Realignment of Doctor's Income 2

[BigM 57]

On 4/11/2020 at 1:38 PM, MDinCanada said:

Also, if your goal is to make >1million income, you need to spend more time reading about finances and taxes! Who even needs more than 500k? I think most people are looking at high incomes because they want to have financial freedom, there are much easier ways to achieve financial freedom... People who are financially literate know that it's not how much you make, but how many assets you have.

I also disagree with the clain that medicine isn’t the thing to go into if you want $1 mil + income. Medicine is a great thing to go into if you want $1 million+ income, but you’re going to bust your rear end to get it. Most professionals don’t have realistic prospects for making $1 million/year no matter how much you work. Nurses won’t, pharmacists won’t, retail clerks won’t. Vets & dentists may if you’re extraordinarily successful and working the equivalent of multiple jobs. However, if you’re a physician willing to combine putting in very long hours with being efficient, you can do it. Nothing prevents you from working 8-6 Monday- Friday with call and then doing a busy private practice on weekends. I’m not going to do it, as I agree with you, above $500,000 it’s questionable what the increase in quality of life is (likely decreases in the case of physicians), but saying that medicine isn’t a good path in order to achieve this just isn’t true.

[ArchEnemy 133]

On 2/17/2020 at 8:12 PM, MacHealthS said:

Thank you for your detailed response -JAG-

There would be no problem if these specialists would be making this much money in private practice

However, as all of this money comes from the common pot, billing disproportionately larger amounts than other specialists/generalists is essentially taking a big fat dump on them

"We are better than every other specialty" mentality...

---

In the US, specialists don't have such an insane spread in compensation. Ophthalmologists receive on average a $366K, Radiologists $419K, Cardiologists $430K and Gastroenterologists $417K. All specialties matter, and the time of some specialists is not valued disproportionately greater than the time of others

Americans have been quite successful at realigning physician compensation, but Canadians have not. I think it is very interesting to analyze the differences in remuneration of various specialties in US compared to Canada, but also physician migration pattern.

There's a reason why Canadian Ophthalmologists, Radiologists & Cardiologists are not moving to the US in big numbers, whereas Canadian Neurosurgeons & Orthopedic surgeons are. Argubly, the prospects of finding a job in bigger Canadian cities are similarly bleak in these specialties.

[ArchEnemy 133]

On 4/7/2020 at 7:17 PM, Medapp2017 said:

https://cmajnews.com/2019/10/08/are-fees-for-cataract-surgery-still-too-high/

"The negotiated fees paid to ophthalmologists for cataract surgery hover around $400 across the country, but they have been falling. Rocha says the fee in Manitoba has decreased by about 10% over the past 20 years, while fees in Ontario have fallen by 25%. Cuts like these will hurt recruitment and retention of doctors, he says.

Sweetman says that although technology costs have risen, productivity appears to have increased faster, so even the reduced fees are probably still too high. And he doubts the costs are too high for surgeons to bear. “I suspect that if the costs were too high relative to their pay, they would give numbers to back that up.”

I looked into ophthalmology fees, and was surprised that they were only able to cut cataract surgery fees by 10%/25% in the past many years, while the length of the surgery decreased from what, 6 hours (?) to 6-10 min. The above article was written in 2019, is it likely that there will there will be more dramatic cuts in the next 20-30 years? 

I can assure you that none of my Ophthalmology colleagues are lining up to move to the US . The ones that are considering the move, are willing to take the financial hit. 

Edited April 12, 2020 by ArchEnemy

[1D7 166]

While many American physicians have had a drop in income, I wouldn't say that American physicians are paid less than us or that physician income disparity is less in America. it's just a different set of docs at the top income levels.

Orthopaedics, neurosurgery, CT surg can gross 800k-1 mill+ (with senior surgeons having the ability to make even more from passive income related to owning outpatient surgicentres and other investments). Procedural medical specialties also enjoy high earnings. On the other hand peds ID makes <200k-250k in comparison and has a much lower income ceiling.

[Medapp2017 14]

2 hours ago, ArchEnemy said:

I can assure you that none of my Ophthalmology colleagues are lining up to move to the US . The ones that are considering the move, are willing to take the financial hit. 

Which shows that they're well compensated here in Canada... 

[ArchEnemy 133]

16 minutes ago, Medapp2017 said:

Which shows that they're well compensated here in Canada... 

