Why would anyone go into primary care nowadays?

[Bulbasaur]

I'm entering medical school next month and I'm basically taking loans for my entire COA. That + my undergraduate loans make my total debt close to $300k once I graduate. That is the equivalent to a down payment for a $1.5 million mansion. After I pay it all back in 10-20 years, I will probably have paid a total of close to $500k.

My question is, what possible reason would a med student in my situation have for pursuing primary care or related fields? And why do medical schools not address this problem especially when everyone and their grandma are saying that there is a great need for primary care docs??


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[KanyeWes]

fish > bulbasaur

I have no idea why people would actively want to go into primary care for financial reasons. But then again, I cannot think of a reason why anyone would go into medical school either.

 

[circulus vitios]

P=MD mentality for 4 years. Do a 3 year of residency and walk into a 40-45 hours a week job in pretty much any city for $150-200k/yr, probably closer to $200k/yr if you don't mind working in a city outside of NYC/SF/SD/DC/LA/Chi. Or you could do the hospitalist thing where you average 42 hours a week for $200-250k/yr. It's pretty sweet if you don't mind the bull**** that comes with being a PCP.

 

[KanyeWes]

P=MD mentality for 4 years, 3 years of residency, and 40-45 hours a week for $200k/yr. It's pretty sweet if you don't mind the bull**** that comes with being a PCP.

I just remembered, your debt can be forgiven.

 

[AlbinoHawk DO]

Because you like it and money isn't everything? Alternatively, there are ways to make good money with primary care if you are business savvy or move to a rural area.

 

[KanyeWes]

Because you like it and money isn't everything? Alternatively, there are ways to make good money with primary care if you are business savvy or move to a rural area.

yeah, but I don't think anything is really fun when you get crushed by debt and deal with the bs that primary care has to put up with. I salute them for being brave enough to do what they are doing because I ain't got the guts to do so.

 

[circulus vitios]

yeah, but I don't think anything is really fun when you get crushed by debt and deal with the bs that primary care has to put up with. I salute them for being brave enough to do what they are doing because I ain't got the guts to do so.

Let's say you make $200k/yr. After taxes, fringe benefits, and PAYE student loan payments, you make $105-110k/yr take-home. After 17 years as an attending you'll free up an extra ~$18k/yr, so your take home will be $123-128k/yr. It's not great but it's not awful.

 

[sinombre]

Reasons off the top of my head: outpatient instead of inpatient (weekends off), regular-ish Monday-Friday schedule, relatively short residency, very broad scope of practice, AAMC lists an average salary of 207k/year (this is very location-dependent) which is far from a low salary, less competitive = easier to end up in a residency in a location you like.

A big problem with everything I just listed is healthcare reform. Although everything I listed is true right now, medicine will probably look very different in 10-20 years.

I think @KnuxNole always answers these questions well... maybe he can chime in.

 

[Arkangeloid]

Do concierge and do it big mang

 

[EMDO2018]

I pmed a guy who is doing the hospitalist thing and he said his schedule is 7-4 on his week on, started at 230k, and on his week off he just sleeps and masturbates all day. Seems like the ideal life.

 

[Arkangeloid]

Let's say you make $200k/yr. After taxes, fringe benefits, and PAYE student loan payments, you make $105-110k/yr take-home. After 17 years as an attending you'll free up an extra ~$18k/yr, so your take home will be $123-128k/yr. It's not great but it's not awful.

It's pretty damn awful when you realize that your buddies in engineering started earning good cash (and thus making investments) OVER A DECADE before you, and by the time you are a mature attending, are probably well into the six figures.

 

[Arkangeloid]

I mean, I'm not a hata because at the rate I'm going, I'm most likely looking at primary care or a similarly low-reimbursing specialty (but I will die before I do pediatrics because it is a woman-dominated profession and I hate children). But I'm just being honest here. Med school isn't really worth it anymore unless you're in a competitive baller in a high-reimbursing specialty.

 

[Mad Jack]

.

 

[SheepInABox]

Wouldn't you get to relax in med school a little more because it's not as competitive to match? That could be why.

 

[circulus vitios]

It's pretty damn awful when you realize that your buddies in engineering started earning good cash (and thus making investments) OVER A DECADE before you, and by the time you are a mature attending, are probably well into the six figures.

