Salaries of specialists adjusted for overhead expenses

[Lactic Folly]

Just a friendly reminder that this is a public thread and if I'm not mistaken, any of the posts on here (esp. on billing practices) could be quoted by media, government, etc. regardless of original context/intent/accuracy.

[GrouchoMarx]

On 3/9/2018 at 9:23 PM, 1D7 said:

As sketchy as looking at the JVP is for fluid assessment, it's 7000x as useful as knowing whatever histology bullcrap they used to teach.

preclinical pathology teaching is theoretical.

actual pathology practice aka diagnosing biopsies and resections is essential knowledge for anyone who deals with patients that have cancer. 

does it have more practical use than the jvp? it depends on your field. if you go into derm, or any form of oncology, id wager yes, it does. imo the jvp is of primarily theoretical use in modern medical practice.

the fact that there are residents out there who are still unaware that pathologists actually look at slides and dont just put everything into a black box machine is an indictment of the poor state of modern medical education.

[GrouchoMarx]

On 3/18/2018 at 5:54 AM, Lactic Folly said:

Just a friendly reminder that this is a public thread and if I'm not mistaken, any of the posts on here (esp. on billing practices) could be quoted by media, government, etc. regardless of original context/intent/accuracy.

THIS IS IMPORTANT.

should the mods edit the numbers in the other posts? 

it is not fiction that certain fields are being targeted for cuts based on anonymous forum posts.

the only solution is to move the conversation to a place where we are all identified by real name. i will never join such a forum, but if you want to have that discussion youd best do it there.

 

[Lactic Folly]

Don't know if mods will edit, but certainly the posters can.

Discussion of billing methods affects all fields and may unjustifiably adversely affect perception of physicians and their contributions to healthcare, especially as negotiations are ongoing.

While it's nice to share different perspectives, please consider keeping anything you might not want to see quoted publicly to private messaging.

[rmorelan]

30 minutes ago, Lactic Folly said:

Don't know if mods will edit, but certainly the posters can.

Discussion of billing methods affects all fields and may unjustifiably adversely affect perception of physicians and their contributions to healthcare, especially as negotiations are ongoing.

While it's nice to share different perspectives, please consider keeping anything you might not want to see quoted publicly to private messaging.

gah it is so hard with this sort of stuff - I mean people use the board for career planning and income is a part of that, but on the other hand there negative effects of people always presenting what they believe to be the best possible scenarios for maximizing income - which if nothing else immediately increases the cases that scenario will simply not work shortly (as the governments responses are continuing to show). There is a reason the old school doctor types will answer the question of how much they make with the simple response "enough" and move on. Professionals are low key about that sort of thing. They also know that doing something solely for the sake of money ultimately tends to backfire in practical ways. Some balance would be nice between all out money at all cost and serving the public well.

and some of what is posted as well is simply over stated, or some form of extreme one off where someone is maximizing to the point of silliness (great you earn X by working 90 hours a week for weeks on end - ok you are working two full time jobs so of course you are making good money. You have no time or energy left to actually do anything with it, but you will in fact earn it). Plus you probably be 30-35 by the time you are earning etc. Your priorities with what to do with money in general probably will change a bit by then ha  

as for editing things I will have to look it over - and as always keep it civilized here. Personal attacks over money almost no one here is actually even earning yet is particularly bad taste. 

[brady23]

Is there an accurate source that specifies overhead for different specialties?

For example, I know overhead is 30% for FM usually, and 35-40% for ophto and endocrine, but what about others?

I know some have NO overhead, while some have low overhead, but it'd be nice to find a source that can differentiate between the two.

[Aconitase]

28 minutes ago, brady23 said:

Is there an accurate source that specifies overhead for different specialties?

For example, I know overhead is 30% for FM usually, and 35-40% for ophto and endocrine, but what about others?

I know some have NO overhead, while some have low overhead, but it'd be nice to find a source that can differentiate between the two.

There isn’t a source bc it’s so variable. Depends on office space size, number of secretaries, EMR, how many docs sharing etc. 

 

A good old starting point is the CMAJ classifieds. People are hiring GPS and GIMs to work in their clinics for about 30 percent overhead. 