Yes.

My response was more directed towards Dr. Rocha in the CMAJ article, who claimed that fee cuts will hurt recruitment and retention of "physicians". He is right in that fee cuts in that 10-25% range will hurt recruitment or retention of overall "physicians", but Canadian Ophthalmologists still vastly outperform their US counterparts that despite those cuts, none are lining up to move to the US.

Edited April 12, 2020 by ArchEnemy

[Thorax 4]

On 4/12/2020 at 3:28 PM, BigM said:

I also disagree with the clain that medicine isn’t the thing to go into if you want $1 mil + income. Medicine is a great thing to go into if you want $1 million+ income, but you’re going to bust your rear end to get it. Most professionals don’t have realistic prospects for making $1 million/year no matter how much you work. Nurses won’t, pharmacists won’t, retail clerks won’t. Vets & dentists may if you’re extraordinarily successful and working the equivalent of multiple jobs. However, if you’re a physician willing to combine putting in very long hours with being efficient, you can do it. Nothing prevents you from working 8-6 Monday- Friday with call and then doing a busy private practice on weekends. I’m not going to do it, as I agree with you, above $500,000 it’s questionable what the increase in quality of life is (likely decreases in the case of physicians), but saying that medicine isn’t a good path in order to achieve this just isn’t true.

The number of doctors actually making $1 million+ is pretty limited, probably a few dozen ophthalmologists, another few dozen cardiologists, radiologists, plastic surgeons etc. 

If you compare that to the number of people in other big industries that do the same, it pales by comparison. The number of lawyers, accountants, bankers, consultants who make $1 million is way higher and they do it at earlier ages than doctors do. Don't forget out of the 40,000 or so doctors in Ontario, perhaps 200 or so actually make over $1mil after billings, that really isn't many when you think about it. I really don't think even working an 80 hour work week for most physicians would let you make over $1mil take home. 

 

[procrastinating 1]

On 4/12/2020 at 6:12 PM, ArchEnemy said:

Yes.

My response was more directed towards Dr. Rocha in the CMAJ article, who claimed that fee cuts will hurt recruitment and retention of "physicians". He is right in that fee cuts in that 10-25% range will hurt recruitment or retention of overall "physicians", but Canadian Ophthalmologists still vastly outperform their US counterparts that despite those cuts, none are lining up to move to the US.

My understanding is that ophthalmology practice is significantly different in the US - and the pay is proportionally the same. The work is chiller, less hours, more control over your life. These are things people really want. Also, ophtho has huge overhead (60-70%) so take-home pay is really not what it seems.

With pay as it is now in Canada, Canadian doctors don't have a big enough reason to uproot their lives and make the big move down south. But compounding already tight job prospects and difficulty securing OR time with reduced pay? New grads will inevitably leave the country. Especially if the choice comes down to moving to some faraway rural Canadian city (where there will be more work, more call, less support) vs. an urban American city that's just south of the border (where you can call all the shots, albeit for slightly less pay ... but that's where the private procedures come in). It's what happened to ortho, ENT, neurosurgery. What that means is that the Cdn govt is paying hundreds of thousands of dollars subsidizing our education only for them to lose us to the states. That's why it'll hurt the retention and recruitment of these specific physicians. 

I'm not defending the obscenely high pay, but rather trying to add some element of nuance to this discussion. It's not as straightforward as it seems.

[1029384756md 16]

On 4/14/2020 at 1:08 AM, Thorax said:

The number of doctors actually making $1 million+ is pretty limited, probably a few dozen ophthalmologists, another few dozen cardiologists, radiologists, plastic surgeons etc. 

If you compare that to the number of people in other big industries that do the same, it pales by comparison. The number of lawyers, accountants, bankers, consultants who make $1 million is way higher and they do it at earlier ages than doctors do. Don't forget out of the 40,000 or so doctors in Ontario, perhaps 200 or so actually make over $1mil after billings, that really isn't many when you think about it. I really don't think even working an 80 hour work week for most physicians would let you make over $1mil take home. 

 

As someone who worked 7 days a week for a while and made 5-6k working 16-18 hours a day not infrequently, I will say that it's very doable for any physician of any specialty to gross 1M+ a year if they are insane and didn't mind sacrificing everything else in life.

