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1D7

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  1. Like
    1D7 got a reaction from conbrio in Spending LOC on fun   
    You can live kinda comfortably with the LOC. Mostly this translates into renting a nicer place, eating out more, and having a few nicer vacations each year. You won't have much more money than that unless you're getting outside help. You could probably buy a nicer car if you forgo the vacations. You can't do a whole lot more than that unless you have help from your family since you'll be in training for 5-7+ years.
    Overall the main threat of debt is running out of money during residency. Yes this happens to people. No banks don't just magically give more money on top of what has already been loaned because you tell them you'll make decent money a few years down the road. What happens if you run out of money or get close to it during residency? Other than the obvious issues with rent and daily costs/expenses, you won't be able to afford to travel for conferences or pay for licensing exams/fees. You may not be able to afford to do a fellowship in X city/country because of the expenses and COL. And of course this will compound stress on what will already be one of, if not the most stressful time in your life.
    Let's say you make it past that and you complete your residency/fellowship. Steady employment is not guaranteed in every specialty. There are fields where you will struggle to find full-time employment where you want to live. You may have to work in an environment where you're underemployed or underpaid. Moreover, what if your future group wants to take X% of your billings for the next year or next few years? What if they want a 6 figure buy-in to allow you to join the practice? What if you get minimal elective OR time because you're the lowest rung on the totem pole? What if you're just way slower/inefficient than other surgeons? Most of these things won't stop you from paying off your debt eventually, but it may add a significant number of years (or hours per week) onto how much you have to work to be financially comfortable.
    Edit: One more thing, your LOC/debt levels will affect the amount of money you can get for a mortgage. Also for at least one bank in one province (i.e. mine) you can use your LOC directly as a downpayment. Sure you may not want your own condo/house now in M0, but your priorities may change as you progress through training or if you decide to start a family.
    Bottom line is that you can afford some nice things like I said above, but you probably don't want to blow your entire LOC on something that will end up leading to more stress or compromise your ability to practice/live the way you want in the future.
  2. Like
    1D7 got a reaction from klamar in Is being a doctor worth it?   
    1. The uncertainty in most careers is a tad bit overstated. If you work hard, fit in, and don't leave/get laid off, by default you will at least reach middle management in most fields (this is from my friends experiences in accounting & finance who have risen to those positions). The timing varies a bit, but typically by only a few years internally within each company/firm. Of course this is still way more uncertainty than medicine (where you don't usually get the threat of being laid off but still have to work hard and fit in), but it's not like you could stay an analyst indefinitely in IB or a junior programmer.
    2. The hours in most careers outside of medicine is definitely overstated. By raw hours except for investment banking you won't find anything that matches a surgical or tough IM residency. The reality is that it's not even comparable to work 100 hours/week with days of 24-36 hr shifts in the hospital (where you often can't use the washroom or eat in a timely manner), vs 100 hours/week working mostly during the day in the office (or at home). You're also paid as a resident literally 40-50% what a junior would make in IB. The responsibilities of a junior resident in these specialties are also usually greater than a junior in IB. Your friend also had it extra rough even for IB, most people only need to start at 8am or 9am (since that's roughly when their bosses/seniors get in).
    Outside of IB, most nonmedicine careers do not regularly work more than 80 hours a week. And again none work those hours and have the same kind of 24hr+ shifts. In tech you can make 120k+ starting off without putting in those sort of hours mentioned above.
    3. You're still a medical student and presumably your friend is still an analyst/associate. When you're a resident talk to her again and compare numbers for how much money you've both accumulated over the years. Then do it again as an attending. If you are in FM you will realize that you will probably never catch up in wealth.
    4. MBA is expensive but not everyone needs it. If you need a career switch or you want to leave your company/firm to seek a higher position? Sure. Otherwise you can often progress pretty far internally without a MBA. Some firms will also pay for your MBA; not all or even many of them, but I only bring that up because you brought up medical school scholarships (very few can offset tuition, which is more than 100k at many Ontario schools).
  3. Haha
    1D7 reacted to 88risingsun in Not happy in medicine.. Not sure what to do?   
    OP, you posted just this past April asking about whether you should mention your hobby for brewing beer in your med school apps/interviews... are you really in clerkship? Doesn't add up + sounds like BS to me lol.
  4. Like
    1D7 got a reaction from Canadian MED in Bleak Job Prospects Post-School?   
    Most people find a job after residency or first fellowship, of which the total length of time rarely exceeds 6-7 years post-medical school. In a few specialties it is common to do multiple fellowships or even advanced degrees, but you'd know that was the reality walking into those specialties tbh.
    Typically 'difficulty finding a job' in medicine means you may have one or a few option(s) but the option(s) may be in an undesirable location, involving work you don't really enjoy (e.g. being forced into taking on general cases in your specialty, only able finding work doing locums, lacking elective OR time, getting undesirable cases dumped on you, etc.). This sounds like what your friend is going through, and it the reality of almost all surgical specialists; though increasingly more and more medical specialists are experiencing this too.
    I wouldn't let this dissuade you from medicine though. Like I said, most still find a job. And if flexibility was high on your priority list chances are you'd do something like family medicine.
  5. Like
    1D7 got a reaction from LupeF in Realignment of Doctor's Income 2   
    This thread is a complete misrepresentation of various careers, cherry picking literal top 1-5% earners in medicine and comparing it to fallacious numbers or some of the lower paid areas in other fields. I'll clarify a few things.
