specialty/subspecialty. I don't think I'm "old school" (hope I'm not), but I still think medicine should only be practiced by those with a calling, and who are unequivocally selflessly devoted to their chosen field.

(descends from soap box...)

I feel like there are a higher percentage of people with the sentiment of medicine as a calling in peds than in most other fields. It's one of the things I love about peds and peds people. However, the broader gist of the post, that money should be disregarded, is I think a sentiment that often goes hand in hand with the "medicine as a passion", and I think it's done a tremendous disservice to the field of peds. Should the services a pediatrician offers deserve compensation significant less than similar services in an adult population? If not, where's the strong drive to try to change that in the field? I think the issue bleeds over to fellowship as well. We have a large percentage of pediatrics fellowship positions going unfilled. Maybe a fair part of that is related to the prospect of being a trainee for an additional three years with a financial penalty for your effort waiting on the other end?
 
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Doximity has peds in the 220k range. The problem with peds and I have said this before, is that it is full of women, and women are passive in salary negotiations and do not know their worth. This directly affects how much male pediatricians can make, because they do not have much bargaining power when the female peds resident that interviewed before them agreed to work for 130k. Physicians should never make less than nurses, that's just sad.

What is this the 1950s? I thought we had moved past this kind of sexist sentiment, especially in the field of pediatrics. Pediatricians earn lower income compared to other physician specialities not because they are women... but because well child checks, the most common office visit type, are not reimbursed well; primary care pediatrics has little to no procedures, again leading to lower reimbursement; and finally adult appointments are reimbursed higher compared to pediatric appointments. Salary negotiations have absolutely no effect on how many RVUs/income a physician brings in. This argument is senseless.
 
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Sadly, tons of my classmates will have almost double that. I will graduate with about 300K myself. Tack on interest from a 3-year res and 3-year fellowship: yikes...

I also think the "average" of 200k is misconstrued because there are a plethora of med students who are having their school paid for. This significantly brings down the average. Personally, everyone I know will either be 300K+ in debt upon graduating or 0-- due to family paying their way.

I love peds and it was a signicant reason I went to med school in the first place. But, coming out of fellowship at 35 with about 1/2 a mil in debt?.....smh......

This is the sad reality today. You're right to think carefully about your financial future. Fortunately medical school graduates still have LOTS of options to choose specialities that will earn them >250k per year, and they will live more than comfortably despite their past massive debts. Should these students with >300k in debt choose primary care pediatrics - no (imo)... unless they can see themselves doing nothing else. However if pediatrics is their calling, and they are financial savvy, they'll make do.
 
IBR on 500K? Yeahhhh... That's pretty much a lifetime of servitude. Also, I'm willing to wager PSLF never gets its foot off the ground. How many checks is the gov. going to write to physicians before they realize the amount of money they can collect by ditching the program? No way it's still around (for physicians) when those of us, whom are currently in school, are able to utilize it.
I have to think that if they take it away from people who are already on IBR/PAYE/REPAYE who have certified their employment then they'd have a massive court battle on their hands... not that going to court against the government isn't an uphill battle.
 
What do all you attendings think about pediatric hospitalist medicine? Would 200k+ be realistic with 7on/7off with some moonlighting in between? I saw a hospitalist survey that out the avg compensation for a peds hospitalist at 207k... but I know that's not necessarily starting out.
 
IBR on 500K? Yeahhhh... That's pretty much a lifetime of servitude. Also, I'm willing to wager PSLF never gets its foot off the ground. How many checks is the gov. going to write to physicians before they realize the amount of money they can collect by ditching the program? No way it's still around (for physicians) when those of us, whom are currently in school, are able to utilize it.

Graduating this year with 250kish in debt. Really holding out hope for PSLF and the slowness of government action, but we'll see what happens. When do the first group of people supposedly start getting forgiven? May-ish?
 
I have to think that if they take it away from people who are already on IBR/PAYE/REPAYE who have certified their employment then they'd have a massive court battle on their hands... not that going to court against the government isn't an uphill battle.

I actually think it's fairly likely that they'll treat the amount 'forgiven' as taxable income, just like they do with IBR/PAYE now. There's nothing in the current MPN that would preclude that, since the exact same wording is there for IBR/PAYE. They might also change what counts as 'qualified' employer, but that would have to take place from the time they make the law, given that they've already allowed people to certify.

Graduating this year with 250kish in debt. Really holding out hope for PSLF and the slowness of government action, but we'll see what happens. When do the first group of people supposedly start getting forgiven? May-ish?

Octoberish 2017. Program went into effect in 2007, so assuming the people who took out loans in Spring 2007 qualify for it, they probably didn't start making payments until 6 months after they graduated (October 2007), so the soonest they could have 120 qualifying payments i probably Octoberish 2017.
 
Mayish 2017

I actually think it's fairly likely that they'll treat the amount 'forgiven' as taxable income, just like they do with IBR/PAYE now. There's nothing in the current MPN that would preclude that, since the exact same wording is there for IBR/PAYE. They might also change what counts as 'qualified' employer, but that would have to take place from the time they make the law, given that they've already allowed people to certify.



