Why would anyone go into primary care nowadays?

[VA Hopeful Dr]

I agree with your point the FM/Hospitalist can out-earn most IM sub-specialties, but I think fields like GI, Cards, and Heme Onc will still win by a large margin over a lifetime of work.

Which is why that post said "several medicine subspecialists" and not "all medicine subspecialists".

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[ERDOC555]

Which is why that post said "several medicine subspecialists" and not "all medicine subspecialists".

It did not say that, it said this:

Why would anyone do primary care?

Because primary care/hospitalists are making bank. You can outearn several medicine specialists being in primary care. If you do the math on fellowship vs just going into hospital medicine or primary care, the finances do not at all add up in favor of fellowship for any I.M. specialty.

 

[VA Hopeful Dr]

It did not say that, it said this:

That is a super weird post. The first half, which you did not quote this time, does say that hospitalist or Primary Care can out earn several of them. But then the second half, which you did quote, says the finances do not add up for any subspecialty.

The first half that I was referring to is true, the second half which you quoted is not.

 

[ERDOC555]

That is a super weird post. The first half, which you did not quote this time, does say that hospitalist or Primary Care can out earn several of them. But then the second half, which you did quote, says the finances do not add up for any subspecialty.

The first half that I was referring to is true, the second half which you quoted is not.

Fixed it for you and included the whole quote, which still doesn't change the fact that the original poster made the claim that primary care can out-earn all medicine sub-specialties. I'm not sure why you felt the need to comment and disagree with what was clearly posted. Either way, I'm not going to argue with you over this further.

However, I would still be interested to get clarification from the original poster whether he actually meant "all" and if so why, or whether it was just a typo and he meant several.

 

[VA Hopeful Dr]

Fixed it for you and included the whole quote, which still doesn't change the fact that the original poster made the claim that primary care can out-earn all medicine sub-specialties. I'm not sure why you felt the need to comment and disagree with what was clearly posted. Either way, I'm not going to argue with you over this further.

However, I would still be interested to get clarification from the original poster whether he actually meant "all" and if so why, or whether it was just a typo and he meant several.

Yeah I misread that so that's completely my bad.

But I also want to know if that last part was a mistake (I have to think it was since its blindingly rare for a PCP to out-earn cards/GI/heme-onc).

 

[cbrons]

I agree with your point the FM/Hospitalist can out-earn most IM sub-specialties, but I think fields like GI, Cards, and Heme Onc will still win by a large margin over a lifetime of work.

No, I don't think so at all, especially when you add in the opportunity cost of 3 years missed salary as an attending to complete fellowship. For GI, the numbers might just barely come out in front for now, but as procedure reimbursement becomes lower and lower as more non-physicians are taught to do scopes and what-have-you, I think that will change. And if you do any rural or locums hospitalist or primary care work, you will significantly out-earn specialists.

 

[VA Hopeful Dr]

No, I don't think so at all, especially when you add in the opportunity cost of 3 years missed salary as an attending to complete fellowship. For GI, the numbers might just barely come out in front for now, but as procedure reimbursement becomes lower and lower as more non-physicians are taught to do scopes and what-have-you, I think that will change. And if you do any rural or locums hospitalist or primary care work, you will significantly out-earn specialists.

I think you underestimate how much specialists often earn. Let's pretend, just for argument's sake, that a GI doctor currently earns 400k/year (most are more than that, especially in PP). Let's even be generous and say that a PCP earns 300k. The extra 3 years of fellowship at, let's say 66k (to make the math easier) has the GI starting out 700k behind the PCP. With the income disparity, that only takes 7 years to catch up while the remaining 23 years of the standard physician career the GI doc just keeps pulling ahead - by 2.3 million when all is said and done.

I also think the uncertainty about reimbursement is somewhat overblown. Everyone talks about how radiology got hosed by CMS, and that's true to an extent. Most of them still make roughly double what primary care does. Is it less than the 800k they used to make? Sure. Is it still one of the top paying specialties? Yes, it is.

