Specialties that are 40 hours a week and pay well

[Kaputt]

right because CMS has nothing better to do then lurk on SDN? Also I’m pretty sure if CMS wants to know how much we get reimbursed they can check the fee schedule lol. I never really understood this notion that we can’t discuss salaries

It was a joke. There is a long-running paranoia on some doctor boards about openly discussing salaries and offers (like on AuntMinnie, a radiology board).

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[stickgirl390]

The cardiologist i did all my premed shadowing with was in private practice in rural GA. He made $400-500k/year and made his own schedule. While I was shadowing, he worked about 7am-3pm with generous lunch breaks. I think once you make it to attending level with some experience under your belt, you can mold your career to fit your priorities.

 

[ewax]

Work as a school hospital administrator and you won’t have to work at all!

FTFY

 

[Kuratz]

While specialty choice does make a difference in lifestyle, many pre-meds and med students get way too tied up in splitting hairs between the perceived lifestyle of Optho vs Derm or whatever. The reality is that for most fields being the practice owner and having solid business skills is far more important than splitting hairs on what field to choose. The other aspect that is huge is location, especially if not a practice owner.

As others have suggested, you can make just about anything work to be both lucrative and with reasonable hours if you are motivated. Hard to be motivated if you chose skin but love eyes.

 

[jambro]

It was a joke. There is a long-running paranoia on some doctor boards about openly discussing salaries and offers (like on AuntMinnie, a radiology board).

Iirc there actually was a leaked CMS powerpoint that actually quoted posts from auntminnie to justify some big cuts to radiology that I believe did in fact happen

 

[Drrrrrr. Celty]

I live in SC, so not the midwest. I know several FPs on SDN that live on the east coast who do at least that well. I'm also not even in the top 15 of FPs in my group.

Breaking 300k in FM is not that hard, it just takes a few things to line up.

First, you need to make sure you're paid on production. You're not making that much if you're salaried.

Second, you need to be willing to work hard. I see on average 25-28 patients per day to pull this off.

Third, you're not likely to make this in large cities. But you definitely can adjacent to large cities or in smaller cities. Really unlikely in DC, easily doable in Richmond.

how do you see that many in 8 hours of work a day? I see like max 12 9 to 4 hours in my res clinic haha

 

[VA Hopeful Dr]

how do you see that many in 8 hours of work a day? I see like max 12 9 to 4 hours in my res clinic haha

Because I'm not a resident working in a residency clinic?

Snark aside, like anything else it takes practice. I've been out of training for almost 8 years doing basically the same thing this whole time. You're bound to get more efficient just by doing this over a course of years.

It also helps that by this point the majority of my patients are established with me so I'm familiar with them, on relatively stable regiments for their conditions with no major changes needed on a regular basis, and most are not medical or social trainwrecks. Epic is not a cumbersome EMR once you get used to it which helps as well.

My nurse works exclusively with me so she knows how I like things to be done. She does 99% of my non-charting paperwork and I just sign it which saves significant time.

 

[Captain_Falcon]

Because I'm not a resident working in a residency clinic?

Snark aside, like anything else it takes practice. I've been out of training for almost 8 years doing basically the same thing this whole time. You're bound to get more efficient just by doing this over a course of years.

It also helps that by this point the majority of my patients are established with me so I'm familiar with them, on relatively stable regiments for their conditions with no major changes needed on a regular basis, and most are not medical or social trainwrecks. Epic is not a cumbersome EMR once you get used to it which helps as well.

My nurse works exclusively with me so she knows how I like things to be done. She does 99% of my non-charting paperwork and I just sign it which saves significant time.

have you ever thought of leaving the practice you're currently at and setting up your own shop? Wondering if your earnings would be decreased/increased/similar to the current setup you're in now

 

[VA Hopeful Dr]

have you ever thought of leaving the practice you're currently at and setting up your own shop? Wondering if your earnings would be decreased/increased/similar to the current setup you're in now

Did that once. I hated running a business, absolutely hated it.

 

[Neopolymath]

right because CMS has nothing better to do then lurk on SDN? Also I’m pretty sure if CMS wants to know how much we get reimbursed they can check the fee schedule lol. I never really understood this notion that we can’t discuss salaries

Radiologists are sensitive about this because it was legitimately used against them in the last.