Octoberish 2017. Program went into effect in 2007, so assuming the people who took out loans in Spring 2007 qualify for it, they probably didn't start making payments until 6 months after they graduated (October 2007), so the soonest they could have 120 qualifying payments i probably Octoberish 2017.

Ah thanks, I had thought it was 2016 for some reason. I anticipate it to be considered taxable income. That can be planned for though, still a significant relief of burden
 
I kind of have this thought that I might save the money I would be paying if I were on a 10 year repayment plan, taking advantage of the new REPAYE program subsidizing half of the interest. Then if PSLF comes through then great, I'll have a ton of savings for the tax bomb and for investing/retirement/etc. If PSLF doesn't come through, I can use the savings to pay down my loans closer to what I would have been paying the whole time.

Any financially savvy people see any problems with this that I'm not?
 
I kind of have this thought that I might save the money I would be paying if I were on a 10 year repayment plan, taking advantage of the new REPAYE program subsidizing half of the interest. Then if PSLF comes through then great, I'll have a ton of savings for the tax bomb and for investing/retirement/etc. If PSLF doesn't come through, I can use the savings to pay down my loans closer to what I would have been paying the whole time.

Any financially savvy people see any problems with this that I'm not?

What's your debt? My 10 year standard repayment plan would be over 3k a month, and that's sure not happening during training for me
 
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Another option is student loan refinancing. There are a few private companies that will buy your loans and offer interest rates between 2-5% depending on several factors.
 
What do all you attendings think about pediatric hospitalist medicine? Would 200k+ be realistic with 7on/7off with some moonlighting in between? I saw a hospitalist survey that out the avg compensation for a peds hospitalist at 207k... but I know that's not necessarily starting out.

This is the best source i've found re: hospitalists. I don't know where this number goes mid-career.

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What's your debt? My 10 year standard repayment plan would be over 3k a month, and that's sure not happening during training for me
~350k :(

And yeah, obviously the whole saving plan would come once I'm out of residency and have a real job. But REPAYE during residency will effectively cut in half any interest not paid under the monthly income-based minimum payment. So there's that.

Problem is all this is still much harder on 150k-200k as a pediatrician than on 200k-275k as an FM or IM hospitalist.
 
I have to think that if they take it away from people who are already on IBR/PAYE/REPAYE who have certified their employment then they'd have a massive court battle on their hands... not that going to court against the government isn't an uphill battle.
The notion that tens of thousands of physicians will have $200,000 of loans forgiven without means testing or taxation of the forgiven debt is a pipe dream. If medical school graduates get stiffed on PSLF, it will be impossible to sue the Congress. That case will be thrown out of court faster than you can say "subpoena duces tecum". Congress pulls the rug out from people all of the time. No one will have standing. This is not a federal contract.

Some people may find it sexist but there is a mountain of evidence in labor economics that women do tend to gravitate to lower paying professions. Based on what I've seen about 80% of pediatric residents are women.

One ray of hope for pediatric salaries is that family practice docs often serve as substitutes for pediatricians. Because the population is aging and family practice docs are increasingly swamped with geriatric patients, pediatricians might gain additional leverage in the labor market.
 
I can't understand how making $150K as a new pediatrician is acceptable. With all the debt? I'm amazed at med students who go for it, and our system that maintains it.

Parents are willing to pay anything for their children. Child psychiatrists mostly run cash practices. Pediatricians could follow suit if they really wanted to.
 
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I can't understand how making $150K as a new pediatrician is acceptable. With all the debt? I'm amazed at med students who go for it, and our system that maintains it.

Parents are willing to pay anything for their children. Child psychiatrists mostly run cash practices. Pediatricians could follow suit if they really wanted to.

We'd miss a significant chunk of the population who couldn't afford it otherwise. Most academic practices are largely medicaid, and some of my patients wouldn't get their albuterol if it weren't for our social workers and getting them set up with insurance.
 
Parents are willing to pay anything for their children. Pediatricians could follow suit if they really wanted to.

No they aren't. 51 % of infants in the US are on public assistance via the WIC program and of the rest, few would be willing to have concierge service for routine care when they can get by with copays, covered Urgicare centers, etc. There are such pediatric practices, but not a lot of them can be supported. As noted, this is a non-starter for hospital based pediatricians such as specialists and hospitalists.
 
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I can't understand how making $150K as a new pediatrician is acceptable. With all the debt? I'm amazed at med students who go for it, and our system that maintains it.

Parents are willing to pay anything for their children. Child psychiatrists mostly run cash practices. Pediatricians could follow suit if they really wanted to.

Child psychiatrists are an entirely different setup, just like psychiatry in general is a very different setup. First of all, it doesn't take much fancy equipment to run a child psych practice, so you're starting from basically no overhead. Hospital based specialties need a hospital and all the support systems to help them function. Secondly, the shortage of child psychiatrists is so bad in most areas of the country that you have plenty of people still available who are able to pay cash for treatment. Once that population gets tapped out, you'd see the number of psychiatrists able to run cash practices go down quickly.