[internalmedicine]

Anyone know why Endocrinology has such high overhead costs? 35-40% seems high for a subspecialty that doesn't require a lot of equipments/ have procedures. Only thing I can think of is having diabetes nurses / educators on the team? 

[youngmoneycrops]

FYI

[youngmoneycrops]

Continued ...

[humhum]

@youngmoneycrops

Where is this from?

[humhum]

On 3/19/2018 at 0:45 PM, GrouchoMarx said:

THIS IS IMPORTANT.

should the mods edit the numbers in the other posts? 

it is not fiction that certain fields are being targeted for cuts based on anonymous forum posts.

the only solution is to move the conversation to a place where we are all identified by real name. i will never join such a forum, but if you want to have that discussion youd best do it there.

 

 

On 3/19/2018 at 4:46 PM, Lactic Folly said:

Don't know if mods will edit, but certainly the posters can.

Discussion of billing methods affects all fields and may unjustifiably adversely affect perception of physicians and their contributions to healthcare, especially as negotiations are ongoing.

While it's nice to share different perspectives, please consider keeping anything you might not want to see quoted publicly to private messaging.

Which top calibre national or local paper will quote any of us here, and spin a story that will create a critical mass to push the negotiation one way or another? I guess they will say something along the lines: " An anonymous physician posting online under the moniker "humhum", whom can be unquestionably trusted to be held in the highest esteem in the medical community according to some sources, has said "[down with] physician [cuts]!", which are fighting words we interpret as an imminent national physician strike."

Anything we say here will not even make it to the footprint of page 10 of Metro News Sunday Edition.

 

 

[humhum]

On 3/19/2018 at 6:16 PM, rmorelan said:

gah it is so hard with this sort of stuff - I mean people use the board for career planning and income is a part of that, but on the other hand there negative effects of people always presenting what they believe to be the best possible scenarios for maximizing income - which if nothing else immediately increases the cases that scenario will simply not work shortly (as the governments responses are continuing to show). There is a reason the old school doctor types will answer the question of how much they make with the simple response "enough" and move on. Professionals are low key about that sort of thing. They also know that doing something solely for the sake of money ultimately tends to backfire in practical ways. Some balance would be nice between all out money at all cost and serving the public well.

I'm sorry if I'm going to come across as always being contrarian to your points, but your raise good ones, and I think it makes for good discussion.

The whole low-key and furtiveness of physician earnings is exactly why we are in this position in the first place. If practice compensation was less nebulous and more transparent nationally, then we probably wouldn't have allowed the large gaps emerge in the first place.

In medical school, it was so odd to spend 80-100 hours a week, week after week with physicians across all specialties, and not once the topic of compensation quantity comes up. Using the F-word and making sexist comments are far less taboo than talking about how much your preceptor is making.

But this conversation matters, and it should be talked about. First reason is what I mentioned earlier: medical students are mostly ignorant how much each specialty pays and have no realistic sense of what compensation they can expect relative to the cognitive, physical, and emotional demands of a specialty. Not once were we taught that you can actually look up fee codes and fee schedules for every procedure and type of visit for each specialty for many provinces. This is as important as knowing as anything else we do in medicine. When you have the knowledge accessible then you can start asking questions of people who are doing the work, and also ask yourself tough questions, and have a good compass to align your future goals with your personal values.

The second benefit of opening public conversations about physician pay is to educate medical students that physicians are paid fucking huge salaries, and start the dialogue about why society has decided to reward us so much, and keep that in mind as we fight to protect what we feel is our due. We can quibble about why specialty X gets paid more than Y, but the reality is that the lowest paid of physicians makes shit ton more than the next highest paid professional. Anything we can say about unjustified compensation gaps among specialists, a PhD Medical Physicists can say about a family doctor, as he/she earns 1/3rd of a an average GP's salary, and has done nearly twice as long of a training. Or take lawyers. A GP in their 2nd year of practice makes more than the average lawyer in Canada with 10+ years of practice. The average GP's salary at $200,000 is higher than salary of the second tier executive at most mid-sized engineering companies in Canada, and these executives don't make it there well in their 40s. To say nothing of the fact that our jobs are far more secure than any other professionals.