As someone who also went through recruiting in management consulting and investment banking post residency, I will tell you that the guys making 1M+ a year in these industries are generally in their 40's and still chugging in 80+ hour work weeks, with shaky job security compared to medicine. You might have a few people here and there making partner or managing director in their 30's but those are the exceptions. If money is all someone wanted, medicine gets there much more reliably (and easier in my opinion).

[AB2 37]

36 minutes ago, 1029384756md said:

As someone who also went through recruiting in management consulting and investment banking post residency, I will tell you that the guys making 1M+ a year in these industries are generally in their 40's and still chugging in 80+ hour work weeks, with shaky job security compared to medicine.

why the decision to recruit for those post-MD? Did you end up working finance/consulting? I know a couple of people who tried for MBB post-MD, some successfully, esp w firms creating dedicated advanced degree/MD pipelines, curious to hear your experience from a non-recruitment cocktail pov. 

asking as an incoming consultant post-grad/premed

[1D7 166]

1 hour ago, 1029384756md said:

As someone who worked 7 days a week for a while and made 5-6k working 16-18 hours a day not infrequently, I will say that it's very doable for any physician of any specialty to gross 1M+ a year if they are insane and didn't mind sacrificing everything else in life.

As someone who also went through recruiting in management consulting and investment banking post residency, I will tell you that the guys making 1M+ a year in these industries are generally in their 40's and still chugging in 80+ hour work weeks, with shaky job security compared to medicine. You might have a few people here and there making partner or managing director in their 30's but those are the exceptions. If money is all someone wanted, medicine gets there much more reliably (and easier in my opinion).

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.

[1029384756md 16]

1 hour ago, AB2 said:

why the decision to recruit for those post-MD? Did you end up working finance/consulting? I know a couple of people who tried for MBB post-MD, some successfully, esp w firms creating dedicated advanced degree/MD pipelines, curious to hear your experience from a non-recruitment cocktail pov. 

asking as an incoming consultant post-grad/premed

Good question. I'll quote a JAMA article here: "Fear of reaching a professional plateau is a reason often cited by physicians who have chosen to enter management consulting. They cite the challenge of continually working on new problems and shaping new industries as a source of professional satisfaction. Medical students and resident physicians are also given to understand that there is widespread dissatisfaction among practicing physicians."

The biggest selling point of MBB and BB banks are their exit opportunities. I found out along the way that some opportunities were already open to me as a post-residency MD, e.g. hedge funds. I don't work there btw.

[blah1234 154]

9 minutes ago, 1D7 said:

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.

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.

As another professional before coming into medicine I agree with this assessment. There are other avenues to reach high salaries without the investment of money or time that medicine requires. No doubt many of these other paths are busy and stressful as well, however, I worked really hard during my training compared to my previous professional experience. If you build in good financial habits and compound interest the comparison isn't even close.

I enjoy my job now and I make a good living. If my passion was just about money though I'm not sure if I would ever recommend medicine.

[-JAG- 5]

On 4/14/2020 at 1:08 AM, Thorax said:

The number of doctors actually making $1 million+ is pretty limited, probably a few dozen ophthalmologists, another few dozen cardiologists, radiologists, plastic surgeons etc. 

If you compare that to the number of people in other big industries that do the same, it pales by comparison. The number of lawyers, accountants, bankers, consultants who make $1 million is way higher and they do it at earlier ages than doctors do. Don't forget out of the 40,000 or so doctors in Ontario, perhaps 200 or so actually make over $1mil after billings, that really isn't many when you think about it. I really don't think even working an 80 hour work week for most physicians would let you make over $1mil take home. 

 

In 2015, over 500 doctors in Ontario billed OHIP more than 1 million dollars. Let’s compare that to some other professionals 

