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rmorelan last won the day on September 22

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About rmorelan

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    Was a computer programmer/project manager. Now a resident.

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  1. a gracious response on the internet! A welcome sight indeed - and I think you still aren't wrong that ultimately family medicine very likely comes ahead (with more work) and the opportunity to increase the income for family medicine is potentially there which tilts the numbers. This stuff isn't easy and medicine isn't the only path of course.
  2. awesome analysis ha I would point one thing that makes it even worse for FM - regardless of how you evaluate the pension amount (which may be higher than 50% - often 60% occurs) whatever that amount is worth more than the doctor just saving the same amount (a pension worth say 1 million is worth more than that doctor having a pile of month at 1 million). The reason is the real world you have deal with inflation so that money is invested. Those investments for a doctor can go up or down in value - so the amount they could take each year without destroying the base amount can go up or down, but for the pension the outcome is guaranteed - and it is guaranteed for longer than 25 years - it just keeps going forever. That sort of protection is hard to come by - and in retirement investments it is very expense to buy. As a rough rule of thumb a pension that spits out 40K a year is worth more a million dollars (roughly 50% of the 120 pretax salary of the PA is 60K would would require a pension valued between 1.5 million and 2 million to make work). Although I should say similarly the doctor wouldn't be just packing away 35K a year either in a savings account - that would also be invested so the amount should grow faster than inflation, reducing the amount needed to be saved to hit the same target as the pension. The net effects could cancel each out depending on the return rate, inflation and so on - still for many a flat out guaranteed amount with minimal work involved on your part is very valuable indeed! The other thing is that so far we are assuming that both the PA and doctor don't actually spend anything. Which obviously isn't going to happen - but once you factor that in you see the way the doctor can pull ahead. If it costs 84,000 a year to live on the PA is saving nothing as that is their full salary after tax (but still has an amazing pension so is probably more than fine anyway - they don't have the same issues with saving - or at least saving for retirement). If the doctor can manage to live on 84,000 they will have left over savings (66K give or take in your model). If that money is then invested over time and grows the return will overwhelm the PA - but that require discipline and some training to do well. Income is not wealth - wealth is not what you make, it is only what you save and compound interest applied to those savings is very powerful. Above is also easy to say - but there is a lot of pressure on doctors not to live radically below their means (I don't care I am doing it anyway ha) and some of this high savings rates would be uncommon. If doctors don't save then we are back right at your example - where it takes a very long time to reach a break even point. This stuff is complex but worth going through - (hopefully I got the points above correct!) and I have to thank you again for adding that analysis!
  3. also should add that if you have an interesting something you should be reading on that topic yourself and getting a better understanding of it. It isn't that hard to leap frog over your peers in a particular area if you are interested in it. Pretend you are a 1st or 2nd year resident for a moment in that field - what skills should they have? Develop those skills. That way when you network and perhaps get on observerships or do your clerkship rotations in XYZ, and then electives you are showing both interest and skill. Plus it help block awkward encounters when someone asks you a question and have no idea what they are talking about. Telling someone you have an interest in a particular area is great but having done the work you can show people you have an interest in it. That is far more powerful.
  4. sure rub it in ha although I will say watch what happens in Quebec if you try to increase it or otherwise take advantage of the situation. There is actually a "response". They are not afraid to get shall I say vocal about the situation. In the rest of Canada in comparison - it goes up and is there is well basically nothing.