My classmates love to regurgitate things like "if I wanted to make money, I'd go into business", or "physicians are upper middle-class".  These are among the most ignorant things I have heard anyone say about realities of financial compensation. It is extremely hard to break $120,000+ annual earnings for other professionals after decades of experience, many of whom have PhDs galore, while GPs might complain about making $200,000 in their late 20s (that is already top 1% in Canada). I think coming from this angle of ignorance does more harm to our image in public's eye than anything else.

 

 

 

[Aconitase]

6 hours ago, humhum said:

I'm sorry if I'm going to come across as always being contrarian to your points, but your raise good ones, and I think it makes for good discussion.

The whole low-key and furtiveness of physician earnings is exactly why we are in this position in the first place. If practice compensation was less nebulous and more transparent nationally, then we probably wouldn't have allowed the large gaps emerge in the first place.

In medical school, it was so odd to spend 80-100 hours a week, week after week with physicians across all specialties, and not once the topic of compensation quantity comes up. Using the F-word and making sexist comments are far less taboo than talking about how much your preceptor is making.

But this conversation matters, and it should be talked about. First reason is what I mentioned earlier: medical students are mostly ignorant how much each specialty pays and have no realistic sense of what compensation they can expect relative to the cognitive, physical, and emotional demands of a specialty. Not once were we taught that you can actually look up fee codes and fee schedules for every procedure and type of visit for each specialty for many provinces. This is as important as knowing as anything else we do in medicine. When you have the knowledge accessible then you can start asking questions of people who are doing the work, and also ask yourself tough questions, and have a good compass to align your future goals with your personal values.

The second benefit of opening public conversations about physician pay is to educate medical students that physicians are paid fucking huge salaries, and start the dialogue about why society has decided to reward us so much, and keep that in mind as we fight to protect what we feel is our due. We can quibble about why specialty X gets paid more than Y, but the reality is that the lowest paid of physicians makes shit ton more than the next highest paid professional. Anything we can say about unjustified compensation gaps among specialists, a PhD Medical Physicists can say about a family doctor, as he/she earns 1/3rd of a an average GP's salary, and has done nearly twice as long of a training. Or take lawyers. A GP in their 2nd year of practice makes more than the average lawyer in Canada with 10+ years of practice. The average GP's salary at $200,000 is higher than salary of the second tier executive at most mid-sized engineering companies in Canada, and these executives don't make it there well in their 40s. To say nothing of the fact that our jobs are far more secure than any other professionals.

My classmates love to regurgitate things like "if I wanted to make money, I'd go into business", or "physicians are upper middle-class".  These are among the most ignorant things I have heard anyone say about realities of financial compensation. It is extremely hard to break $120,000+ annual earnings for other professionals after decades of experience, many of whom have PhDs galore, while GPs might complain about making $200,000 in their late 20s (that is already top 1% in Canada). I think coming from this angle of ignorance does more harm to our image in public's eye than anything else.

 

 

 

I agree with the general sentiment of what you have said here. 

 

Med school is annoying like that - it’s almost like money is a bad word and the class has an almost echo chamber effect of thinking doctors are upper middle class and should never think about money. They also feel like all other jobs make way more money and that they should have done that if they wanted money.

 

Physicians are paid well for what they do. Some are paid extremely well (ie rads) some are paid moderately well (ie most others) and some are just well (ie psych). It’s the truth. 

 

This forum is a good outlet for young docs to see the reality of what their compensation will be like. Yes, they can google it and see rads makes 350k a year But we all know this number is artificially lower since academic docc make less and some people work part time as they are older etc  it won’t highlight what is the truth - rads in a large community hospital don’t pay over head and make 750k+ a year.  I think it’s good to have this forum to help people realize this and make the right career choices.

 

Howevwr I would point out they most docs aren’t paid a salary per say. We don’t get benefits or pension or vacation or any of that good stuff. Also some specialists pay large overhead  

 

the other point is that practice setting is relevant. Hospital based docs pay little to no overhead versus clinic based ones. Larger community hospitals (ie GTA) make the most whereas academic docs make less. 

 

 

 

 

[brady23]

That overhead image was very helpful thanks!