    1. A career in medicine entails much longer training and burden of debt. Tuition is $100k over 4 years plus interest, as well as the opportunity cost of 4 years lost earnings. Because of that, physicians are remarkably behind at each stage compared to other professionals. If you compare careers with that consideration in mind, it looks more like the following:
    While I accumulated -$120,000 in medical school, the barista down the street accumulated $200,000 more than me (25k/yr), accountant $420,000 more than me (55k/yr), and the banker made $700,000 more than me (175k/yr). When I was a PGY-3 my net earnings finally reached $0 and I was making $70k/yr, while the accountant became a director making 120k/yr and the banker a VP making $350k/yr.
    2. Direct comparisons in compensation are flawed because payouts are structured differently in medicine vs high earning white collar careers. Physicians billings are typically an upfront number. Compensation in many 'white collar business' careers often have 30-50%+ of their earnings paid out as bonuses (which are regularly expected each year, though the amount varies). There is also a significant amount of money paid out as stock options. Remember reading the news about X company's CEOs/directors making aridiculous millions upon millions of dollars? Most of that money is 'paid' through stock options, which is how senior partners/management directors make a significant amount of money as well. So while physician income after billings is on avg 25% LESS, a banker's income is 50-1000%+ MORE than what their salary is.
    3. Most comparisons often conveniently ignore salary level in residency/fellowship (which has a 6+ year duration in highest earning specialties) and as a junior attending (where pay is reduced and call is increased). Instead they jump to money as established physician top 10% in a highly paid specialty and compare it to someone barely established in another field.
    4. Entry into medicine is generally more competitive than finding entry in most careers listed in this thread except IB. While I don't think competitiveness is necessarily a virtue in itself, posts about other careers always mention how you can only reach the top rungs if you work hard, demonstrate great skills, etc. Newsflash, to enter medicine in itself you have to be extremely academically successful and to do well in residency you will work harder than almost every other career. The skill sets are different obviously, and while a physician may not succeed in banking, the reverse is also true for a banker trying to enter medicine.
    5. Lastly, there is also a hidden implication by many of these posters than physicians SHOULD earn less than bankers/accountants for whatever reason. I'm happy earning what a family doctor makes, but I realize that for the administrators/government bean counters, our pay is how much they see our worth (and how easy it is to control us and diminish our autonomy at the expense of patients).
    These discussions around reducing physician pay are always fallaciously dichotomized into physician's benefit vs public good. In reality, when a worker's wages are reduced, it does not benefit the service nor the worker, but the C-suite executives and bureaucrats. See the U.S., where medicine is driven by bureaucrats/C-suite execs—patient care has taken a backseat to $$$, and while physicians suffer, bureaucrats/C-suite execs reap the benefit. Even though our system rewards cost savings instead of profit, the mindset of administrators always boils down to $$$ because we're the ones who have to face and advocate for patients.
  6. Like
    1D7 got a reaction from futureortho in How to become an orthopedic surgeon   
    1. You will learn how the match works in medical school. You can think of it as the algorithm going down your list of program preferences and checking to see if they ranked you highly enough for a spot. It will do this over and over until all spots are filled. In this way the applicant is essentially always favoured in the match and you should always rank by your true preference; the program liking you should have no sway on your decision.
    2. Research comes about usually by either applying to some standardized research program your school does (if applicable) or finding mentors in your specialty of interest praying they have a research position open. Other than that you can try getting to know residents and seeing if they have anything or cold emailing if you're desperate. Other extracurriculars are mostly either to help demonstrate interest or some CanMEDS quality; not too important.
    3. The overarching strategy is similar for most specialties. Do well on electives. Build your CV. Get to know and try to impress your home program by networking (there are always some sort of surgical events for medical students every year). Don't do anything that shoots yourself in the foot. Etc.
    There are dozens of similar topics and hundreds of posts from recent years about this, just search around.
  7. Like
    1D7 got a reaction from MedSchoolHope101 in Arts background - Success in med school   
    It was rare my science undergrad reinforced anything that wasn't sufficiently taught in medical school. It probably let me get away with doing a bit less work in the first 2 years, and helped me answer a few questions in the latter 2 clinical years, but all in all it didn't make much of a difference as long as you work hard.
    Most of medical school is dedicated towards teaching you pathology/disease. The normal biochemistry/physiology is typically limited to one or a few intro lectures in an entire block—not much of an advantage assuming you knew enough to do okay on the MCAT.
  8. Like
    1D7 got a reaction from brattatat in Buying index funds with LOC   
    To answer OP's question you may do decent with leveraged index funds and blue chip tech. While you are likely to make money than lose money doing this, invest only what you can afford to lose.
  9. Like
    1D7 got a reaction from blah1234 in Buying index funds with LOC   
    Yeah but that's basically buying a winning lottery ticket. It's pretty rare day to day that this happens to any single stock—the vast majority of triple digit % gains are made overnight. The opposite also happens with top gainers on other days. You do see drops of 20% in seconds, and those are far more common than seeing 1000% increases in a single day.
  10. Like
    1D7 got a reaction from JohnGrisham in Surgical specialties with good job prospects?   