  5. it is true the shear timescale of things is hard to initial grasp with things (I mean of course they are - we are talking timelines longer than how long many people on the forum have been alive ha). (actually having done exactly that masters degree I will say many do it part time so there is no loss of income and they are set up to do exactly that with those programs, the tuition is a tax write off which helps lowering cost for it to say 12K give or take, they can count often the time towards professional activities they have to do anyway which helps, and absolutely the return on investment is then 2-3 years (7K x marginal rate of tax on the increase in salary = ~4.5-5K again against the 12K cost give or take plus the bump also applies to their pension as well. so.....well that probably is a no brainer ha! Plus the masters often isn't terribly hard by most standards. Some do the longer masters for sure - but often that is tied into actually even getting the teaching job in the first place as well which is not easy rather than just increasing the salary. I was a high school teacher for a year - the complaints people had about the system are quite impressive ). It still works out mathwise for medicine of course ha - but the return on investment is not 2-3 years (your career of course is hopefully quite long as well mind you). You have to recover 350K+ in after tax income not including practise startup costs to hit even point compared at the true value of the PA salary, pension and benefits, and the higher tax rates involved along with greater time you have to spend on the job and maintaining your skills (time you could use to earn in theory more income or heaven forbid not work ha). Point is I guess is that in case anyone is wondering - a PA is a very good job, although it is totally ok to want more (and I don't mean income really with that - but just to do more stuff in your career)
  6. I mean that isn't much more conservative - That is right in the range of average. Doesn't mean people cannot do more of course, and there are many ways family doctors have increased it. Medicine's flexibility is one of its strengths. Your are right in terms of the positives! I would say to be complete you have to add the say 150K+ in costs of med school, the lost of after tax income for the 4 years and any return you would make on any money invested from that, the likely interest on the costs of med school, and whatever else you could have earned in all the extra time you are now spending studying (which for the motivated is definitely not zero). Also you double your salary but the doubled part is taxed at a much higher rate than the first half so your real increase is less than half. There is also the likely loss of a true pension which is something worth a definite real value above your base salary of no small amount. I am 100% not saying someone shouldn't do it - if I were to do that in fact I would have to call myself out because I basically did do that when I left my career as a software engineer to go into medicine (and you have to at least start with this math assuming you would get family medicine as you cannot assume you would get any particular field you want). I would just caution saying it is a no brainer though from pure economics. Even as staff now in a higher paying speciality it will take years to mathematically come out ahead here from what I was doing with my prior high savings rate. Still glad I did make the choice I did.
  7. some of that is just hard I think to get across - I mean it is all abstract until you do it. Still we should do a better job. The problem with passion as a sole motivator is first off not every doctor will actually be passionate about about their field and may be passionate even about a field they didn't get into (which truly sucks) . Many just want to do a job that they enjoy and pays well but that isn't the sort of passion they are getting at with that line - they are describing the sort of enthusiasm where you would do it for the shear joy of it alone, endless, and be one of those radiant people inspiring those around you. Relying on that for the field as a whole is a bit nuts in my opinion - those people are rare. Ideally there would be a list of reasons you make a particular career work - expecting people to always passionate about doing their 1000th on call surgery at 3am knowing you are rounding in 3 hours and have a few decades more to go is asking a lot I don't see a lot of other professional fields using the passion argument anywhere near the degree medicine does. Worse it is often a code word to almost force people to doing things in an unfair fashion (as an example I love teaching, and would do it regardless - but to expect every doctor to do it for free is not a way to build a proper medical education system). We have tried to fix the stress previously in a few ways - getting rid of grades for instance - and have GREATLY improved both med student and residency life (not that we are done yet). Still haven't fixed the underlying problem that for competitive things no grades means you end us doing more of research and ECs as you have to do something to stand out (and will always have that problem). Also haven't fixed the problem that ultimately the end job for a lot of fields is ton of work, pain, stress and will involve big sacrifices even at baseline. We have to be at least open about that.
  8. yup that happens for sure. Nothing beats experience - and I don't think any system is going to be perfect for getting everyone that exposure ( for instance neuro surg in clerkship is an elective at many places and you simply may not get it even if you want it - which means you could miss out considering that field. Far too many subfields to do them all. You cannot do everything in clerkship). Hopefully there is enough early on self-reflection and opportunity to explore at least broad things early on. For instance maybe you don't know neuro surg until clerkship but ideally you would at least know if surgery of some kind is an option - there is overlap in many of the basics of those fields at least. Then you can further explore those routes and know you are considering something competitive and adjust accordingly. and even if you don't start "on time" at least all hope is not completely lost - I know people that went for competitive things in the end with little prep - as much as all this research and ECs are valuable the programs are aware good people can come on late. I have friends that decided out of the blue on plastics during clerkship and still go it without a lot of prep (not ideal but there is once again randomness and luck involved here). at the very least med students I think have to have the idea in their heads that one of the primary purposes of pre-clerkship is to try and narrow this down. There are no deadlines/tests/assignments or other external pressure to do it in most places so it is all on the student - still ultimately if med school doesn't lead to a suitable residency for you that isn't a great outcome so you have work at it.