Not everyone has the mind to study engineering. It's not like memorizing a phonebook or whatever -- you need to have a mathematical inclination to make it through the more advanced math and engineering classes. As far as lifetime earnings go, I really doubt the average engineer edges out the average family med physician, either.

 

[Mad Jack]

It's pretty damn awful when you realize that your buddies in engineering started earning good cash (and thus making investments) OVER A DECADE before you, and by the time you are a mature attending, are probably well into the six figures.

Most engineers do not make over 100k. The average starting salary for an engineer is just over 53k, and most people don't crack the six figure mark for a decade or more unless they're pretty damn talented or go back to school for a Master's. The highest paid engineers generally are in high COL cities, so they may be clocking 120k in SF or NYC, but most cities with cheaper COL indexes they will be just under (or barely cracking) 100k. The highest paid in the field also tend to have Master's or PhDs in engineering, not just a BS, so it's not like they hopped right into the field, never went back to school, and started at 120k in a low COL area lol.

Meanwhile, a physician that spent the extra 7 years training can pick up an employed PCP gig that pays 200k just about anywhere in the country. Many jobs offer loan repayment, and there's a lot of national and state-level loan repayment programs for PCPs. If you've got any decent business sense, you can even start your own practice and employ a few midlevels. Skimming 20k per midlevel with a few of them working under you can put you within spitting distance of specialty pay. If you're in a state where NPs operate without supervision, all the better, as you can employ them and have far less liability in the case of malpractice.

Primary care isn't all that bad. The hours can be solid, you basically never have to deal with call, liability is low compared to many specialties, the pay isn't as bad as people make it out to be, and the lifestyle can be pretty relaxed if you're in the right practice.

https://www.asme.org/getmedia/788e9...d/32673_Engineering_Income_Salary_Survey.aspx

Actual facts on engineering salaries contained above. They're good, but not OMFGamazing like erryone makes them out to be. Their after tax income is substantially lower than a physician on a PAYE plan.

 

[Arkangeloid]

Not everyone has the mind to study engineering. It's not like memorizing a phonebook or whatever -- you need to have a mathematical inclination to make it through the more advanced math and engineering classes. As far as lifetime earnings go, I really doubt the average engineer edges out the average family med physician, either.

Heh, you don't have to tell it to me. Prob should tell Anastomoses though, who argued that there is only one kind of intelligence.

Honestly, math is pretty easy and enjoyable, I would say it's ten times more difficult to go through the heap of garbage they call "organic chemistry."

 

[Arkangeloid]

Also, some people will accuse me of trolling, but let's call a spade a spade: for a woman, it matters less what specialty you go into, because 1) many female physicians work part-time anyways, and 2) a woman is not expected to be the primary provider for her family. It's no surprise that the lowest-reimbursing specialty, pediatrics, is thus overwhelmingly dominated by women.

So I would clarify my earlier statement to argue that:

1) If you are a woman, primary care is a good choice because it has a shorter residency, which means you can get out while you are still fertile (I talked to a 28yo MS3 at my school who intended to go into neurosurgery, she said this was a very real concern). And it won't matter too much what you make after you get married.

2) If you are a man, you gotta do it big, I guess.

 

[EMDO2018]

This will be another thread that degerates into how lawyers and engineers make more than docs and start at an early age. Just proof that most people here have never had a real job.

 

[DermViser]

I pmed a guy who is doing the hospitalist thing and he said his schedule is 7-4 on his week on, started at 230k, and on his week off he just sleeps and masturbates all day. Seems like the ideal life.

Really?

 

[CherryRedDracul]

Really?

What, you haven't slept and masturbated all day in your free time?

 

[DermViser]

What, you haven't slept and masturbated all day in your free time?

For a week?

 

[Psai]

For a week?

Well by the end of the week you'll probably be tired. And sleepy

 

[jakeislove]

Healthcare reform probably means a lot more AMGs will be doing primary care. It's not like the 44 million (they claim were uninsured) need dermatologists, LOL!

 

[Promethean]

Money isn't everything.

I want to do primary care because I want to do primary care. If I wanted to make crazy bank, I'd go into finance. I want to help people live healthier lives, access care when they need it, and have a doc they can build an ongoing relationship with.

 

[DermViser]

Money isn't everything.