    There is nothing in your post that is unique to surgery nor this current point in time—for the past 10+ years medical students have had those exact thoughts. In fact aside from surgeons retiring, everything else you mentioned (i.e. universal increased demand for medical & surgical services) is worsening the situation. You cannot simply "create more surgeon jobs". For ORs alone you need OR nurses, anesthesia, porters, cleaners, x-ray/fluoro technologists, technicians, equipment, etc. The reality is that OR time is limited by government funding & factors other than having enough surgeons. And things will likely continue to worsen because money is being stretched thinner every year.
  11. Like
    1D7 got a reaction from winston87 in Neurosurgery vs. Radiology   
    As an incoming M1 you should explore as many fields as you can (i.e. family) before settling on neurosurgery or radiology—one of the biggest mistakes is forming an identity too early and becoming attached to it. It's not unheard of to hear about a med student who always wanted to be a neurosurgeon realize his/her mistake the first week shadowing.
    I have known a few people who have switched out of neurosurgery into other specialties, including radiology. Mostly it boiled down to years and years of endless job training (6 years residency, 1-2 years fellowship plus often 1-4 years advanced degree) in a residency infamous for its hellish hours. That's a minimum of 8-9 years of inhumane, grueling training in most cases, though 10+ years is not uncommon. The end result is that you are a highly specialized surgeon waiting for someone to retire, probably in a place you may not like, just so you can take their job. You need a very specific personality and family life (or lack of) for that to work and for you to not hate/regret your life. There's not much upside either if you want to do neuro IR: the training pathway through radiology is shorter (~7 years total).
  12. Like
    1D7 got a reaction from Let'sGo1990 in Realignment of Doctor's Income 2   
    I didn't say there aren't advantages to medicine. It can be a rewarding career (for some of us at least). It's much more stable & structured. The pay floor is high. Everyone is well paid at a minimum and can work harder to make more. You can get very hands on and technical with your work in a way other professions cannot. It's a good career. Everyone who browses this forum knows that already; most of these facts are plainly obvious to the public.
    But more and more posters in these forums quote statistics from top 1-5% physician earners (or in some cases, the literal highest billing physician) and compare them to the lower or mid ranges in other careers. These comparisons remind me premeds or M1s glorifying medicine as the ultimate career, lacking any real understanding of it. If we're talking top 1-5% of earners in each respective field, then make that comparison of the established cardiologist/radiologist/ophthalmologist/GI to the established investment/corporate banker. If you want to compare someone starting out in their career, look at the M1 vs the analyst, M3 vs the associate, etc.
    I grew up in a lower-middle income neighbourhood and many of my friends and family have careers in a wide spectrum of professions (IB, corporate banking, accounting, software engineer, teaching, nursing, pharmacy, PT) and we openly share our career progression with each other.
    If you don't know people who have succeeded in IB, corporate banking, accounting, software engineering, etc. that doesn't mean they don't exist.
     
     
  13. Like
    1D7 got a reaction from Thorax in Realignment of Doctor's Income 2   
    This thread is a complete misrepresentation of various careers, cherry picking literal top 1-5% earners in medicine and comparing it to fallacious numbers or some of the lower paid areas in other fields. I'll clarify a few things.
    1. A career in medicine entails much longer training and burden of debt. Tuition is $100k over 4 years plus interest, as well as the opportunity cost of 4 years lost earnings. Because of that, physicians are remarkably behind at each stage compared to other professionals. If you compare careers with that consideration in mind, it looks more like the following:
    While I accumulated -$120,000 in medical school, the barista down the street accumulated $200,000 more than me (25k/yr), accountant $420,000 more than me (55k/yr), and the banker made $700,000 more than me (175k/yr). When I was a PGY-3 my net earnings finally reached $0 and I was making $70k/yr, while the accountant became a director making 120k/yr and the banker a VP making $350k/yr.
    2. Direct comparisons in compensation are flawed because payouts are structured differently in medicine vs high earning white collar careers. Physicians billings are typically an upfront number. Compensation in many 'white collar business' careers often have 30-50%+ of their earnings paid out as bonuses (which are regularly expected each year, though the amount varies). There is also a significant amount of money paid out as stock options. Remember reading the news about X company's CEOs/directors making aridiculous millions upon millions of dollars? Most of that money is 'paid' through stock options, which is how senior partners/management directors make a significant amount of money as well. So while physician income after billings is on avg 25% LESS, a banker's income is 50-1000%+ MORE than what their salary is.
    3. Most comparisons often conveniently ignore salary level in residency/fellowship (which has a 6+ year duration in highest earning specialties) and as a junior attending (where pay is reduced and call is increased). Instead they jump to money as established physician top 10% in a highly paid specialty and compare it to someone barely established in another field.
    4. Entry into medicine is generally more competitive than finding entry in most careers listed in this thread except IB. While I don't think competitiveness is necessarily a virtue in itself, posts about other careers always mention how you can only reach the top rungs if you work hard, demonstrate great skills, etc. Newsflash, to enter medicine in itself you have to be extremely academically successful and to do well in residency you will work harder than almost every other career. The skill sets are different obviously, and while a physician may not succeed in banking, the reverse is also true for a banker trying to enter medicine.
    5. Lastly, there is also a hidden implication by many of these posters than physicians SHOULD earn less than bankers/accountants for whatever reason. I'm happy earning what a family doctor makes, but I realize that for the administrators/government bean counters, our pay is how much they see our worth (and how easy it is to control us and diminish our autonomy at the expense of patients).