 

[LimpSpatula]

Psychiatry all day. Best field for lifestyle hands down. As a PGY-3, I worked all year in my pajamas ~35 hrs/week from home.

 

[Captain_Falcon]

Psychiatry all day. Best field for lifestyle hands down. As a PGY-3, I worked all year in my pajamas ~35 hrs/week from home.

And how did that make you feel?

 

[Mh0311]

There's the hours worked per field in a survey published in JAMA.

Here are the income IQRs for some of the lower down specialties (I'm also adding Radiology and Pathology which were missing from their survey but very possible to work 8 hours/day). Keep in mind the lower end are probably the ones working the best hours, and the higher end are working a lot of hours, though other factors like region matter a lot too.

RadOnc: 450 - 660
Diagnostic Rads: 410 - 630
Plastics: 400 - 660
Dermatology: 360 - 615
Emergency Med: 300 - 420
Pathology: 290 - 420
Ophthalmology: 280 - 520
Neurology: 250 - 380
Hospitalists: 250 - 340
Allergy/Immuno: 240 - 470
PM&R: 230 - 370
Psych: 220 - 320
Occupational: 210 - 280
Endocrine: 210 - 300
Family Med: 200 - 290
Peds: 190 - 290

why isn’t radiology more competitive?

 

[scoopdaboop]

why isn’t radiology more competitive?

AI buzz word gutted the profession in the eyes of med students.

 

[The Last Ankibender]

why isn’t radiology more competitive?

paranoia of AI
many people idea of s Doctor is seeing patients and don’t want to give that up

 

[LimpSpatula]

And how did that make you feel?

 

[LimpSpatula]

paranoia of AI
many people idea of s Doctor is seeing patients and don’t want to give that up

Until they actually start seeing patients.

 

[Steve_Zissou]

Until they actually start seeing patients.

Lol I was on the fence about DR at the end of second year. Then I went into my FM rotation, but it was my IM rotation that really cemented it. All the alcoholics, the druggies, the diabetics, the hypertensives, etc and attempting to manage it all while they’re whining and not taking their medications is exhausting. Can’t care more about people than they care about themselves.

 

[efle]

why isn’t radiology more competitive?

It has too many seats. Fields like derm and surgical subspecialties have an excess of US MD Senior applicants with the complete package. DR only fills ~70% from US Seniors each year. It's actually remarkable that the median board scores remain so high. Scores in the 220s still have a 95% match rate, so it seems to be self selection more than competitive pressure that even puts DR above average.

 

[Chibucks15]

some people prefer having fun things to do in their free time. I’d kill myself if I had to live in the Midwest. Plus also some want to live closer to family and grew up in these areas.

Some people still realize that there's plenty to do in the Midwest. Don't complain about salary or "that's not how it is" when it quite literally is the case. The coastal bias on here is just ridiculous. Been to the coasts, it ain't all its cracked up to be. I get family ties and all that but miss me with the "life is just better here" BS. But more power to ya, it'll leave the cush gigs for us plebians who want to be in the Midwest

 

[LimpSpatula]

Lol I was on the fence about DR at the end of second year. Then I went into my FM rotation, but it was my IM rotation that really cemented it. All the alcoholics, the druggies, the diabetics, the hypertensives, etc and attempting to manage it all while they’re whining and not taking their medications is exhausting. Can’t care more about people than they care about themselves.

We’re all cogs in this broken medical care machine, but medicine are the bottom bitches. Hospital administrators walking on to the floor for their bi-annual visit:

 

[Fried Plantaris]

Does the VA have a high turnover rate among physicians? What is the difficulty in securing a job at various VA since so many people are going for public loan forgiveness? How much does prior military service matter to their hiring process?

@VA Hopeful Dr

 

[efle]

Some people still realize that there's plenty to do in the Midwest. Don't complain about salary or "that's not how it is" when it quite literally is the case. The coastal bias on here is just ridiculous. Been to the coasts, it ain't all its cracked up to be. I get family ties and all that but miss me with the "life is just better here" BS. But more power to ya, it'll leave the cush gigs for us plebians who want to be in the Midwest

Agreed. Spent the last 10 years in some of the "worst" cities in the country incl. midwest and never felt like I needed anything that wasn't available. There's 1mil+ in the bigger cities out there, it's not all cows and cornfields.