  9. the other thing is there are some relatively common themes in some of these more competitive specialities - in other words most people can figure out if they are for them way earlier. One big question is just surgery vs non-surgery - and if you can figure that out at least you can really reduce to the things you have to consider. If you decide surgery is possible then you want to do that networking anyway as you want to get that figured out for sure - you need to learn all you can about the field because it is a big choice to make. Plus at least initially any surgery related research/networking etc probably would help for any surgery field (some competitive programs are also skeptical of people immediately gunning for a subtype of surgery anyway - I mean why do you want plastics over any other type of surgery would be an obvious question.)
  10. W0lfgang - never heard of it. As you know a bit of a step curve to hit anything that is actually useful - I always joke to do anything in radiology you almost have to be able to everything ha. I though there was some talk about mammography at one point - at least that is a more isolated system(?)
  11. actually I should add the income can even be a real trap as well - once you ramp up to a particular roaster of patients, or develop your practice so you are the expert people go to in a particular area etc. it is often hard to ramp down if you want to. Those patients are now attached to you, people will need you to still be the available expert in area XYZ and so on. If you realize you have taken on too much, you cannot quickly adjust - it takes a long time to adjust things - and if you aren't careful you can become dependent on the income to the point where you cannot change things financially either. That is not a good situation to be in and leads to burnout or worse. One of the hardest transitions for many medical students in clerkship. Not just because it is a lot of work - they have been working hard already for a long time. It is the loss of control of their schedule. No matter what now you need to do the tasks assigned when they are assigned for as long as they are assigned. That is quite often new - to have your entire schedule locked in for the majority of your waking hours without any particular break really for the year (and then beyond). You have no choice in when to do something. If you are tired, mentally out of it, or just going through something it doesn't matter - at 6am you are going to be rounding etc. The time you have to study is at a fixed point as well. Other jobs of course have this as well but they aren't working 80+ hours a week, and probably have more than 2-3 weeks vacation in most cases (and that vacation is always tied up usually with something else - like preparing for electives etc.) Point is that continues and even becomes more concrete as staff for a variety of reasons. A lot of these intense fields sound fun until you actually do them and experience that loss of flexibility for a long period of time.
  12. I have seen that even in 5th year - that even they look ahead and realize that residency wasn't some hurtle you have to get over to reach green pastures - often over the hill is just more hill and while they could probably do it they just "had enough". Delayed gratification is very dangerous in medicine because you realize that really there isn't a clear end to it. Many staff work just as hard or harder than residents. The income only compensates for that so much - particularly when normal family matter crop up as well. You understand quickly why some professional really have very very little downtime.
  13. completely not surprised ha - as a first year of course most don't really know the fields yet and a lot of different things can seem quite exciting. well they are exciting and as you put it "cool" - although after you have done your 1000s fill in the blank it may not be as much (but hopefully if you choose well still satisfying). Plus some may just be afraid that somehow saying they want family medicine is being uninspired about their choices ha. again in life it is probably best not to be punishing yourself for no reason. I like the fact that my job doesn't really seem like a job to me - I show up, there is a ton to do so time goes fast, and I am constantly interested. By some people standards that would be intense - particularly compared to other fields of radiology. However it works for me - I would like to think I found the right balance. Others need to do the same
  14. Oh I don't either - was mapping out worst case for that field in particular only because of all the fields surgeons going into family after going unmatched is consider to be the most "tragic" by many- there is more overlap in the jobs between IM, peds, emerg (which even potentially has of course a +1) and even psych than surgery particularly with some tailoring to your actual practice
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