The Deceptive Income of a Physician

[Renoir]

Given the recent flavour of conversations here, I thought this post might be timely. Very interesting article (although a very American perspective) on student debt, income, taxes, and propinquity of study-to-work. Hardly a surprise for most...

 

http://benbrownmd.wordpress.com/

[shady]

When I first said I wanted medicine, I was told if you are in it for the money, you are in it for the wrong reasons. I believe in that.

 

That being said, a few points can be raised here:

1. This is in the US. The average graduate has $300,000 of student debt, whereas here in Canada the number is closer to $100,000-150,000. Still not small, but significantly smaller.

2. The gov't student loan part (e.g. OSAP) is tax-deductible

3. Residency here pays more. In Ontario, $59,000-75,000.

 

At the end of the day, however, if you look at it on a per-hour basis after tax, doctors don't make that much more than other professionals. Gone are the days when physicians could lead a lavish life-style.

 

Which kinda sucks considering that many of today's richest are corrupt bankers.

 

NINJA EDIT: shameless plug for McMaster: this is why you young premeds should come to Mac; you save a year of education and living expenses, and you get to make a doctor's salary a year earlier in your life

[qszwdxefc]

When I first said I wanted medicine, I was told if you are in it for the money, you are in it for the wrong reasons. I believe in that.

 

That being said, a few points can be raised here:

1. This is in the US. The average graduate has $300,000 of student debt, whereas here in Canada the number is closer to $100,000-150,000. Still not small, but significantly smaller.

2. The gov't student loan part (e.g. OSAP) is tax-deductible

3. Residency here pays more. In Ontario, $59,000-75,000.

 

At the end of the day, however, if you look at it on a per-hour basis after tax, doctors don't make that much more than other professionals. Gone are the days when physicians could lead a lavish life-style.

 

Which kinda sucks considering that many of today's richest are corrupt bankers.

 

NINJA EDIT: shameless plug for McMaster: this is why you young premeds should come to Mac; you save a year of education and living expenses, and you get to make a doctor's salary a year earlier in your life

 

Also nurses here go through 4 years instead of 2 right?

 

And not trying to bash teachers or anything but I have a lot of older friends who went to teacher's college. Even after 2 years they either have no job or just a part-time supply teacher job. Have to consider that too, it's not easy being a new teacher right now especially in subjects that are overloaded.

[ralk]

When I first said I wanted medicine, I was told if you are in it for the money, you are in it for the wrong reasons. I believe in that.

 

That being said, a few points can be raised here:

1. This is in the US. The average graduate has $300,000 of student debt, whereas here in Canada the number is closer to $100,000-150,000. Still not small, but significantly smaller.

2. The gov't student loan part (e.g. OSAP) is tax-deductible

3. Residency here pays more. In Ontario, $59,000-75,000.

 

At the end of the day, however, if you look at it on a per-hour basis after tax, doctors don't make that much more than other professionals. Gone are the days when physicians could lead a lavish life-style.

 

Which kinda sucks considering that many of today's richest are corrupt bankers.

 

NINJA EDIT: shameless plug for McMaster: this is why you young premeds should come to Mac; you save a year of education and living expenses, and you get to make a doctor's salary a year earlier in your life

 

We also get a much more favourable rate on our credit - 0% on OSAP while in school, prime-to-near-prime on everything else. The author used a 7% rate in their calculations; even with a probable rise in the prime interest rate over the next few years, we get much better than that.

[Satsuma]

3. Residency here pays more. In Ontario, $59,000-75,000.

 

 

The cost of living is higher in Canada compared to the US. Our minimum wage is roughly $3 more an hour than in the US. Still when you factor in cost of living, the average Canadian making minimum wage has less buying power than an American making minimum wage.

[NLengr]

3. Residency here pays more. In Ontario, $59,000-75,000.

 

If you look up the PAIRO pay scale, you'll see it's actually around $52k - 72k

 

You also need to account for all your expenses as a resident (CMPA, OMA, LMCC's, Royal college exams, tuition etc.). That brings you income down a bit, since you need them to work and you have to pay them from your net income.