I want to do primary care because I want to do primary care. If I wanted to make crazy bank, I'd go into finance. I want to help people live healthier lives, access care when they need it, and have a doc they can build an ongoing relationship with.

Says the premed who obviously knows nothing about how primary care works in real life. Hope you enjoy P4P - Primary care is up first.

 

[DermViser]

I mean, I'm not a hata because at the rate I'm going, I'm most likely looking at primary care or a similarly low-reimbursing specialty (but I will die before I do pediatrics because it is a woman-dominated profession and I hate children). But I'm just being honest here. Med school isn't really worth it anymore unless you're in a competitive baller in a high-reimbursing specialty.

Actually, you're not.

 

[AlbinoHawk DO]

Let's say you make $200k/yr. After taxes, fringe benefits, and PAYE student loan payments, you make $105-110k/yr take-home. After 17 years as an attending you'll free up an extra ~$18k/yr, so your take home will be $123-128k/yr. It's not great but it's not awful.

lol your take home would still put you in the top 10% of earners. You'd be at the top 3% if you're counting just the 200k. It's incredible the bubble we live in thinking being in the top earners is "not great."

 

[KanyeWes]

What, you haven't slept and masturbated all day in your free time?

this is the funniest argument!

 

[DrDrangus]

Money isn't everything.

I want to do primary care because I want to do primary care. If I wanted to make crazy bank, I'd go into finance. I want to help people live healthier lives, access care when they need it, and have a doc they can build an ongoing relationship with.

it bothers me when people say this, no offense to you, but people dont just walk into finance and "make bank". if you're not advancing at a firm in the first 5-10 years, you're most likely not gonna kill it. and most people dont.

 

[KanyeWes]

lol your take home would still put you in the top 10% of earners. You'd be at the top 3% if you're counting just the 200k. It's incredible the bubble we live in thinking being in the top earners is "not great."

gotta look at the debt too.

I see people making 70k a year, but have no debt. They live very comfortably.

vs.

making 200k a year but being a million in debt from student loans, house, car, and other necessary non luxury things (in the states)

personally, I would rather be in the latter than the former.

 

[circulus vitios]

lol your take home would still put you in the top 10% of earners. You'd be at the top 3% if you're counting just the 200k. It's incredible the bubble we live in thinking being in the top earners is "not great."

I mean not great relative to other specialties.

 

[circulus vitios]

Money isn't everything.

I want to do primary care because I want to do primary care. If I wanted to make crazy bank, I'd go into finance. I want to help people live healthier lives, access care when they need it, and have a doc they can build an ongoing relationship with.

If I wanted to make crazy bank I'd just be a professional astronaut basketball CEO hedge fund manager which is more or less a guaranteed career path because I'm so smart and hard working as evident by my A- average from a bottom-tier college and my ability to answer a bunch of multiple choice questions on a standardized test.

 

[DermViser]

Healthcare reform probably means a lot more AMGs will be doing primary care. It's not like the 44 million (they claim were uninsured) need dermatologists, LOL!

How is that different from now?

 

[DermViser]

lol your take home would still put you in the top 10% of earners. You'd be at the top 3% if you're counting just the 200k. It's incredible the bubble we live in thinking being in the top earners is "not great."

Says the premed. Along with the ridiculous hours it encompasses. Money isn't everything.

 

[KanyeWes]

Healthcare reform probably means a lot more AMGs will be doing primary care. It's not like the 44 million (they claim were uninsured) need dermatologists, LOL!

when you typed amg, it took me a minute to realize you were talking about American medical graduates and not Mercedes.

#firstworldproblems

 

[circulus vitios]

Along with the ridiculous hours it encompasses. Money isn't everything.

If you want to make money in engineering, you're going to be putting in a lot more than 40 hours a week. What's an FM residency, like 60 hours a week average for 3 years?

 

[KanyeWes]

Says the premed. Along with the ridiculous hours it encompasses. Money isn't everything.

do people not realize that time is a precious resource too?

 

[DermViser]

If you want to make money in engineering, you're going to be putting in a lot more than 40 hours a week. What's an FM residency, like 60 hours a week average for 3 years?

Engineering has a lot less years of formal education and tuition investment as well. And 60 hours a week in Family Medicine residency?? LOL!

 

[DermViser]

do people not realize that time is a precious resource too?

Apparently not. But they're MS-0s so not surprised.