 

[Lawpy]

AI buzz word gutted the profession in the eyes of med students.

Which is funny since the AI stuff is what got me more interested in rads, not less

 

[underthesun]

It has too many seats. Fields like derm and surgical subspecialties have an excess of US MD Senior applicants with the complete package. DR only fills ~70% from US Seniors each year. It's actually remarkable that the median board scores remain so high. Scores in the 220s still have a 95% match rate, so it seems to be self selection more than competitive pressure that even puts DR above average.

I don’t think it’s surprising that high scorers choose rads. The smart people see the light sooner and realize that the rest of medicine is soul-sucking. It’s just that a lot of other high scorers also want that ortho/derm prestige, which rads is lacking

 

[Drrrrrr. Celty]

Because I'm not a resident working in a residency clinic?

Snark aside, like anything else it takes practice. I've been out of training for almost 8 years doing basically the same thing this whole time. You're bound to get more efficient just by doing this over a course of years.

It also helps that by this point the majority of my patients are established with me so I'm familiar with them, on relatively stable regiments for their conditions with no major changes needed on a regular basis, and most are not medical or social trainwrecks. Epic is not a cumbersome EMR once you get used to it which helps as well.

My nurse works exclusively with me so she knows how I like things to be done. She does 99% of my non-charting paperwork and I just sign it which saves significant time.

Hah, I wish my patients were stable. Even the ones who are medically stable still need so much social support and to talk about ****.
But it's encouraging I guess.

 

[YCAGA]

FM. I work 36h/week in the office only. 2020 I grossed 310k. It would've been more but my partner retired in July so the first 6 months of the year were slow, plus 2 months where my numbers just tanked due to COVID. Also took 4 weeks off for vacation and another 1-2 for sick kids/long weekends/COVID quarantines.

If I keep the same numbers for this year that I did August-December of last year I should end up between 375-400k for 2021.

Do you have a money printer in an unused exam room?

Seriously though, 375k would easily be 90th percentile income for FM so that’s very impressive and must have required some hustle.

 

[YCAGA]

Spoiler: Hours per Specialty - JAMA paper

There's the hours worked per field in a survey published in JAMA.

Here are the income IQRs for some of the lower down specialties (I'm also adding Radiology and Pathology which were missing from their survey but very possible to work 8 hours/day). Keep in mind the lower end are probably the ones working the best hours, and the higher end are working a lot of hours, though other factors like region matter a lot too.

RadOnc: 450 - 660
Diagnostic Rads: 410 - 630
Plastics: 400 - 660
Dermatology: 360 - 615
Emergency Med: 300 - 420
Pathology: 290 - 420
Ophthalmology: 280 - 520
Neurology: 250 - 380
Hospitalists: 250 - 340
Allergy/Immuno: 240 - 470
PM&R: 230 - 370
Psych: 220 - 320
Occupational: 210 - 280
Endocrine: 210 - 300
Family Med: 200 - 290
Peds: 190 - 290

That research is super old

 

[efle]

That research is super old

I havent seen a better new alternative though :/ this study is still the one being used on the AAMC careers in medicine explorer for example.

 

[fldoctorgirl]

I don’t think it’s surprising that high scorers choose rads. The smart people see the light sooner and realize that the rest of medicine is soul-sucking. It’s just that a lot of other high scorers also want that ortho/derm prestige, which rads is lacking

I met a radiologist the other day who told me about how he went to Hawaii for 2 weeks and just read scans while chilling on the beach. Dude legit got paid to be on vacation. I spent a solid couple of hours trying to convince myself to like rads after that.

 

[YCAGA]

I havent seen a better new alternative though :/ this study is still the one being used on the AAMC careers in medicine explorer for example.

Me neither just letting people know that it is probably better to go off anecdotes of multiple physicians in different practice settings because the only systematic study is so dated. A lot has changed in medicine since 2011.