 

Still probably better on average than US programs though.

[rmorelan]

If you look up the PAIRO pay scale, you'll see it's actually around $52k - 72k

 

You also need to account for all your expenses as a resident (CMPA, OMA, LMCC's, Royal college exams, tuition etc.). That brings you income down a bit, since you need them to work and you have to pay them from your net income.

 

Still probably better on average than US programs though.

 

Plus call I guess call stipend for me in year one that is about 5K - about 400-500 a month.

 

CMPA is mostly given back, the rest are at at least tax deductable

 

One other point a lot of people still have UG debit - that can boost you well above 150k

[rogerroger]

I'm envious of our Scandinavian colleagues who get educated for free. But then again you pay for it later in taxes...

 

The situation isn't bad in Canada. Yeah med school is expensive, yeah living costs are higher than down south, sure some specialties may earn more down south.

 

However, med school is more affordable than down south, and you can earn more here than in many European countries. We got a pretty balanced deal here. I've said it before and will say it again, if you are an ambitious and intelligent person you can earn much more money with greater ease NOT doing medicine. However, if medicine is a calling it isn't a bad gig.

[obi]

The Windsor 2016's are gonna be splitting on http://www.jamesedition.com/yachts/benetti/other/daf-for-sale-684633. Feel free to join our pool

[rmorelan]

The Windsor 2016's are gonna be splitting on http://www.jamesedition.com/yachts/benetti/other/daf-for-sale-684633. Feel free to join our pool

 

seriously? because a class of 32 med students really could go in on something like that.....

[Renoir]

seriously? because a class of 32 med students really could go in on something like that.....

 

My budget allows for me to go in on about one hour's worth of timeshare on that one... And that's splurging at approx $6000.

[thebouque]

If you're not in medicine for the money, you're in for the wrong reasons . You want to help people? You want to work with the public? You want to work in healthcare? You like science? There are many other jobs that'll give you all this, but very few of those jobs will give you the kind of stability and financial security of medicine.

 

I can count on one hand the number of physicians that I've met who truly love their job. Sure they can stand it, but it's not a calling. However, I've never met a single physician who doesn't love his pay check. Only premeds and 1st year students think medicine is a calling.

[Orcamute]

Lmao. Its not just money man..

 

Obviously the prestige and paycheque play a decent role in the majority of peoples decisions, but I would say it would be a long shot to assume that it is the main reason..

 

I want to help people, I want to live a life that I know that I can save my families life and help people who are in need. I want that added comfort of knowledge and skills that will benefit my ability to give people hope..iunno man. But if your in it for the 6 digits, ..well I hope you aren't in family medicine.

[medigeek]

Given the recent flavour of conversations here, I thought this post might be timely. Very interesting article (although a very American perspective) on student debt, income, taxes, and propinquity of study-to-work. Hardly a surprise for most...

 

http://benbrownmd.wordpress.com/

 

Paper =/= real world.

 

On paper it may work out like that if you make generalizations. In the real world, there's a significant difference between the financial status of a doctor and a teacher or nurse.

[thebouque]

Lmao. Its not just money man..

 

Obviously the prestige and paycheque play a decent role in the majority of peoples decisions, but I would say it would be a long shot to assume that it is the main reason..

 

I want to help people, I want to live a life that I know that I can save my families life and help people who are in need. I want that added comfort of knowledge and skills that will benefit my ability to give people hope..iunno man. But if your in it for the 6 digits, ..well I hope you aren't in family medicine.

 

Well I truly love my field and I couldn't see myself doing anything else. I wouldn't say it's a calling because I don't agree with the very concept of having a calling. However, I can't talk only for myself and most of the residents I know don't have a passion for what they do.

 

It's funny you mention family because I've yet to meet a family physician who has a passion for his field. Of course there might be a few who do, I haven't met a lot of FPs in my training.

[Jochi1543]

And not trying to bash teachers or anything but I have a lot of older friends who went to teacher's college. Even after 2 years they either have no job or just a part-time supply teacher job. Have to consider that too, it's not easy being a new teacher right now especially in subjects that are overloaded.