1. Lawyers. Here’s a study of self employed lawyers’ incomes from 2012. [https://www.thestar.com/news/canada/2012/03/30/the_verdict_lawyer_well_paid_at_8_million.html]
Only 8 self employed lawyers in the entire country made over seven figures. Sure, that ignores employed lawyers such as partners in large law firms, but hitting a million a year there isn’t a guarantee either. While profits per partner aren’t an exact portrait of salaries, it’s still pretty telling that of Canada’s seven largest law firms, only one, Osler, reported profits per partner above 1 million dollars, and even then, its really only those at the top of the partner hierarchy with significant equity in the firm that make those numbers. Big names like Blake’s and McCarthy don’t make the cut. If you’re a junior partner on Bay St. (meaning even though you’ve been with your firm for over a decade likely), you won’t be given any equity and will be pulling in mid-tier family doctors money. Here’s a 2007 report commissioned by Canada’s judges on compensation for lawyers in the private sector. [http://www.quadcom.gc.ca/archives/2007/Media/Pdf/2007/Resources/CommentsNavigant Report.pdf] It exclusively considered private sector lawyers with over 10 years experience who worked for law firms, meaning that the lower earning in house counsels were excluded from the data. In Canada, the 75th percentile fell between 350 and 400k/yr. While it’s impossible to confirm this, one would think that this group would exclusively be composed of equity partners. In Toronto, the number was 550k, the highest in Canada. A seven figure salary was had only at the 93rd percentile (in Toronto) and remember, this is a pretty restrictive study. If we considered government lawyers, in house counsels, lawyers working in non profits and lawyers with under 10 years of experience, the numbers would be much worse, just as all the part time family physicians and low billing paediatricians, neurologists and psychiatrists bring down the Ontario numbers for physicians. To demonstrate my point, the jobs bank lists a 90th percentile salary for all lawyers in Toronto of 400k.

2. Accountants. Seven figures is reserved for the top of the Big 4 or extremely successful private practices. A senior manager at the Big 4 in accounting usually doesn’t clear 130k and many work specialist physician hours while living in some of the most expensive cities in Canada all the while having little prospects of making partner. If you do, you can expect to make 3-400k for a while before usually topping out at 700k, but I have no data to back this up.

3. For banking, you have to be a managing director at a large investment bank. If it’s not investment banking (or sales and trading if you’re a superstar) forget about it. Just getting an analyst offer at one of these places is just as hard as getting into medical school, and after finishing top of your class in finance or economics at a prestigious university, you’ll be lucky enough to spend 80 hours per week making pitch books, changing fonts on PowerPoint and making models in Excel. You make quite a bit for only a bachelors, around 150k your fist year with bonus, but the vast majority of bankers will never make it past VP/Executive Director, where the salary + bonus is usually 350-750k. That’s because to become a Managing Director, you not only need great technical skills, but great sales ability. If the firm doesn’t think you’re going to be a rainmaker for them and be bringing in tons of new clients, they aren’t going to promote you. Even if you are good, the guy above you could simply never retire and leave you stuck as a VP/ED for a decade. I know it’s not banking, but private equity usually recruits the best of the best from investment banking (which already recruits the best of the best from finance and economics programs at prestigious universities) and have similar (if not higher salaries). The Heidrick and Struggles compensation report outlines salaries for PE jobs in the US. [https://www.heidrick.com/Knowledge-Center/Publication/North-American-Private-Equity-Investment-Professional-Compensation-Survey-2019] The short of it is that unless you’re a partner, you’re not hitting seven figures, and making partner in PE is easier said then done. It’s demonstrating that you’re an expert in your field and being able to quarterback deals that involve managing hundreds of people and billions of dollars. 

For consultants, I don’t have any data, but trust me when I say that you have to be a senior partner at McKinsey, Bain or BCG to be there. 
 

There are two problems with of these paths. Firstly, they require a great deal of dedication over your whole career and proving that you are the best in the business to your superiors for at least a decade. Secondly, they require great technical skills, great people skills, great sales skills, great negotiation and conflit resolution skills and a whole lot of luck.

You’ll have a much easier time hitting a million a year in medicine. Just gun for cards, rads, derm or ophtho, and if you end up in family med, internal or psych, just do pain clinic. Even if the restrictions actually go through in Ontario, there’s always Sask., Manitoba and Quebec that pay well for nerve blocks.

Lastly, I wanted to say that even if the top billing doctors likely have substantial overhead, they probably have equally large sources of private income.

The two top billing family doctors in Ontario both do aesthetic medicine, Botox for chronic migraines (not covered by OHIP) and one is the medical director of a large cannabis company. 

The second highest billing radiologists also used to hold a license to operate private MRI’s and CT’s in the public system, that he sold for a few million dollars. Reports from the auditor of Ontario on his company, Oxford Advanced Imaging, showed that he was making at least a few million a year from that as well.