Another not insignificant part of this is that most pediatricians went into pediatrics to take care of kids. It doesn't sit right with many of them when kids get screwed over because their parents either can't or won't pay for treatment. It's a significant ethical issue when you exclude large amount of children who have little to no control over their own care based on ability to pay. It's not easy to sleep at night if you think about the 6 year old with severe asthma that you wouldn't see in clinic because her parent's couldn't pay cash who won't have any controllers, will probably show up at the local ED repeatedly and get admitted every year until she's a teenager and eventually takes one last trip to the ICU that she doesn't come back from. Very different than the adult world from an ethics standpoint to many people.
 
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Very good points. Didn't at all mean to suggest children not get healthcare. I'm saying in a round-about way that I'm a big fan of you guys getting paid more.
 
any more contributions to this would be greatly appreciated!
 
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I second @thebrightside 's bump. Residents/attendings ... if you don't mind my asking obviously ... how did you overcome the issue of (relatively) lower pay? I'm assuming most of you out there either enjoy kids too much to not work with them, or disliked working with adults enough to choose peds? Did you like the pathology of pediatric diseases more? Or maybe not having to deal with as many patients with multiple chronic lifestyle-induced diseases? I'm just spitballing but I'd love to hear your thoughts
 
I second @thebrightside 's bump. Residents/attendings ... if you don't mind my asking obviously ... how did you overcome the issue of (relatively) lower pay? I'm assuming most of you out there either enjoy kids too much to not work with them, or disliked working with adults enough to choose peds? Did you like the pathology of pediatric diseases more? Or maybe not having to deal with as many patients with multiple chronic lifestyle-induced diseases? I'm just spitballing but I'd love to hear your thoughts
Yes to all of the above, but a little perspective is in order. $150k/year easily puts you in the top 2% in terms of income. We don't live like kings and may not all drive Teslas, but it's enough to pay loans and live comfortably while still saving for retirement. It is frustrating that adult counterparts make considerably more than we do, but we have good job security, one of the highest job satisfaction rating of any specialty, and we do just fine. I suspect that over time physician salaries will even out (as is common in other countries), though I have no idea over what time frame that will play out.
 
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Agree with Stitch, practically word for word.

To be clear, there are many options out there for loan repayments including lots of companies that are willing to refinance for longer terms and lower interest rates. Like anything, there are pros and cons to those options, but they can provide flexibility when you're just starting out to figure out your cash flow, start proper saving habits, and create long term stability. I wouldn't count on anything that forgives large amounts of money, but as a borrower with considerable income (compared to the general populace) you do have some power in this situation. If you want details on the possibilities PM me.

Much of it comes down to knowing yourself, and figuring out how to navigate the world in a manner that you find tolerable. Would my financial life be easier with higher pay? Very much so, but I think Biggie and Puffy were right - mo' money, mo' problems...I was on a trip recently with a bunch of anesthesiologists and while I was envious of their income, the amount of BS they deal with was ridiculous. Lazy partners, incompetent surgeons, hospital administrators that don't want to do what's best for the patient, practices being bought or taken over, the difficulties of being an independent contractor and so on. I had a discussion with one of my partner's husbands who is a general internist and some of his patient stories were so incredibly frustrating (simple problems, like hypothyroidism, easily fixed if his patients would just take their meds) and he just had to throw his hands up. While I think those other docs enjoy their jobs, the circumstances would make me miserable, to the point that no amount of money would make up for it. Maybe other people can create the mental disconnect, but that is just not something I can do.

So in the end, I give up money for my mental/emotional well being. It's a tradeoff I would gladly make everyday (and my wife probably would too). But I don't recommend it for everyone.
 
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With all due respect, I just want to defend our reality.

An average student with 200k in student loans accruing interest at 6.8% (current Unsubsidized Stafford) over 6 years of residency and fellowship while making IBR payments will leave fellowship owing $312,000 (per AAMC's MedLoans calculator).

$312,000 on a 10-year repayment plan is 3,600 per month. On a 15-year repayment plan it's 2,700 per month (x 12 months) = 32,400 per year in student loans for the first 15 years of one's career (for a total educational cost of ~$500,000.)

$150,000 salary (ballpark pediatric subspecialty per Careers in Medicine) after taxes is $97,000. Subtracting student loans, this is $65,000. Anyone finishing fellowship at ~33-35 needs to urgently begin at minimum probably 15% retirement savings ($22,000 per year), for a take-home income of $43,000.

It's hard to listen to a calling when you're talking about paying rent, expenses, childcare, and saving for college on $43,000. We are the first generation with this size loan and no deferral through training.

The reality, as far as I can tell, is that most pediatric applicants now have a high-earning partner, a loan-forgiveness program (nobody is counting on PSLF), or somehow took out less than the average medical school debt. It can't just be about a calling.

What if a person has 500K+ of debt?
 
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At $500k in debt as a pediatrician, I'd argue that your debt is now going to control some of your career decisions. Either put all your eggs in the PSLF program or accept that being an academic pediatrician in a city like LA, NYC, Boston, etc is not an option. There are jobs that pay better than $150k. There are jobs that come with loan repayment. There are jobs with both. These generally mean living in an undesirable location, working hard, or both.
 
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