 

[YCAGA]

I met a radiologist the other day who told me about how he went to Hawaii for 2 weeks and just read scans while chilling on the beach. Dude legit got paid to be on vacation. I spent a solid couple of hours trying to convince myself to like rads after that.

From what I have read, telerads jobs require top tier productivity and they expect you to read studies for 8-10hrs with basically no breaks. To put it another way, there is a reason those jobs aren’t super competitive to get.

 

[Neopolymath]

From what I have read, telerads jobs require top tier productivity and they expect you to read studies for 8-10hrs with basically no breaks. To put it another way, there is a reason those jobs aren’t super competitive to get.

Reading remotely doesn't have to be done through telerads corporations. Many groups have internal agreements with their partners and employees to do stuff like she said above. I know of a couple places that send you somewhere to read while the rest of your family essentially gets a free vacation out of it and it doesn't count as a vacation week for you.

 

[ChordaEpiphany]

Depends on your definition of what well paying is. Endo and Rheum are 40h a week

Plus, 40h/week means you have time for a side hustle if you want. Personally, I'd rather have the flexibility and variety. You can pick up work doing all sorts of things as a physician, and if you're used to working 80+ hours/week as a resident, throwing an extra 20 hours/week at a side gig will still feel like a vacation.

What do you mean by paying well? Because I think you can work 40 hrs a week in any specialty and still get "paid well" meaning top 5% of income earners in the U.S.

Never judge physician salaries as equivalent to other salaries in the US. No other career has this long a training pathway or this high of a debt burden. Anyone making $100k/year (~$70-75k after taxes), but living like a medical student/resident (i.e. spending less than $25k/year on living expenses until attending age), will have saved up an even $1MM at least by the time you're making that $250-300k, meaning they are effectively making an extra $60-100k/year depending on how that money is invested, and they have a huge retirement savings advantage on you and no medical school debt. It is not "enough" for physician salaries to keep pace. Physician lifetime net worth potential is the only thing that matters. Salary is a marginally meaningful metric. I'm convinced the only reason salary is the primary discussion point around career pay is that actively encouraging the masses to save instead of consistently spend 90%+ of their income would be disastrous for the economy.

I don’t think it’s surprising that high scorers choose rads. The smart people see the light sooner and realize that the rest of medicine is soul-sucking. It’s just that a lot of other high scorers also want that ortho/derm prestige, which rads is lacking

What do you think is more "prestigious," a lower-tier ortho/derm residency or a top-tier residency in peds/IM/neuro/anesthesiology? I think they're about the same competitiveness, but the former will net you better money for clinical work while the latter will set you up for top jobs in the field, better geographic flexibility, more promotion potential to top hospital positions, and much better non-clinical positions (e.g. industry jobs, consulting side gigs, etc...).

 

[Candidate2017]

Because I'm not a resident working in a residency clinic?

Snark aside, like anything else it takes practice. I've been out of training for almost 8 years doing basically the same thing this whole time. You're bound to get more efficient just by doing this over a course of years.

It also helps that by this point the majority of my patients are established with me so I'm familiar with them, on relatively stable regiments for their conditions with no major changes needed on a regular basis, and most are not medical or social trainwrecks.

I ran into a FM resident whose multigenerational family owned a clinic. Their notes were started before the patient was roomed, and finished by the time the patient hopped off the exam table. After visit summary waiting at the front desk and still warm from the printer. No doubt they are making a ton as an attending.

 

[VA Hopeful Dr]

Do you have a money printer in an unused exam room?

Seriously though, 375k would easily be 90th percentile income for FM so that’s very impressive and must have required some hustle.

Yes, but not as much as you'd think.

25 patients/day for 4.5 days per week is 113 patient encounters per week. My billing works out to 1.5 wRVUs per patient encounter. That's 170 wRVUs/week. Let say I work 46 weeks per year (that's 6 weeks off including holidays). We're now at 7820 wRVUs per year. National average for wRVUs in FM is I think $42. So based on productivity alone we're talking 329k on the year. Between all the various bonuses, adding another 45k to that shouldn't be hard at most places.

 

[VA Hopeful Dr]

I ran into a FM resident whose multigenerational family owned a clinic. Their notes were started before the patient was roomed, and finished by the time the patient hopped off the exam table. After visit summary waiting at the front desk and still warm from the printer. No doubt they are making a ton as an attending.