 

[Promethean]

it bothers me when people say this, no offense to you, but people dont just walk into finance and "make bank". if you're not advancing at a firm in the first 5-10 years, you're most likely not gonna kill it. and most people dont.

No offense taken. You are right, I don't have what it takes to really earn as a banker or stockbroker, etc. I don't have the necessary ruthlessness. I worry that the other side of a deal might be disavantageous to my trading partner. I would fail to maximize profits.

 

[circulus vitios]

No offense taken. You are right, I don't have what it takes to really earn as a banker or stockbroker, etc. I don't have the necessary ruthlessness. I worry that the other side of a deal might be disavantageous to my trading partner. I would fail to maximize profits.

This is like a kid with leg braces saying he doesn't have what it takes to be an NBA player because he wouldn't want to make the other team feel bad by winning.

 

[KanyeWes]

No offense taken. You are right, I don't have what it takes to really earn as a banker or stockbroker, etc. I don't have the necessary ruthlessness. I worry that the other side of a deal might be disavantageous to my trading partner. I would fail to maximize profits.

ruthlessness =\= charm, social game, and business acumen.

ur rt, u know nothing of business

 

[darklabel]

Let's say you make $200k/yr. After taxes, fringe benefits, and PAYE student loan payments, you make $105-110k/yr take-home. After 17 years as an attending you'll free up an extra ~$18k/yr, so your take home will be $123-128k/yr. It's not great but it's not awful.

If PAYE and IBR stay, then at least medical graduates would have a lifeline and even as reimbursements go down and BS goes up (a la Pay for performance that DermViser said and other nonsensical crap the government can come up with). My biggest fear is if you're making IBR/PAYE payments (which may not even touch the principle, thus leading to increase in debt) and after 10 years, the government decides "lol we're capping the forgiveness part at ~65k", then not only will a small part of your loan be "forgiven" (likely taxed), but you're also stuck with a large debt that you could've paid more into before had you known that PAYE/IBR would be changed. I think this is part of the reason why med students/residents etc say not to rely on loan forgiveness in the future. And sadly I doubt we'll get a lot of sympathy from the general public about the increasing amount of medical students who need IBR/PAYE.

 

[Promethean]

This is like a kid with leg braces saying he doesn't have what it takes to be an NBA player because he wouldn't want to make the other team feel bad by winning.

Only on SDN can someone make a comment of sincere humility, admitting that they are not cut out for something, and still have someone find a way to use it as the basis of a personal attack.

Good thing I don't need your approval for, well, anything.

 

[KanyeWes]

Only on SDN can someone make a comment of sincere humility, admitting that they are not cut out for something, and still have someone find a way to use it as the basis of a personal attack.

Good thing I don't need your approval for, well, anything.

have u met real doctors?

 

[circulus vitios]

Only on SDN can someone make a comment of sincere humility, admitting that they are not cut out for something, and still have someone find a way to use it as the basis of a personal attack.

Good thing I don't need your approval for, well, anything.

Never mind the difficult of making 'crazy money' in finance, you couldn't even get your foot in the door because you lack the necessary pedigree (unless you go to H/P/Y/UPenn/MIT/Stanford) that nearly every single banking analyst has. If you don't believe me then go look up the biographies of investment bankers -- they're usually publicly available.

 

[Promethean]

Never mind the difficult of making 'crazy money' in finance, you couldn't even get your foot in the door because you lack the necessary pedigree (unless you go to H/P/Y/UPenn/MIT/Stanford) that nearly every single banking analyst has. If you don't believe me then go look up the biographies of investment bankers -- they're usually publicly available.

What makes you think that you know the first thing about my pedigree?

 

[DermViser]

What makes you think that you know the first thing about my pedigree?

Maybe bc you wish to be a D.O.?

 

[Promethean]

Maybe bc you wish to be a D.O.?

Yup. I do. That doesn't mean that I didn't graduate from an Ivy with a decent GPA and score better on the MCAT than anybody giving me crap in this thread.

I want to go to a DO school because I think there will be fewer stat obsessed douchebags there. I think that as a DO, I won't get ragged on for actively choosing a primary care specialty without concern about the financial implications of that choice. I work with some exceptional doctors who are DOs, and I have seen that they are not any less than their MD colleagues in the eyes of the people who really matter, that is our patients and their families.