 

[boogaaloo]

I think you underestimate how much specialists often earn. Let's pretend, just for argument's sake, that a GI doctor currently earns 400k/year (most are more than that, especially in PP). Let's even be generous and say that a PCP earns 300k. The extra 3 years of fellowship at, let's say 66k (to make the math easier) has the GI starting out 700k behind the PCP. With the income disparity, that only takes 7 years to catch up while the remaining 23 years of the standard physician career the GI doc just keeps pulling ahead - by 2.3 million when all is said and done.

You need a course in finance.

 

[VA Hopeful Dr]

You need a course in finance.

No, I really don't but thanks for your worthwhile addition.

I'm being purposefully simplistic to prove my point which is this: there is a certain income difference where taking a few more years to get to the higher income makes good financial sense. What that exact point is requires much more effort than I'm willing to put forth so I distilled the basic idea down into nice easy round numbers to illustrate the overall point.

 

[boogaaloo]

No, I really don't but thanks for your worthwhile addition.

I'm being purposefully simplistic to prove my point which is this: there is a certain income difference where taking a few more years to get to the higher income makes good financial sense. What that exact point is requires much more effort than I'm willing to put forth so I distilled the basic idea down into nice easy round numbers to illustrate the overall point.

Yes, but you're way off in those numbers. Some of the main things you're missing are income tax brackets and the power of compounding.

 

[PlutoBoy]

I think you underestimate how much specialists often earn. Let's pretend, just for argument's sake, that a GI doctor currently earns 400k/year (most are more than that, especially in PP). Let's even be generous and say that a PCP earns 300k. The extra 3 years of fellowship at, let's say 66k (to make the math easier) has the GI starting out 700k behind the PCP. With the income disparity, that only takes 7 years to catch up while the remaining 23 years of the standard physician career the GI doc just keeps pulling ahead - by 2.3 million when all is said and done.

I also think the uncertainty about reimbursement is somewhat overblown. Everyone talks about how radiology got hosed by CMS, and that's true to an extent. Most of them still make roughly double what primary care does. Is it less than the 800k they used to make? Sure. Is it still one of the top paying specialties? Yes, it is.

I don't know that most are earning more than that, at least according to the numbers I get from friends and surveys. Our generation is largely employed which affects our salaries.

Putting money aside, I still think that primary care is worth it. It's not a bad lifestyle at all. If the main argument against doing primary care is paperwork, I guess we are doing well.

 

[VA Hopeful Dr]

Yes, but you're way off in those numbers. Some of the main things you're missing are income tax brackets and the power of compounding.

Well duh, but as I stated I don't want to spend the time and effort required to calculate out everything including tax brackets, money saved and interest accrued from that, and so on.

Working with gross pay makes the point well enough and saves significant time on my part.

 

[VA Hopeful Dr]

I don't know that most are earning more than that, at least according to the numbers I get from friends and surveys. Our generation is largely employed which affects our salaries.

Putting money aside, I still think that primary care is worth it. It's not a bad lifestyle at all. If the main argument against doing primary care is paperwork, I guess we are doing well.

Maybe not, but most primary care docs aren't making 300k - at least not that I know of.

I obviously agree about primary care being a pretty good setup. We work banker's hours, no weekends/holidays, only call is phone, we rarely deal with true life/death scenarios, pretty much never have to tell anyone their loved ones have died, short relatively painless residency (compared to others, that is), and for that we get median starting pay of right at 200k.

 

[boogaaloo]

Well duh, but as I stated I don't want to spend the time and effort required to calculate out everything including tax brackets, money saved and interest accrued from that, and so on.

Working with gross pay makes the point well enough and saves significant time on my part.

Nope. You are WAY off. Your point is invalid.

 

[VA Hopeful Dr]

Nope. You are WAY off. Your point is invalid.

No, it really isn't. The timeline might be, but the overall point is not.

Prove me wrong.

 

[boogaaloo]

No, it really isn't. The timeline might be, but the overall point is not.

Prove me wrong.