    These discussions around reducing physician pay are always fallaciously dichotomized into physician's benefit vs public good. In reality, when a worker's wages are reduced, it does not benefit the service nor the worker, but the C-suite executives and bureaucrats. See the U.S., where medicine is driven by bureaucrats/C-suite execs—patient care has taken a backseat to $$$, and while physicians suffer, bureaucrats/C-suite execs reap the benefit. Even though our system rewards cost savings instead of profit, the mindset of administrators always boils down to $$$ because we're the ones who have to face and advocate for patients.
  14. Like
    1D7 got a reaction from QueenStan in Realignment of Doctor's Income 2   
    This thread is a complete misrepresentation of various careers, cherry picking literal top 1-5% earners in medicine and comparing it to fallacious numbers or some of the lower paid areas in other fields. I'll clarify a few things.
    1. A career in medicine entails much longer training and burden of debt. Tuition is $100k over 4 years plus interest, as well as the opportunity cost of 4 years lost earnings. Because of that, physicians are remarkably behind at each stage compared to other professionals. If you compare careers with that consideration in mind, it looks more like the following:
    While I accumulated -$120,000 in medical school, the barista down the street accumulated $200,000 more than me (25k/yr), accountant $420,000 more than me (55k/yr), and the banker made $700,000 more than me (175k/yr). When I was a PGY-3 my net earnings finally reached $0 and I was making $70k/yr, while the accountant became a director making 120k/yr and the banker a VP making $350k/yr.
    2. Direct comparisons in compensation are flawed because payouts are structured differently in medicine vs high earning white collar careers. Physicians billings are typically an upfront number. Compensation in many 'white collar business' careers often have 30-50%+ of their earnings paid out as bonuses (which are regularly expected each year, though the amount varies). There is also a significant amount of money paid out as stock options. Remember reading the news about X company's CEOs/directors making aridiculous millions upon millions of dollars? Most of that money is 'paid' through stock options, which is how senior partners/management directors make a significant amount of money as well. So while physician income after billings is on avg 25% LESS, a banker's income is 50-1000%+ MORE than what their salary is.
    3. Most comparisons often conveniently ignore salary level in residency/fellowship (which has a 6+ year duration in highest earning specialties) and as a junior attending (where pay is reduced and call is increased). Instead they jump to money as established physician top 10% in a highly paid specialty and compare it to someone barely established in another field.
    4. Entry into medicine is generally more competitive than finding entry in most careers listed in this thread except IB. While I don't think competitiveness is necessarily a virtue in itself, posts about other careers always mention how you can only reach the top rungs if you work hard, demonstrate great skills, etc. Newsflash, to enter medicine in itself you have to be extremely academically successful and to do well in residency you will work harder than almost every other career. The skill sets are different obviously, and while a physician may not succeed in banking, the reverse is also true for a banker trying to enter medicine.
    5. Lastly, there is also a hidden implication by many of these posters than physicians SHOULD earn less than bankers/accountants for whatever reason. I'm happy earning what a family doctor makes, but I realize that for the administrators/government bean counters, our pay is how much they see our worth (and how easy it is to control us and diminish our autonomy at the expense of patients).
    These discussions around reducing physician pay are always fallaciously dichotomized into physician's benefit vs public good. In reality, when a worker's wages are reduced, it does not benefit the service nor the worker, but the C-suite executives and bureaucrats. See the U.S., where medicine is driven by bureaucrats/C-suite execs—patient care has taken a backseat to $$$, and while physicians suffer, bureaucrats/C-suite execs reap the benefit. Even though our system rewards cost savings instead of profit, the mindset of administrators always boils down to $$$ because we're the ones who have to face and advocate for patients.
  15. Like
    1D7 got a reaction from blah1234 in Realignment of Doctor's Income 2   
    It's a net difference in net earnings position compared to a physician at the equivalent stage. I'll edit that to make it more clear but thought it was obvious a barista isn't earning that per year. Medicine is a better career path than being a Starbucks barista but just wanted to illustrate that 4 years of lost earnings plus paying tuition is a significant amount of money that most people don't consider.
  16. Like
    1D7 got a reaction from blah1234 in Realignment of Doctor's Income 2   
    This thread is a complete misrepresentation of various careers, cherry picking literal top 1-5% earners in medicine and comparing it to fallacious numbers or some of the lower paid areas in other fields. I'll clarify a few things.
    1. A career in medicine entails much longer training and burden of debt. Tuition is $100k over 4 years plus interest, as well as the opportunity cost of 4 years lost earnings. Because of that, physicians are remarkably behind at each stage compared to other professionals. If you compare careers with that consideration in mind, it looks more like the following:
    While I accumulated -$120,000 in medical school, the barista down the street accumulated $200,000 more than me (25k/yr), accountant $420,000 more than me (55k/yr), and the banker made $700,000 more than me (175k/yr). When I was a PGY-3 my net earnings finally reached $0 and I was making $70k/yr, while the accountant became a director making 120k/yr and the banker a VP making $350k/yr.
    2. Direct comparisons in compensation are flawed because payouts are structured differently in medicine vs high earning white collar careers. Physicians billings are typically an upfront number. Compensation in many 'white collar business' careers often have 30-50%+ of their earnings paid out as bonuses (which are regularly expected each year, though the amount varies). There is also a significant amount of money paid out as stock options. Remember reading the news about X company's CEOs/directors making aridiculous millions upon millions of dollars? Most of that money is 'paid' through stock options, which is how senior partners/management directors make a significant amount of money as well. So while physician income after billings is on avg 25% LESS, a banker's income is 50-1000%+ MORE than what their salary is.