Yeah we have some doctors in the network who work that way as well - heavy use of scribes and precharting. They see more like 30-40 patients per day. They're the ones breaking 450k+.

I don't want to do that. I don't like scribes or having my nurses take the history for me.

 

[YCAGA]

Yeah we have some doctors in the network who work that way as well - heavy use of scribes and precharting. They see more like 30-40 patients per day. They're the ones breaking 450k+.

I don't want to do that. I don't like scribes or having my nurses take the history for me.

Thanks for both of your replies, I learned a lot. Why don’t you like scribes? Slow you down? Bad notes? Too chatty? I was a scribe before med school and I probably did all three of those things at times so don’t hold any punches lol

 

[efle]

Plus, 40h/week means you have time for a side hustle if you want. Personally, I'd rather have the flexibility and variety. You can pick up work doing all sorts of things as a physician, and if you're used to working 80+ hours/week as a resident, throwing an extra 20 hours/week at a side gig will still feel like a vacation.

Never judge physician salaries as equivalent to other salaries in the US. No other career has this long a training pathway or this high of a debt burden. Anyone making $100k/year (~$70-75k after taxes), but living like a medical student/resident (i.e. spending less than $25k/year on living expenses until attending age), will have saved up an even $1MM at least by the time you're making that $250-300k, meaning they are effectively making an extra $60-100k/year depending on how that money is invested, and they have a huge retirement savings advantage on you and no medical school debt. It is not "enough" for physician salaries to keep pace. Physician lifetime net worth potential is the only thing that matters. Salary is a marginally meaningful metric. I'm convinced the only reason salary is the primary discussion point around career pay is that actively encouraging the masses to save instead of consistently spend 90%+ of their income would be disastrous for the economy.

What do you think is more "prestigious," a lower-tier ortho/derm residency or a top-tier residency in peds/IM/neuro/anesthesiology? I think they're about the same competitiveness, but the former will net you better money for clinical work while the latter will set you up for top jobs in the field, better geographic flexibility, more promotion potential to top hospital positions, and much better non-clinical positions (e.g. industry jobs, consulting side gigs, etc...).

I personally find a CHOP match or Big 4 IM match at least as impressive. I can tell you in radiology the well known programs in popular cities maintain step averages in the 250s and focus a lot on your research, just like the small competitive fields. If these peeps had wanted ophtho or derm instead they would be solid candidates, not low tier

 

[Chibucks15]

Plus, 40h/week means you have time for a side hustle if you want. Personally, I'd rather have the flexibility and variety. You can pick up work doing all sorts of things as a physician, and if you're used to working 80+ hours/week as a resident, throwing an extra 20 hours/week at a side gig will still feel like a vacation.

Never judge physician salaries as equivalent to other salaries in the US. No other career has this long a training pathway or this high of a debt burden. Anyone making $100k/year (~$70-75k after taxes), but living like a medical student/resident (i.e. spending less than $25k/year on living expenses until attending age), will have saved up an even $1MM at least by the time you're making that $250-300k, meaning they are effectively making an extra $60-100k/year depending on how that money is invested, and they have a huge retirement savings advantage on you and no medical school debt. It is not "enough" for physician salaries to keep pace. Physician lifetime net worth potential is the only thing that matters. Salary is a marginally meaningful metric. I'm convinced the only reason salary is the primary discussion point around career pay is that actively encouraging the masses to save instead of consistently spend 90%+ of their income would be disastrous for the economy.

What do you think is more "prestigious," a lower-tier ortho/derm residency or a top-tier residency in peds/IM/neuro/anesthesiology? I think they're about the same competitiveness, but the former will net you better money for clinical work while the latter will set you up for top jobs in the field, better geographic flexibility, more promotion potential to top hospital positions, and much better non-clinical positions (e.g. industry jobs, consulting side gigs, etc...).

My friend in commercial real estate at a big name place ran the numbers and even if I come out making 250k then I still out earn him by 10%. Yes they get a head start but you make it up quick

 

[Candidate2017]

Hah, I wish my patients were stable. Even the ones who are medically stable still need so much social support and to talk about ****.
But it's encouraging I guess.