 

Teaching is quite bizarre. My husband's family has a few teachers and while the new grads are struggling to find work, the two older women keep getting asked to come out of semi-retirement all the time. It was quite strange sitting at one recent family gathering where the 30-year-old could barely find a few days' work in October, and the 65-year-old was complaining that she's barely ever home. I understand that not every teaching grad might be an excellent candidate, but if they have to rely so much on the semi-retired staff, there's something wrong with the system.

[Jochi1543]

 

CMPA is mostly given back, the rest are at at least tax deductable

 

Not here, no reimbursement at UBC.

[Jochi1543]

Well I truly love my field and I couldn't see myself doing anything else. I wouldn't say it's a calling because I don't agree with the very concept of having a calling. However, I can't talk only for myself and most of the residents I know don't have a passion for what they do.

 

It's funny you mention family because I've yet to meet a family physician who has a passion for his field. Of course there might be a few who do, I haven't met a lot of FPs in my training.

 

I'm surprised you say that, I've honestly never met a miserable family doc. Of course, as trainees we are mostly exposed to physicians who take on trainees, and given the fairly low compensation for having a med student or resident, these people generally have a passion for teaching and for their field. So maybe after a decade in practice, it'll be different. I've met some specialists who regret not going into FM, though.

[rmorelan]

Not here, no reimbursement at UBC.

 

you are right - forgot to mention that is Ontario specific. There certainly are province to province variation.

[thebouque]

I'm surprised you say that, I've honestly never met a miserable family doc. Of course, as trainees we are mostly exposed to physicians who take on trainees, and given the fairly low compensation for having a med student or resident, these people generally have a passion for teaching and for their field. So maybe after a decade in practice, it'll be different. I've met some specialists who regret not going into FM, though.

 

You're totally right, and it doesn't necessarily contradict what I was saying Miserable family docs are rare (and miserable docs are rare in general), but they're as rare are truly passionate docs ! And why are they not miserable? Mainly because of their work conditions, absolute job and financial security, very minimal hierarchy within the medical system etc.

 

And yes I've met a few specialists who regret not doing FM but I've met just as many FM who regretted not doing a specialty so in my experience it evens out.

 

I still think family medicine is a great field and a great job, and I would've seen myself in it for the rest of my life. I wouldn't be miserable in family, but it's just not my passion nor my calling.

[Renoir]

thebouque said:

You're totally right, and it doesn't necessarily contradict what I was saying Miserable family docs are rare (and miserable docs are rare in general), but they're as rare are truly passionate docs ! And why are they not miserable? Mainly because of their work conditions, absolute job and financial security, very minimal hierarchy within the medical system etc.

 

And yes I've met a few specialists who regret not doing FM but I've met just as many FM who regretted not doing a specialty so in my experience it evens out.

 

I still think family medicine is a great field and a great job, and I would've seen myself in it for the rest of my life. I wouldn't be miserable in family, but it's just not my passion nor my calling.

 

[ellorie]

I think it might be unreasonable to expect to have a job that will fill you with joy and passion every second of every day. I used to think that that was what it meant to have a "calling" but I don't think that it is.

 

I think that medicine will be satisfying, and I think that the good will outweigh the bad, and that at times I will find it joyful and feel passionate about it, and that it's a lot more satisfying of a way to make money than many other ways. Other times I will probably be tired and frustrated and grumpy.

 

I am okay with that. There's a reason they call it "work" and there's a reason we don't do it for free. Well, right now I do it for free - but that's because I don't know what I'm doing

[D-Rock]

Here are some practical stats from experience:

 

PGY-4

Family of four, spouse at home

33 years old

 

Current debt:

NSLC: 86,000

LOC: 190,000

Family loan: 40,000

Total: ~$316,000

When I finished med school, my LOC was only about $40,000, but it cost a lot of money to move, buy a used second car in order to manage a family in a commuting city, and recognize that my resident salary does not cover life for a single income family for the first few years. Speaking of which:

 

Salary: 53,250 (2010) - 76,600 (2015), that breaks down to ~$4000 net per month averaged over the five years and taking call stipends into account

 

Mortagage + taxes/insurance: $1850/month, 3 bedroom house. Comparable rent is 1500 - 2500, depending on location. Cheaper rent means more driving.