    3. Most comparisons often conveniently ignore salary level in residency/fellowship (which has a 6+ year duration in highest earning specialties) and as a junior attending (where pay is reduced and call is increased). Instead they jump to money as established physician top 10% in a highly paid specialty and compare it to someone barely established in another field.
    4. Entry into medicine is generally more competitive than finding entry in most careers listed in this thread except IB. While I don't think competitiveness is necessarily a virtue in itself, posts about other careers always mention how you can only reach the top rungs if you work hard, demonstrate great skills, etc. Newsflash, to enter medicine in itself you have to be extremely academically successful and to do well in residency you will work harder than almost every other career. The skill sets are different obviously, and while a physician may not succeed in banking, the reverse is also true for a banker trying to enter medicine.
    5. Lastly, there is also a hidden implication by many of these posters than physicians SHOULD earn less than bankers/accountants for whatever reason. I'm happy earning what a family doctor makes, but I realize that for the administrators/government bean counters, our pay is how much they see our worth (and how easy it is to control us and diminish our autonomy at the expense of patients).
    These discussions around reducing physician pay are always fallaciously dichotomized into physician's benefit vs public good. In reality, when a worker's wages are reduced, it does not benefit the service nor the worker, but the C-suite executives and bureaucrats. See the U.S., where medicine is driven by bureaucrats/C-suite execs—patient care has taken a backseat to $$$, and while physicians suffer, bureaucrats/C-suite execs reap the benefit. Even though our system rewards cost savings instead of profit, the mindset of administrators always boils down to $$$ because we're the ones who have to face and advocate for patients.
  17. Like
    1D7 got a reaction from MDinCanada in Realignment of Doctor's Income 2   
    This thread is a complete misrepresentation of various careers, cherry picking literal top 1-5% earners in medicine and comparing it to fallacious numbers or some of the lower paid areas in other fields. I'll clarify a few things.
    1. A career in medicine entails much longer training and burden of debt. Tuition is $100k over 4 years plus interest, as well as the opportunity cost of 4 years lost earnings. Because of that, physicians are remarkably behind at each stage compared to other professionals. If you compare careers with that consideration in mind, it looks more like the following:
    While I accumulated -$120,000 in medical school, the barista down the street accumulated $200,000 more than me (25k/yr), accountant $420,000 more than me (55k/yr), and the banker made $700,000 more than me (175k/yr). When I was a PGY-3 my net earnings finally reached $0 and I was making $70k/yr, while the accountant became a director making 120k/yr and the banker a VP making $350k/yr.
    2. Direct comparisons in compensation are flawed because payouts are structured differently in medicine vs high earning white collar careers. Physicians billings are typically an upfront number. Compensation in many 'white collar business' careers often have 30-50%+ of their earnings paid out as bonuses (which are regularly expected each year, though the amount varies). There is also a significant amount of money paid out as stock options. Remember reading the news about X company's CEOs/directors making aridiculous millions upon millions of dollars? Most of that money is 'paid' through stock options, which is how senior partners/management directors make a significant amount of money as well. So while physician income after billings is on avg 25% LESS, a banker's income is 50-1000%+ MORE than what their salary is.
    3. Most comparisons often conveniently ignore salary level in residency/fellowship (which has a 6+ year duration in highest earning specialties) and as a junior attending (where pay is reduced and call is increased). Instead they jump to money as established physician top 10% in a highly paid specialty and compare it to someone barely established in another field.
    4. Entry into medicine is generally more competitive than finding entry in most careers listed in this thread except IB. While I don't think competitiveness is necessarily a virtue in itself, posts about other careers always mention how you can only reach the top rungs if you work hard, demonstrate great skills, etc. Newsflash, to enter medicine in itself you have to be extremely academically successful and to do well in residency you will work harder than almost every other career. The skill sets are different obviously, and while a physician may not succeed in banking, the reverse is also true for a banker trying to enter medicine.
    5. Lastly, there is also a hidden implication by many of these posters than physicians SHOULD earn less than bankers/accountants for whatever reason. I'm happy earning what a family doctor makes, but I realize that for the administrators/government bean counters, our pay is how much they see our worth (and how easy it is to control us and diminish our autonomy at the expense of patients).
    These discussions around reducing physician pay are always fallaciously dichotomized into physician's benefit vs public good. In reality, when a worker's wages are reduced, it does not benefit the service nor the worker, but the C-suite executives and bureaucrats. See the U.S., where medicine is driven by bureaucrats/C-suite execs—patient care has taken a backseat to $$$, and while physicians suffer, bureaucrats/C-suite execs reap the benefit. Even though our system rewards cost savings instead of profit, the mindset of administrators always boils down to $$$ because we're the ones who have to face and advocate for patients.
  18. Like
    1D7 got a reaction from procrastinating in Realignment of Doctor's Income 2   
    This thread is a complete misrepresentation of various careers, cherry picking literal top 1-5% earners in medicine and comparing it to fallacious numbers or some of the lower paid areas in other fields. I'll clarify a few things.