The second highest billing ophthalmologist in Ontario over the last 10 years, Dr. Anjema, provides many uninsured services at his clinic, AEI, just look up his website. I would wager that probably every ophthalmologist on the list is also charging for bogus and unnecessary eye drops and diagnostic tests for cataract patients. Where I’m from (Quebec) public clinics sometimes charge as much as 1000$ for these and pressure the patient into getting these tests even if they are not medically necessary.

[1D7 166]

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.

[BernieMac 526]

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[1D7 166]

7 minutes ago, YesIcan55 said:

If you can find me a barista position where I can make "$200,000 in 3-4 years (length of medical school)", then I'll quit my job and run to Starbucks right now...my accountant friends who are unemployed would also literally kill to make half of the "420,000 in 3-4 years (length of medical school)" that you quoted..

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.

[BernieMac 526]

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[Coldery 29]

2 hours ago, 1D7 said:

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.

How do I get a VP job at an IB? Hit me up if you know. 

The reality is that not every business school grad comes out and works at a VP job making $1mil-$6mil after a decade or two. It takes a certain type of person to: climb over others, suck up to the right people, and strike while others are down, to get to the top of the business world. They call them sociopaths. Very common phenomenon at the top of the corporate ladder.

To top that, statistically speaking, how many people with business degrees can be VP/directors/managing directors at IBs? Most of my business peers are happy to get a job as a retail banker. 

Medicine hedges those who go into it with a guarantee of employment with the additional benefit of guaranteed top 1% incomes. The business world doesn't do any of this. 

The belief that medicine doesn't remunerate its practitioners handsomely (minus GPs) is just short of delusional and it angers me. Especially when there are so many others around us that have it much worse, barely getting by on their monthly paycheck.

[BernieMac 526]

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[BernieMac 526]

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[1D7 166]

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.

1 hour ago, Coldery said:

The reality is that not every business school grad comes out and works at a VP job making $1mil-$6mil after a decade or two. It takes a certain type of person to: climb over others, suck up to the right people, and strike while others are down, to get to the top of the business world. They call them sociopaths. Very common phenomenon at the top of the corporate ladder.

To top that, statistically speaking, how many people with business degrees can be VP/directors/managing directors at IBs? Most of my business peers are happy to get a job as a retail banker. 

Medicine hedges those who go into it with a guarantee of employment with the additional benefit of guaranteed top 1% incomes. The business world doesn't do any of this. 

The belief that medicine doesn't remunerate its practitioners handsomely (minus GPs) is just short of delusional and it angers me. Especially when there are so many others around us that have it much worse, barely getting by on their monthly paycheck.

 

1 hour ago, YesIcan55 said:

but now that I have chimed in I can't help but further point of the delusion...I have friends who finished Business degrees without jobs....let alone on track to make the millions that you state lol 

 

[Coldery 29]

39 minutes ago, 1D7 said:

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 careers cannot. 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 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.

 

 

I mean Bill Gates or the one 15 year old kid I know who makes $70k/month also exist. An anecdote will only ever be an anecdote, meaning nothing in the face of data.

The statistics on the 50th percentile of each specialty (including opthos) exist. Stratify it by province and you get more detailed numbers. The 20-year compensation chart has this data. The average optho makes $1,250,000 in Alberta, $944k in BC. It's technically the mean and not the median but do a quick search for your local ophthalmologist and check their billings on your provincial website. Not sure about Ontario but BC has almost all salaries listed on their MSP "Bluebook". I'll guarantee you that it isn't just 1%-5% of the ophthalmologists hoarding the green mass.

Also, check the stats on the 50th percentile BCom grad. 

Compare mid-range BCom to mid-range Opthos (or even mid-range MDs at-large) then think about it.

Physician billings as a whole isn't as much of a concern as the top specialties who get all the cream. Leaving the healthcare system in a GP drought due to an artificially-imposed specialty brain-drain is not ethical and spits in the face of those who need the care. 

[-JAG- 5]

Is everyone forgetting the cost of an MBA for banking? That's 100k tuition (UofT) (4x what med school costs in Quebec, 2x in the prairie provinces) and 2 years (the same as FM residency) lost. If you go to an M7 program in the States (as many Canadians do, especially if they want to be competitive for elite PE firms, it's over 200k, not even counting lost income. 

[BernieMac 526]

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