Academic attendings love to have residents play social worker. In reality, it's not your horse, not your rodeo, not your job. You're not their therapist. Also, if you observe good therapists, they are very good at keeping patients on time and on topic, because whining and complaining is actually unhelpful to anyone.

 

[Candidate2017]

Thanks for both of your replies, I learned a lot. Why don’t you like scribes? Slow you down? Bad notes? Too chatty? I was a scribe before med school and I probably did all three of those things at times so don’t hold any punches lol

The former resident I mentioned didn't have any scribes, so they probably don't have a scribe now as an attending. The only scribe notes I see are from the ED and they suck. But that's only because a scribe is paid to write stuff without thinking. Sort of like how med student and intern notes really really suck even though they spend a lot of time thinking about their lengthy note. They just don't have the experience. Experience leads to focused thinking, which leads to crisp, clear notes, and ability to see a ton more patients. At least for some people.

 

[Kaputt]

Iirc there actually was a leaked CMS powerpoint that actually quoted posts from auntminnie to justify some big cuts to radiology that I believe did in fact happen

That’s probably where the fear comes from! Those idiots, don’t they know that 99% of what is posted on here and Aunt Minnie is BS??

 

[ChordaEpiphany]

I personally find a CHOP match or Big 4 IM match at least as impressive. I can tell you in radiology the well known programs in popular cities maintain step averages in the 250s and focus a lot on your research, just like the small competitive fields. If these peeps had wanted ophtho or derm instead they would be solid candidates, not low tier

That's not surprising. I'd assume a Big 4 IM residency is more competitive than a community ortho residency. I'd also imagine it depends a lot on your school (i.e. matching big 4 IM from a lower tier school will be far more difficult than matching community ortho). I also don't think of rads as a less competitive specialty like peds/neuro/IM. I assume anyone matching into a top 20 rads program could have their pick of mid-tier ortho/derm residencies if they focused on that in med school instead.

I still wonder about the other points though. Is there any point in picking prestige over specialty from a career earnings perspective? I'd imagine most people, even with a prestigious degree, won't get the sorts of jobs that net them more.

My friend in commercial real estate at a big name place ran the numbers and even if I come out making 250k then I still out earn him by 10%. Yes they get a head start but you make it up quick

I bet that's true. However, keep in mind I was imagining the scenario where these people earn money and live like a med student. It's one thing to say that a physician will retire with more money than an engineer. It's another thing to say a physician has greater earnings potential than an engineer/real estate agent/manager/etc...

Without getting too in depth, imagine making ~$80-120k from age 22-30 and then renting and only spending ~$25k/year like a med student. You're putting away $45-50k/year after taxes, which, on average, will net you $4.5-5k if you just invest it in the S&P500. By age 30 you've got almost $500k in the bank and it's making you an extra $50k/year on average. By 35 you've got $1MM and you've basically boosted your total income by $100k. Get a mortgage and you'll put less into your brokerage account, but you'll be effectively spending less and saving more because you're investing in real estate.

The people into FIRE are all over this sort of phenomenon, and they become millionaires before 40 with $50-60k salaries while basically living on peanuts.

The point of all of this is not to say that physicians will be out-earned. Earnings potential of a physician is actually not much higher than that of someone making $80-200k from the start to the end of their career, despite the salaries being so far apart. In practice that rarely happens because of things like lifestyle creep. You go slowly from ramen and roommates to vacations and granite countertops, always spending 80-95% of your income. If these people live like med students and get their money working for them early on, they can definitely earn what a physician earns over a career. It's just extremely difficult to justify biking to work, living with roommates, and eating rice and pasta 7 days a week when you can very obviously afford not to.

 

[YCAGA]

That's not surprising. I'd assume a Big 4 IM residency is more competitive than a community ortho residency. I'd also imagine it depends a lot on your school (i.e. matching big 4 IM from a lower tier school will be far more difficult than matching community ortho). I also don't think of rads as a less competitive specialty like peds/neuro/IM. I assume anyone matching into a top 20 rads program could have their pick of mid-tier ortho/derm residencies if they focused on that in med school instead.

I still wonder about the other points though. Is there any point in picking prestige over specialty from a career earnings perspective? I'd imagine most people, even with a prestigious degree, won't get the sorts of jobs that net them more.