Okay, from your post, the PCP starts out 700k ahead while the GI earns 100k more per year after graduation. 700k is about 500k post-tax at the effective 27.5% tax rate while the extra 100k is taxed at 33%, leaving a net cushion of 66k each year.

500k invested for the 30 year career period (also per your assumption) at an extremely conservative 8% annualized growth is 5 million (even the S&P has returned about 10% over the past century so 8% is quite conservative). The GI investing 66k each year in the same fund would have to wait 25 years just to break even. Also, the GI is now three years older. So if both retire at the same age, the GI will end up with only about 66k x 2 (plus some growth) more.

So only going by finance is not the best way to pick specialties. The money isn't going to be worth much if you are miserable at your job because you don't love what you do.

 

[VA Hopeful Dr]

Okay, from your post, the PCP starts out 700k ahead while the GI earns 100k more per year after graduation. 700k is about 500k post-tax at the effective 27.5% tax rate while the extra 100k is taxed at 33%, leaving a net cushion of 66k each year.

500k invested for the 30 year career period (also per your assumption) at an extremely conservative 8% annualized growth is 5 million (even the S&P has returned about 10% over the past century so 8% is quite conservative). The GI investing 66k each year in the same fund would have to wait 25 years just to break even. Also, the GI is now three years older. So if both retire at the same age, the GI will end up with only about 66k x 2 (plus some growth) more.

So only going by finance is not the best way to pick specialties. The money isn't going to be worth much if you are miserable at your job because you don't love what you do.

Am I reading this incorrectly or are you suggesting that the PCP invested their entire post-tax salary from the first 3 years they were out of residency?

Your last sentence there is 100% true.

 

[boogaaloo]

Am I reading this incorrectly or are you suggesting that the PCP invested their entire post-tax salary from the first 3 years they were out of residency?

Your last sentence there is 100% true.

No I'm not suggesting that. Everyone has their own views on what they want to get out of their money. What I was saying is that it doesn't take just 7 years for a GI earning 400k to catch up with a PCP earning 300k to catch up as you suggested. It takes 25 years after the GI fellowship, or 28 years after they both finish their respective residencies.

 

[VA Hopeful Dr]

No I'm not suggesting that. Everyone has their own views on what they want to get out of their money. What I was saying is that it doesn't take just 7 years for a GI earning 400k to catch up with a PCP earning 300k to catch up as you suggested. It takes 25 years after the GI fellowship, or 28 years after they both finish their respective residencies.

So we're back to my point earlier, which was, in fact, correct:

No, it really isn't. The timeline might be [wrong], but the overall point is not.

I was way off about the timeline admittedly, but as I lowballed GI and used the top 1-2% of primary care income that's not a surprise. The timeline likely is better than your math (using my bad numbers) suggests as the pay difference between primary care (210k) and GI (391k) is greater than the numbers I more or less made up - 100k in my example and 181k per Medscape's 2017 report (although interestingly MGMA puts the difference at more like 233k with GI at 458k and FM at 225k).

 

[medgunner888]

Who cares about the money anyways? It's all about helping the patient as much as you can. Since primary care makes the biggest difference in patient's health (more so than specialists) that alone should make you go towards specialties like FM, general IM, peds, psych, etc... easily.

 

[el_duderino]

[Nevermind]

 

[libertyyne]

Okay, from your post, the PCP starts out 700k ahead while the GI earns 100k more per year after graduation. 700k is about 500k post-tax at the effective 27.5% tax rate while the extra 100k is taxed at 33%, leaving a net cushion of 66k each year.

500k invested for the 30 year career period (also per your assumption) at an extremely conservative 8% annualized growth is 5 million (even the S&P has returned about 10% over the past century so 8% is quite conservative). The GI investing 66k each year in the same fund would have to wait 25 years just to break even. Also, the GI is now three years older. So if both retire at the same age, the GI will end up with only about 66k x 2 (plus some growth) more.

So only going by finance is not the best way to pick specialties. The money isn't going to be worth much if you are miserable at your job because you don't love what you do.

I wish someone had a calculator like this online for comparing specialties and time lost/ student loan debt growth etc.