    1. A career in medicine entails much longer training and burden of debt. Tuition is $100k over 4 years plus interest, as well as the opportunity cost of 4 years lost earnings. Because of that, physicians are remarkably behind at each stage compared to other professionals. If you compare careers with that consideration in mind, it looks more like the following:
    While I accumulated -$120,000 in medical school, the barista down the street accumulated $200,000 more than me (25k/yr), accountant $420,000 more than me (55k/yr), and the banker made $700,000 more than me (175k/yr). When I was a PGY-3 my net earnings finally reached $0 and I was making $70k/yr, while the accountant became a director making 120k/yr and the banker a VP making $350k/yr.
    2. Direct comparisons in compensation are flawed because payouts are structured differently in medicine vs high earning white collar careers. Physicians billings are typically an upfront number. Compensation in many 'white collar business' careers often have 30-50%+ of their earnings paid out as bonuses (which are regularly expected each year, though the amount varies). There is also a significant amount of money paid out as stock options. Remember reading the news about X company's CEOs/directors making aridiculous millions upon millions of dollars? Most of that money is 'paid' through stock options, which is how senior partners/management directors make a significant amount of money as well. So while physician income after billings is on avg 25% LESS, a banker's income is 50-1000%+ MORE than what their salary is.
    3. Most comparisons often conveniently ignore salary level in residency/fellowship (which has a 6+ year duration in highest earning specialties) and as a junior attending (where pay is reduced and call is increased). Instead they jump to money as established physician top 10% in a highly paid specialty and compare it to someone barely established in another field.
    4. Entry into medicine is generally more competitive than finding entry in most careers listed in this thread except IB. While I don't think competitiveness is necessarily a virtue in itself, posts about other careers always mention how you can only reach the top rungs if you work hard, demonstrate great skills, etc. Newsflash, to enter medicine in itself you have to be extremely academically successful and to do well in residency you will work harder than almost every other career. The skill sets are different obviously, and while a physician may not succeed in banking, the reverse is also true for a banker trying to enter medicine.
    5. Lastly, there is also a hidden implication by many of these posters than physicians SHOULD earn less than bankers/accountants for whatever reason. I'm happy earning what a family doctor makes, but I realize that for the administrators/government bean counters, our pay is how much they see our worth (and how easy it is to control us and diminish our autonomy at the expense of patients).
    These discussions around reducing physician pay are always fallaciously dichotomized into physician's benefit vs public good. In reality, when a worker's wages are reduced, it does not benefit the service nor the worker, but the C-suite executives and bureaucrats. See the U.S., where medicine is driven by bureaucrats/C-suite execs—patient care has taken a backseat to $$$, and while physicians suffer, bureaucrats/C-suite execs reap the benefit. Even though our system rewards cost savings instead of profit, the mindset of administrators always boils down to $$$ because we're the ones who have to face and advocate for patients.
  19. Like
    1D7 got a reaction from MDinCanada in Realignment of Doctor's Income 2   
    Someone who makes managing director at an IB firm can make the same amount of money an entire Cardiology division does. The timing and earnings per stage of career are also completely different. And physicians earning 1M+/yr are also typically in their 40s: it takes a few years to build up your practice, work past junior/associate level attending positions, and/or find OR time. Trying to do 120 hours/week is not sustainable.
    Investment banking post-undergrad: 1-2 years of working as an analyst at 100-150k/yr, a few years of working as an associate at 150-200k/yr, then a variable path to VP/director/junior MD/senior managing director with an endpoint of making 1M-6M+/yr in his/her mid 40s-50s. 
    Specialist resident post-undergrad: 4 years of medical school at -25k/yr, 5 years of residency at 75k/yr, 1-2 years of fellowship at 75k/yr, junior attending, attending/senior attending with the end point of making 1M-1.2M/yr in his/her mid 30s, assuming highest earning specialty at the time.
    Most physicians will literally never catch up in lifetime $ earned to anyone who makes VP. Some will never catch up to someone who made associate. The attrition rate for IB is high but many find other careers in finance/consulting with similar pay but better hours after working in IB—if you stick around past associate it's because you want to (or you're addicted to making boatloads of money).
    Lastly physician earnings have gone down each year and are continuing to trend downwards, whereas IB incomes remain high & increasing.
  20. Like
    1D7 got a reaction from blah1234 in Realignment of Doctor's Income 2   
    Someone who makes managing director at an IB firm can make the same amount of money an entire Cardiology division does. The timing and earnings per stage of career are also completely different. And physicians earning 1M+/yr are also typically in their 40s: it takes a few years to build up your practice, work past junior/associate level attending positions, and/or find OR time. Trying to do 120 hours/week is not sustainable.
    Investment banking post-undergrad: 1-2 years of working as an analyst at 100-150k/yr, a few years of working as an associate at 150-200k/yr, then a variable path to VP/director/junior MD/senior managing director with an endpoint of making 1M-6M+/yr in his/her mid 40s-50s. 
    Specialist resident post-undergrad: 4 years of medical school at -25k/yr, 5 years of residency at 75k/yr, 1-2 years of fellowship at 75k/yr, junior attending, attending/senior attending with the end point of making 1M-1.2M/yr in his/her mid 30s, assuming highest earning specialty at the time.
    Most physicians will literally never catch up in lifetime $ earned to anyone who makes VP. Some will never catch up to someone who made associate. The attrition rate for IB is high but many find other careers in finance/consulting with similar pay but better hours after working in IB—if you stick around past associate it's because you want to (or you're addicted to making boatloads of money).