So I guess every medical specialty has overhead in one way or another? (I did some calculations based on the image above, and the overhead tends to be around the same for majority of specialties which is around 30% plus or minus 5%)

Of note:

Radiation Oncology: 9%
Anesthesia: 14%
Emergency: 17%
Psychiatry: 23%
Internal/Occupational: 28% (a little surprised about this)
Ophthalmology/Dermatology: 40%

 

[rmorelan]

14 hours ago, humhum said:

I'm sorry if I'm going to come across as always being contrarian to your points, but your raise good ones, and I think it makes for good discussion.

The whole low-key and furtiveness of physician earnings is exactly why we are in this position in the first place. If practice compensation was less nebulous and more transparent nationally, then we probably wouldn't have allowed the large gaps emerge in the first place.

In medical school, it was so odd to spend 80-100 hours a week, week after week with physicians across all specialties, and not once the topic of compensation quantity comes up. Using the F-word and making sexist comments are far less taboo than talking about how much your preceptor is making.

But this conversation matters, and it should be talked about. First reason is what I mentioned earlier: medical students are mostly ignorant how much each specialty pays and have no realistic sense of what compensation they can expect relative to the cognitive, physical, and emotional demands of a specialty. Not once were we taught that you can actually look up fee codes and fee schedules for every procedure and type of visit for each specialty for many provinces. This is as important as knowing as anything else we do in medicine. When you have the knowledge accessible then you can start asking questions of people who are doing the work, and also ask yourself tough questions, and have a good compass to align your future goals with your personal values.

The second benefit of opening public conversations about physician pay is to educate medical students that physicians are paid fucking huge salaries, and start the dialogue about why society has decided to reward us so much, and keep that in mind as we fight to protect what we feel is our due. We can quibble about why specialty X gets paid more than Y, but the reality is that the lowest paid of physicians makes shit ton more than the next highest paid professional. Anything we can say about unjustified compensation gaps among specialists, a PhD Medical Physicists can say about a family doctor, as he/she earns 1/3rd of a an average GP's salary, and has done nearly twice as long of a training. Or take lawyers. A GP in their 2nd year of practice makes more than the average lawyer in Canada with 10+ years of practice. The average GP's salary at $200,000 is higher than salary of the second tier executive at most mid-sized engineering companies in Canada, and these executives don't make it there well in their 40s. To say nothing of the fact that our jobs are far more secure than any other professionals.

My classmates love to regurgitate things like "if I wanted to make money, I'd go into business", or "physicians are upper middle-class".  These are among the most ignorant things I have heard anyone say about realities of financial compensation. It is extremely hard to break $120,000+ annual earnings for other professionals after decades of experience, many of whom have PhDs galore, while GPs might complain about making $200,000 in their late 20s (that is already top 1% in Canada). I think coming from this angle of ignorance does more harm to our image in public's eye than anything else.

 

 

 

Oh I am 100% not trying to stop the discussion - or ha somehow opposed to alternative views. Plus I as well think there isn't enough discussion about how and what we get paid (and on a personal note - what we do with the money we do earn so we aren't taken advantage of)

Entitlement is always a problem - and the consequence is ultimately punishment. It is hard to fight against as we often live our lives in isolation. We have succeeded in reach high incomes but victory breeds weakness and we have to figure out how to continue to be worth what we are commanding (and shouting out how "simple" it is to access high income is a great way to just make people want to take it away from you). If  we don't work to be worth what we charge, we will both loss the income and the right to practice the way we want to - and patients will very likely suffer. Don't forget the median household income is about 72K, the average salaried job is about 51K. There are a lot of people out there earning a lot less but have had to work just as hard.  

And that is the issue with just reporting incomes in isolation, creating a false understanding of what "average" really is (the media constantly quote max as average, gross as net and so on), every presenting anything as easy money. Even the targeted "overpaid" people work their asses off (has anyone actually shadowed an cardio interventionalist - if so you know exactly the kind of work and hours they are doing). Those studies rads are reading - don't twitch because you have exactly one chance to read that study, one chance to get it right and if you miss something subtle it can be lethal easily - it is terrifying actually. 

 

[psychiatry2017]

17 hours ago, youngmoneycrops said:

FYI

I am not sure if the salary of P&MR specialists are accurate? Perhaps that they have private income that they don't report. 