Gas/utilities/phone/etc = $400 - $800/month, depending on season

LOC payments = $500/month

NSLC payments = $200/month (I'm on repayment assistance program, it will increase to $700/month soon)

 

As you can see, I am barely breaking even without taking any extra things into account. I anticipate this will grow to about $350,000 by the time I finish fellowship in 2016. Debt is the most stressful situation in my life, despite the long work hours, tests, family issues, etc. While I know I can pay it off in about 3-4 years, I project, that assumes I get a job in a saturated field. But it also assumes interest will not dramatically increase. And that I don't have a massive capital start-up cost for practice. If I wind up setting up my own clinic rather than being affiliated with a university, that will probably add on another $150,000 - $200,000.

 

It's a little sobering to acknowledge that I should hopefully be paid off student debts (but not any other debts) when I'm approximately 40. That gives me 25 years of earning time to develop a retirement fund and pay off mortgages and kids' education.

[thebouque]

A calling? Maybe that's an excessive term. A passion? Yes. You paint with a broad brush stroke when you say "only premed and first years" do such and such. Remember how bad the word "only" is. It implies very categorical thinking.

 

Here's my list of reasons for leaving a $120K job in my late 20s and going on this crazy med run, all of which are directly "passion" issues:

 

Boring, unchallenging work

(On average) folks who can't deal with ambiguity, environmental issues, social issues, politics, or other topics of interest

Poor opportunity for advancement (due to rigid specialized training and job descriptions)

A feeling of brain stagnation

 

Why environmental/biology/(Medicine)?

Love of public health, the environment, human geography, sociology, philosophy, politics

Had a copy of Lange's Pathophys and couldn't put it down over the course of 4 years

Love interacting with people (usually)

I am now a plant guy - research in trees and agriculture, super enjoyable

 

Why a physician?

Social capital - community respects and (somewhat) honours your advice because of your title. (It shouldn't be like this, but it is.)

Political Capital - Easier to get into the political arena due to a number of factors, but the option is available when you get frustrated with the state of politics in your city/province/country.

Money - yes, a reason, but certainly makes no business sense to go for this when you're already starting out with a large base salary and little education investment

Monetary stability - More desireable skill set means if the economy tanks, you're still likely employed.

Interest - It's freaking cool, this body thing. microbio, biochem, and physiology are all incredible, amazing topics that will always serve as a wellspring for fascination.

Education - continual improvement, self-challenge, continual training and classes PRN

Work culture - more likely to find like-minded colleagues who are as interested in training, sharing ideas, and doing interesting extra-curricular stuff.

Public health - social capital (and others) above means you're more likely to be able to advance public health goals, education, and awareness

Flexibility - define your own career path, specialize or lean your practice towards things that keep your interest

Travel - The ability (FM/EM for me if I make it in this cycle) to do international development due to a) social capital to be able to get into developing nations money to make it happen c) useful skill set and knowledge that can open opportunities with NGOs or local governments d)love of improving people's lives (education, health, community)

People - of course I like people (sometimes I don't because they do dumb things), but this is the trite answer we try to avoid, so I put it at the end of the list.

 

That's my list, and money plays only a small factor. So do people go in it for the money? I hope not. I have better ways for that, PM me if interested.

 

Is it miserable? I hope not. Self-actualization means that I would be on to the next thing, or else modifying practice to do something that is affirmative. Of course I say these without experience on the doctor's side of the gurney, but I would also say that they're not all that far off the mark.

 

 

Interesting but go easy with the huge wall of text please

[obi]

seriously? because a class of 32 med students really could go in on something like that.....

 

I really wish it were true We do have a couple of guys half-joking about a smaller one though so who knows what could happen in years to come..

 

I would much rather have a racing license to bust out on track days in Montreal though

 

For those of you with some extra cash and a need for speed... check this out!

http://www.race2000.com/courses/wwr