    Lastly physician earnings have gone down each year and are continuing to trend downwards, whereas IB incomes remain high & increasing.
  21. Like
    1D7 reacted to Real Beef in NOSM Family physician 2 years out now   
    I haven't been active on this forum for a number of years now. Now two years out from family medicine graduation and I can tell you life improves significantly from medical school and residency. Don't think for a second that life slows down unless you want to coast in a part time fashion. 
    People are always interested in money but people never want to talk about it.
    For those people that are worried about not making enough money as a family doctor I can reassure you with the fact that if you want to work your guts out that you can earn plenty ... I grossed $647k last year and I'll be adding an additional $80k this upcoming year I added 288 extra patients to my roster, most of them diabetics which will account for half the raise. So next year I should gross $727k - which is akin to a lasy cardiologist's earnings (?) lol. Also don't just concentrate on medicine as a money making endeavour - as soon as I came out of the gate I bought an investment property, a triplex, also fixed up an old pre-residency house I couldn't sell before moving for residency ... got a property management to manage it. I am months away from buying a Four-plex which will all gross $113k when all properties combined and plan on buying one investment property a year for the next 10-15 years. So from all sources Ill have gross earnings of $840k next year. 
    So as a family doc I won't ever make a million from family medicine exclusively unless I become one of those shady 5-minute per patient docs but I don't want to practice medicine like that and you will certainly be comfortable. Sure I have colleagues who have graduated and when I spoke to them they said that they 'only' made $200k last year but thats because they do clinic from 9 am to 3 pm 4 days a week lol. I do inpatients at 0700 in the hospital, clinic from 0900 to 4 pm, do walk in clinics a couple times a month, weekend walk in clinic every 2 months, do 100 hrs of rural and city ER a month  and during COVID-19 have put myself on the list for on-call COVID shifts. So if you want to kill it in your bank account you have to work hard almost until you kill yourself. I do have a reasonable balance though as I do go to the gym 4x a week, now home gym with covid closing things. Hope that gives a bit of insight 2 year post grad for someone who wants to put the pedal to the metal from an earning potential.
  22. Like
    1D7 got a reaction from clever_smart_boy_like_me in Feeling alone in med school   
    OP what you feel is completely normal. I grew up in a lower-middle class family and most of my friends are not in medicine. Over my 4 years in school, I didn't meet many people I liked—I had no desire to have any interaction beyond work with 90%+ of the class.
    Most are not bad people, but as you mentioned, fundamentally their social interactions are different because of their socioeconomic background. Typically, you will not enjoy their company much, and they will not enjoy yours.
    My personal recommendation is to avoid them altogether and find friends outside of medicine (see suggestions made by other posters).
  23. Like
    1D7 reacted to afines08 in Physician on 'hands and knees' trying to transfer to Family   
    Hi everyone,
    Alison here. I just found this thread- better late than never. Great conversations and ideas! I applaud you for the open conversation about all of this.
    Perhaps going to CBC wasn't the best route, I'll fully admit. Hindsight is 20/20, though, and back then I felt so stuck and frustrated with the situation.
    Here is what actually happened:
    - As @A-Stark mentioned, yes, I took a leave for mental health from IM residency. I have and will always be open about this as I feel mental health and burnout have, unfortunately, become so engrained in the life of medical residents/practitioners...it is an issue that I know is being worked on. I was diagnosed with Major Depressive Episode and GAD. I took that time on voluntary leave to go to therapy, start meds, and recover.
    - What people probably don't know is that I was very torn between IM and FM during CaRMS and had very strong references for both. I sought advise from my department and the academic advisor, and was told to rank IM #1 as the transfer to FM would be a very good possibility. I even remember the advisor saying: "From a 5 year program to a 3 year, it's much easier". I won't call it bad advice, as it was probably true at the time, but I acted upon that, ranking IM at Dal first, followed by all FM programs. I got my top choice in a very competitive year for Dal IM because I was very involved in medical school, had a solid application, and great references.
    - I never failed a rotation, and passed all exams/evaluations throughout medical school and residency. On paper, everything was great during my first year of residency, with really solid feedback from staff on evals. I prided myself on teaching clerks, and enjoyed the MTU and the people I worked with. Personally, though, everything was crumbling down. Towards the middle of my second year of residency, my performance did, admittedly, stumble a little bit- preceptors noted lack of self confidence, and my knowledge/recall skills were not up to par in some areas- but, I still managed to make it through without failure or red flags. 
    - I realized that IM was not a good fit for me while I was on voluntary leave after much (much!!) self-reflection. To that point, I had built my resume headed towards Allergy & Immunology. I enjoyed parts of A & I and had great preceptors/mentors. However, it kind of felt forced- I didn't love it, and maybe (as mentioned) I was looking for everything to be 100% perfect, but it just did not feel right. I know beggars can't be choosers, but I always felt there was something better out there for me. I felt perhaps family medicine would be a better fit for me, my health, and my "generalist" interests. It was a conflicting time for me and I think my thought was I had come so far and worked so hard, if I had to stay in medicine, then I'd thrive better in FM.