For dermatology, the overhead is 40%, because a lot of private office practice (i.e: you hire your own secretary+ office space+ equipment), it's like a business. 

I am not sure if internists working primarily in hospitals, pay 30% overhead, from what I understand, they pay little overhead, as the secretary is employed by the hospital, office is hospital property.

@ Aconitase, you are right about the setting of your practice. Academic internists make 40% less than community internists, however, they do have senior residents doing evening calls+ weekend calls for them, and not get waken up for a page for septic fever at 3 am in the night. Academic lifestyle can be very good, if you trust your residents and decide to be more behind the scene and <<hands-off>>. In Community, no one works with you, you are the one doing the 1 am consult on delirium, getting paged at anytime about the the patients in ward, etc...

[1D7]

17 hours ago, humhum said:

The second benefit of opening public conversations about physician pay is to educate medical students that physicians are paid fucking huge salaries, and start the dialogue about why society has decided to reward us so much, and keep that in mind as we fight to protect what we feel is our due. We can quibble about why specialty X gets paid more than Y, but the reality is that the lowest paid of physicians makes shit ton more than the next highest paid professional. Anything we can say about unjustified compensation gaps among specialists, a PhD Medical Physicists can say about a family doctor, as he/she earns 1/3rd of a an average GP's salary, and has done nearly twice as long of a training. Or take lawyers. A GP in their 2nd year of practice makes more than the average lawyer in Canada with 10+ years of practice. The average GP's salary at $200,000 is higher than salary of the second tier executive at most mid-sized engineering companies in Canada, and these executives don't make it there well in their 40s. To say nothing of the fact that our jobs are far more secure than any other professionals.

My classmates love to regurgitate things like "if I wanted to make money, I'd go into business", or "physicians are upper middle-class".  These are among the most ignorant things I have heard anyone say about realities of financial compensation. It is extremely hard to break $120,000+ annual earnings for other professionals after decades of experience, many of whom have PhDs galore, while GPs might complain about making $200,000 in their late 20s (that is already top 1% in Canada). I think coming from this angle of ignorance does more harm to our image in public's eye than anything else.

Have you worked another high level white collar job before starting medicine or know many people in high level white collar professions? Medicine does not pay exceptionally well for the effort put in, except for a select few specialties. FM certainly does not.

I know about a dozen people who have graduated from compsci/software eng programs straight from undergrad into positions making 110-125k/year and are now close to 150k/year 4 years out from undergrad. Most of my close friends from undergrad graduated middle of the pack from a prestigious Canadian business program and about half have hit the 100k mark 4 years after graduation without having gone into IB. The few of my friends who were able to go straight to IB are mostly in the mid-upper 100k/year range now.

Do you know how long it would take for an average FM to catch up to someone working in Silicon Valley? At the end of 4 years of medical school, medical students are ~150,000 in debt and behind ~500,000 in relative earnings, a total of 650,000. After a 2 year residency, about 850,000 - 1,000,000 behind in total (with all your money going towards paying off your debt while their money works for them via investments). Assuming their careers stagnate and they stop investing, it could take 10-15 years for a staff FM doc to 'catch up'. Realistically closer to 20 years when you account for investment/retirement funds.

Sure, you might say my acquaintances working in Silicon Valley or IB were not average students in their undergrad programs: I would agree completely. However it's unlikely you or most of the posters here were average students. Fact is that physicians are well paid, but the numbers are within the realm that hardworking, smart white collar professionals should be making. The one thing medicine does have over these other careers however, is the stability.

[indefatigable]

2 hours ago, 1D7 said:

Have you worked another high level white collar job before starting medicine or know many people in high level white collar professions? Medicine does not pay exceptionally well for the effort put in, except for a select few specialties. FM certainly does not.

I know about a dozen people who have graduated from compsci/software eng programs straight from undergrad into positions making 110-125k/year and are now close to 150k/year 4 years out from undergrad. Most of my close friends from undergrad graduated middle of the pack from a prestigious Canadian business program and about half have hit the 100k mark 4 years after graduation without having gone into IB. The few of my friends who were able to go straight to IB are mostly in the mid-upper 100k/year range now.