I bet that's true. However, keep in mind I was imagining the scenario where these people earn money and live like a med student. It's one thing to say that a physician will retire with more money than an engineer. It's another thing to say a physician has greater earnings potential than an engineer/real estate agent/manager/etc...

Without getting too in depth, imagine making ~$80-120k from age 22-30 and then renting and only spending ~$25k/year like a med student. You're putting away $45-50k/year after taxes, which, on average, will net you $4.5-5k if you just invest it in the S&P500. By age 30 you've got almost $500k in the bank and it's making you an extra $50k/year on average. By 35 you've got $1MM and you've basically boosted your total income by $100k. Get a mortgage and you'll put less into your brokerage account, but you'll be effectively spending less and saving more because you're investing in real estate.

The people into FIRE are all over this sort of phenomenon, and they become millionaires before 40 with $50-60k salaries while basically living on peanuts.

The point of all of this is not to say that physicians will be out-earned. Earnings potential of a physician is actually not much higher than that of someone making $80-200k from the start to the end of their career, despite the salaries being so far apart. In practice that rarely happens because of things like lifestyle creep. You go slowly from ramen and roommates to vacations and granite countertops, always spending 80-95% of your income. If these people live like med students and get their money working for them early on, they can definitely earn what a physician earns over a career. It's just extremely difficult to justify biking to work, living with roommates, and eating rice and pasta 7 days a week when you can very obviously afford not to.

This is a great point and something you rarely see outside of the FIRE subreddit. Just poking fun but if you can get inflation adjusted 10% yearly return on your investments, let’s start a hedge fund! 7% over decades is more realistic, 10% consistently over 10 years requires a LOT of luck...just so happens that the last 10 years provided that type of luck so people think that is normal.

Also, unfortunately by the time we realize this, most of us are at least in a few hundred thousands in med school debt and kinda have to keep going. And as much as people seem to hate medicine on SDN and scoff at the idea that it can be spiritually rewarding, I don’t think I could emotionally survive working in tech or finance...absolutely 0 sense of purpose.

 

[DoctwoB]

I'll throw the Urology hat into the ring.

I work 4 days/week in a in-demand area on the coasts, 8-5 x4 so 36 hours a week, ends up closer to 40-45 once you factor coming in on call occasionally or rounding on an inpatient on the weekend, or some OR days which start at 715. I take call every 4th week . Pay >400 and can/will be significantly higher.

 

[Steve_Zissou]

This is a great point and something you rarely see outside of the FIRE subreddit. Just poking fun but if you can get inflation adjusted 10% yearly return on your investments, let’s start a hedge fund! 7% over decades is more realistic, 10% consistently over 10 years requires a LOT of luck...just so happens that the last 10 years provided that type of luck so people think that is normal.

Also, unfortunately by the time we realize this, most of us are at least in a few hundred thousands in med school debt and kinda have to keep going. And as much as people seem to hate medicine on SDN and scoff at the idea that it can be spiritually rewarding, I don’t think I could emotionally survive working in tech or finance...absolutely 0 sense of purpose.

I was about to say exactly this. Bruh, hook me up with that consistent 10%. I’m expecting 5% consistently tbh.

 

[VA Hopeful Dr]

Thanks for both of your replies, I learned a lot. Why don’t you like scribes? Slow you down? Bad notes? Too chatty? I was a scribe before med school and I probably did all three of those things at times so don’t hold any punches lol

it's not a problem with how the scribes are, I just am too much of a control freak to delegate that much

 

[YCAGA]

it's not a problem with how the scribes are, I just am too much of a control freak to delegate that much

Fair enough, can’t say I don’t imagine myself being the same way. Does work feel like a grind pumping out so many RVUs or is it still enjoyable?

 

[YCAGA]

I was about to say exactly this. Bruh, hook me up with that consistent 10%. I’m expecting 5% consistently tbh.

Average yearly return from 2010-2020 was an insane 13.6% and that doesn’t even account for the post-COVID-crash run up, which was in large part from printing US dollars like we are Zimbabwe in 2008. So it’s no wonder people think amazing returns are to be excepted in the future