    - When I came back to my IM program after voluntary leave, I asked for a transfer to FM. This is where the system really showed lack of support. I requested rotations in FM, and was able to do 1 while waiting for a transfer opportunity. Both my psychiatrist and academic advisors supported doing rotations in FM or "FM-friendly rotations" like GIM; however, there was a clear understanding that continuing IM like nothing had happened would negatively impact my mental health and risk deteriorating while working in an area that wasn't a good fit. The Postgrad department would not allow me to complete more rotations in FM due to funding/availability reasons (very reasonable!); they wanted me to jump back into an ICU rotation, which I felt uncomfortable with given my mental health history. Unfortunately, the postgrad department especially was not supportive or accommodating of my mental health, and I felt somewhat ostracized. I was asking for an olive branch, sure. I felt getting back slowly into IM while waiting for a transfer would be a good compromise, but it wasn't an option with them. It was almost like they wanted me to return from leave and act like nothing had happened. I argue that depression is a chronic disease and it's not something you can just get over in 4 months.
    - I applied for a transfer at every FM program across the country. It was difficult and consisted of many conversations with postgrads, but the bottom line was, with the exception of Dal, I was considered an out of province resident. As such, priority was lower, and I will say this: FM programs across Canada at the time were getting inundated with transfer requests- it was crazy!
    - I met my husband in this same time frame, who lived in BC. I moved out there and pursued a transfer to UBC FM in BC. The town we live in has a FM residency program, and a local FP advocated on my behalf to UBC to add me to their program. Things were actually looking promising as my application was solid (I had great references from my FP rotation), but again, a stringent system prevented it from going through. That FP has since closed his practice and moved, unfortunately for the people of our city.
    - After this, I continued to pursue transfer to FM anywhere, everywhere. I applied to the second round of CaRMs the following year. I asked to do FM rotations at other academic centres, but again, priority was given to their home residents. CaRMS round 2 snagged me 5 interviews at out of province schools, but to no success- I was told FM was so popular, it was nearly impossible to match to an out of province school, and Dal had a number of transfer requests to FM at the time (I was told at least a dozen). Eventually time passed and I timed out. I withdrew formally from residency, and you know what? I was content and at peace with that. In the meantime I was establishing a new life in BC for myself, and had discovered an industry I absolutely love and continue to work in to this day. 
    - I don't regret anything about my journey. Yes, CBC skipped a lot of the details. The thing that makes me most sad is the fact that I received many, many messages from medical students and residents across Canada after going public with my story, who were battling the same inflexible system. Shortly after my story came out, a student at the U of T committed suicide due to CaRMS. Sure, perhaps medicine wasn't a great fit for me (and it took me a while to realize this), but I cannot imagine what going through this would've been like for a resident who has the passion for practicing family medicine and only realized it after CaRMs. It really does take a toll on mental health. Residency shouldn't be a destiny; life happens, change occurs- like any other career, one should be able to change their mind without having to face such monstrous road blocks. My application wasn't perfect, but when I was in medicine, I will say I was a good practitioner and had the references and feedback to support this. I prided myself on patient care, and if you knew me, you'll know that I can establish rapport with most. I advocated for my patients whenever I could. I never failed a rotation and my knowledge competency only stuttered due to depression & anxiety I was experiencing at the time. I really did want it to work.
    I don't wish to defend my decision, but hope this explains things. I get asked from time to time if I want to go back- I don't. I don't miss it at all. I feel selfish and guilty sometimes due to the taxpayers dollars spent on me and the lack of FPs in Canada- I wish I could have made it work- but life goes on, and it's my life. I've met several other individuals who've left medicine since, so I'm not alone.
    I haven't kept abreast of the goings on with medical residencies and CaRMS since I left, but I do hope that others found strength in my story (even though I left in the end), and hope they continued to push for their transfers. More importantly I hope that mental health and burnout are at the forefront of discussions at every program in Canada, and are better accommodated when they occur. If you are suffering from it, PLEASE do not be ashamed to get help. I'm glad I did, as it's led me to a path of contentment and fulfillment.
    Alison
     
     
  24. Like
    1D7 reacted to rogerroger in Doing A Masters During Medical School   
    Good question. 
    My residency program fully supported me. Modified clinical load etc. Because of grants (most not from my program) and so on I didn’t pay a cent out of pocket for the degree. So basically I was paid to go to school in residency. It was a great time. This is not all that uncommon in RCPSC emergency medicine programs.  
    My second masters was after residency. I got that one largely paid for as well, funny enough my first masters enabled this. But a reduced work load was not possible. By this time I needed the staff physician income and asking my colleagues to cover me for a reduced work load so early in my career wasn’t an ideal option. It was a grind. I would not do it that way again in hindsight. This second masters however did fold directly into a  new part time gig very separate from my medical work. So there was some immediate doors opened through obtaining it. 

    I work at an academic site. I think the masters I obtained in residency certainly assisted my job prospects. Jobs at popular academic sites are getting tighter. The masters wasn’t the end all be all. You don’t NEED it to get an academic position. But I’m certainly under the impression it helped. A significant proportion of my colleagues do hold a graduate degree, especially those who joined in more recent times.
     
  25. Like
    1D7 got a reaction from JohnGrisham in COVID-19 Impact on Electives and Clerkships   
    Healthcare workers are superspreaders. We work with populations most likely to die from the disease. This isn't time for some hero-martyrdom complex bullshit; that's how vulnerable patients die.
    If a patient is suspected to have coronavirus on a service where the patient has to be seen relatively closely by an attending, and the patient isn't immediately dying in front of you, I would argue residents have a duty to request staff see the patient instead.
     
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