Do you know how long it would take for an average FM to catch up to someone working in Silicon Valley? At the end of 4 years of medical school, medical students are ~150,000 in debt and behind ~500,000 in relative earnings, a total of 650,000. After a 2 year residency, about 850,000 - 1,000,000 behind in total (with all your money going towards paying off your debt while their money works for them via investments). Assuming their careers stagnate and they stop investing, it could take 10-15 years for a staff FM doc to 'catch up'. Realistically closer to 20 years when you account for investment/retirement funds.

Sure, you might say my acquaintances working in Silicon Valley or IB were not average students in their undergrad programs: I would agree completely. However it's unlikely you or most of the posters here were average students. Fact is that physicians are well paid, but the numbers are within the realm that hardworking, smart white collar professionals should be making. The one thing medicine does have over these other careers however, is the stability.

Agree with much of this.. Except - the hidden factor of cost of living.  San Jose and the Bay Area are extremely expensive places to live in - outside of Vancouver and TO, Canada is much more affordable.  So looking at numbers only doesn't fully account for purchasing power parity - it's another reasons that perception of physician pay may vary in different parts of the country, and why relatively speaking it's much better to work in a smaller community since one is paid the same but real estate costs much less.  But for sure in the Bay Area, FPs feel fairly underpaid and I heard of many residents from competitive program even switching to startups.  

Edit: From this article
"'I never thought I would leave medicine,' said Eichstadt, who now works at Grand Rounds Health, a San Francisco-based startup that helps patients access second opinions from top medical experts online. 'But there's such a rich opportunity at companies here.'
Eichstadt graduated from Stanford and pursued several years of residency, specializing in plastic and reconstructive surgery.

I realized that the system isn't designed for doctors to make the real change you would like to for the patient.' Eichstadt concluded that she could make a bigger impact elsewhere."

[A-Stark]

3 hours ago, psychiatry2017 said:

I am not sure if internists working primarily in hospitals, pay 30% overhead, from what I understand, they pay little overhead, as the secretary is employed by the hospital, office is hospital property.

@ Aconitase, you are right about the setting of your practice. Academic internists make 40% less than community internists, however, they do have senior residents doing evening calls+ weekend calls for them, and not get waken up for a page for septic fever at 3 am in the night. Academic lifestyle can be very good, if you trust your residents and decide to be more behind the scene and <<hands-off>>. In Community, no one works with you, you are the one doing the 1 am consult on delirium, getting paged at anytime about the the patients in ward, etc...

Internists aren't usually working hospital-based salaried jobs. They might have an office connected to the hospital, but there is often associated rent or overhead expenses. Same goes for secretaries, and leaving that to a hospital or RHA means you have no control over who gets hired. 

I suppose the academic environment can be good, but the politics can be *highly* toxic. But nurses aren't calling staff in the middle of the night for the kinds of nonsense they dump on R1s. I almost always sleep through the night on staff locums. Emerg holds consults for you until the morning too. 

1 hour ago, 1D7 said:

Have you worked another high level white collar job before starting medicine or know many people in high level white collar professions? Medicine does not pay exceptionally well for the effort put in, except for a select few specialties. FM certainly does not.

I know about a dozen people who have graduated from compsci/software eng programs straight from undergrad into positions making 110-125k/year and are now close to 150k/year 4 years out from undergrad. Most of my close friends from undergrad graduated middle of the pack from a prestigious Canadian business program and about half have hit the 100k mark 4 years after graduation without having gone into IB. The few of my friends who were able to go straight to IB are mostly in the mid-upper 100k/year range now.

Do you know how long it would take for an average FM to catch up to someone working in Silicon Valley? At the end of 4 years of medical school, medical students are ~150,000 in debt and behind ~500,000 in relative earnings, a total of 650,000. After a 2 year residency, about 850,000 - 1,000,000 behind in total (with all your money going towards paying off your debt while their money works for them via investments). Assuming their careers stagnate and they stop investing, it could take 10-15 years for a staff FM doc to 'catch up'. Realistically closer to 20 years when you account for investment/retirement funds.

Sure, you might say my acquaintances working in Silicon Valley or IB were not average students in their undergrad programs: I would agree completely. However it's unlikely you or most of the posters here were average students. Fact is that physicians are well paid, but the numbers are within the realm that hardworking, smart white collar professionals should be making. The one thing medicine does have over these other careers however, is the stability.

It all depends on how you spend and save. One staff was telling me the other day all the details of how he's organized his finances. He lives quite comfortably but isn't at all interested in extravagances. And he's put away close $2m in about 7 years despite having a salaried job at the lower end of scale. 

I suppose it all comes down to what you enjoy. I like working with people and acuity and doing some variably invasive procedures. I guess being a banker or sitting around at a computer all day can pay the bills pretty well but it's boring. Money is important but after a certain point we're pretty lucky when we actually like (or even sometimes love!) what we do. I guess for some people that means wearing a suit everyday and working in an office. Sounds like hell to me!

[psychiatry2017]

6 minutes ago, A-Stark said:

Internists aren't usually working hospital-based salaried jobs. They might have an office connected to the hospital, but there is often associated rent or overhead expenses. Same goes for secretaries, and leaving that to a hospital or RHA means you have no control over who gets hired. 

I suppose the academic environment can be good, but the politics can be *highly* toxic. But nurses aren't calling staff in the middle of the night for the kinds of nonsense they dump on R1s. I almost always sleep through the night on staff locums. Emerg holds consults for you until the morning too. 

It all depends on how you spend and save. One staff was telling me the other day all the details of how he's organized his finances. He lives quite comfortably but isn't at all interested in extravagances. And he's put away close $2m in about 7 years despite having a salaried job at the lower end of scale. 

I suppose it all comes down to what you enjoy. I like working with people and acuity and doing some variably invasive procedures. I guess being a banker or sitting around at a computer all day can pay the bills pretty well but it's boring. Money is important but after a certain point we're pretty lucky when we actually like (or even sometimes love!) what we do. I guess for some people that means wearing a suit everyday and working in an office. Sounds like hell to me!

With the new federal tax law, there is no more 24% rate of small-middle companies anymore, we will be paying 50% or more of taxes as future staff physicians. Better learn how to save money and invest early! As the law has been approved, it will never go back, unless history could prove us wrong lol

[A-Stark]

What do you mean? You still qualify for the small business tax rate for net business income under $500,000. 

[humhum]

On 3/21/2018 at 5:15 PM, 1D7 said:

Have you worked another high level white collar job before starting medicine or know many people in high level white collar professions? Medicine does not pay exceptionally well for the effort put in, except for a select few specialties. FM certainly does not.

Yes. I had two different long-term careers in two different industrial sectors, and have seen the careers trajectories of dozens of colleagues in wide-ranging fields as law, engineering, consulting, technology start ups, etc, with employments in multiple provinces, and internationally, including silicon valley . So yes, I have, and my conclusions are based on all of this.

[humhum]

On 3/21/2018 at 5:15 PM, 1D7 said:

I know about a dozen people who have graduated from compsci/software eng programs straight from undergrad into positions making 110-125k/year and are now close to 150k/year 4 years out from undergrad. Most of my close friends from undergrad graduated middle of the pack from a prestigious Canadian business program and about half have hit the 100k mark 4 years after graduation without having gone into IB. The few of my friends who were able to go straight to IB are mostly in the mid-upper 100k/year range now.

Do you know how long it would take for an average FM to catch up to someone working in Silicon Valley? At the end of 4 years of medical school, medical students are ~150,000 in debt and behind ~500,000 in relative earnings, a total of 650,000. After a 2 year residency, about 850,000 - 1,000,000 behind in total (with all your money going towards paying off your debt while their money works for them via investments). Assuming their careers stagnate and they stop investing, it could take 10-15 years for a staff FM doc to 'catch up'. Realistically closer to 20 years when you account for investment/retirement funds.

Sure, you might say my acquaintances working in Silicon Valley or IB were not average students in their undergrad programs: I would agree completely. However it's unlikely you or most of the posters here were average students. Fact is that physicians are well paid, but the numbers are within the realm that hardworking, smart white collar professionals should be making. The one thing medicine does have over these other careers however, is the stability.

It always confuses me the outward glamour that medical students think people in Silicon Valley have. I worked in the Silicon Valley industry specifically for many years, and let me tell you, it is shit work compared to day in the clinic. You may think 150K/year is good income, except either you are worked to death doing the most meaningless repetitive tasks like debugging the latest issue of a crappy app that will be obsolete in 6 months, or you are constantly living with the threat of getting laid off in the umber-competetive industry that is basically defined by "disruption" and permanent state of flux and transience , or you are paying most of your income for housing and still commuting a good chunk of your waking hours. You probably will see your engineer friend get hired out of school by Tesla (oooooh), and think that now he is an object of envy. Let me tell, I will not trade a PGY1 year for being an engineer at any company in Silicon Valley. The competitiveness in the workplace is brutal, and your employers are not constrained by any ethical values when it comes to doing WHATEVER it takes to polish their quarterly earnings. You do that for 15 years, you will still be at best a middle class earner, and look back at your professional life being basically defined as nothing but having been a gadget-maker.

And you have to remember, you are now comparing a completely different market to your employment opportunities in Canada. The earnings of the tech sector in Canada compared to states is a fraction of the numbers you are quoting above. We can start talking about how much orthopaedic surgeons, bariatric surgeons, cosmetic surgeons, etc. make in the states, and Silicon Valley engineers have nothing over these money-making factories in the private medical world..

The real high-earners in the tech world are the successful start ups, or the top-tier executives. In the former, you might be impressed by the survival-bias stories, but the reality is that vast vast vast majority of start ups fail miserably, with huge losses. In the latter, you can set your sights on becoming CEO, but to get there as a bottom-feeding engineer, you have to pass through the Valley of Death. That is the valley of first having to become a middle-manager. Do you know who is the first to get laid off in any "restructuring"? Hordes upon hordes of middle managers. Again, following the careers of my colleagues now that we are nearly 14 years out of comp sci degrees, for many, their life has basically one lay off after another. They are not living on the streets by any stretch, but far from the rosy picture you might extrapolate from the earnings of starting engineers in one isolated area in California.

[indefatigable]

5 hours ago, humhum said:

It always confuses me the outward glamour that medical students think people in Silicon Valley have. I worked in the Silicon Valley industry specifically for many years, and let me tell you, it is shit work compared to day in the clinic. You may think 150K/year is good income, except either you are worked to death doing the most meaningless repetitive tasks like debugging the latest issue of a crappy app that will be obsolete in 6 months, or you are constantly living with the threat of getting laid off in the umber-competetive industry that is basically defined by "disruption" and permanent state of flux and transience , or you are paying most of your income for housing and still commuting a good chunk of your waking hours. You probably will see your engineer friend get hired out of school by Tesla (oooooh), and think that now he is an object of envy. Let me tell, I will not trade a PGY1 year for being an engineer at any company in Silicon Valley. The competitiveness in the workplace is brutal, and your employers are not constrained by any ethical values when it comes to doing WHATEVER it takes to polish their quarterly earnings. You do that for 15 years, you will still be poor, and look back at your professional life being basically defined as nothing but having been a gadget-maker.

And you have to remember, you are now comparing a completely different market to your employment opportunities in Canada. The earnings of the tech sector in Canada compared to states is a fraction of the numbers you are quoting above. We can start talking about how much orthopaedic surgeons, bariatric surgeons, cosmetic surgeons, etc. make in the states, and Silicon Valley engineers have nothing over these money-making factories in the private medical world..

I agree with almost all of this .. except senior engineers in management especially, can certainly outearn physicians in the Bay Area, since management will get a lot of stock options, even more so if they got in early.

It's a crush, with ageism, and companies are always looking to cut on labour costs - willing to use H1B visas to sponsor employees from asia especially.  They essentially lose their right to stay if they lose their job.  

Even though the starting salary at a place like Google is now ~175K/year, the median home price in Mountain View ~2 Mill, so the money really doesn't go that far.

The low-income cut-off in SF at ~100K/year (family of four), which is higher than the median income in most places in Canada. 

Middle and front-office (especially) IB quants do well too (better than software engineers) - but nothing compared to front-office IB in a place like NY  Not to mention the hyper-competitiveness of getting a job and the lifestyle.  And IB is all about the bonus.

Plus, as you point out, unless the careers really excite you, what's the point?