Author Topic: Any MDs here?  (Read 3231 times)

poetdereves

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Any MDs here?
« on: December 31, 2017, 06:40:34 PM »
So, I have been working in the medical field as and EMT for a while and I am finishing nursing school with my BSN soon and will continue working at the hospital where I am currently employed. It is an academic medical center, and I have really been thinking that I would love to continue school and possibly become an MD. I have met all prerequisites for school, but would need to take the MCAT before applying. The doctors I work with highly recommend me and many of them have gone on the same path I am looking at. (9 of the ER doctors were previous RNs). They all suggest it was the best decision they have made, but I am already close to thirty, so I would be near 40 by the time I finished med school and my residency. They some of the NPs there (including a couple spouses of MDs) also say they wish they would have gone on to med school to gain more autonomy and training than they got being NPs. It would push my FI date back by a lot, but I also can imagine being in a more fulfilling position if I would continue school, so I am not necessarily opposed to that.

What are some things I need to consider? Have any of you had children while in med school? Are you still able to be as good of a parent as you want to be? Were you able to pay your loans quickly? Was you salary high enough to make those loans not seem so enormous? I just really want to consider my options and get advice from some financially savvy and family oriented physicians who have gone through the process.

ysette9

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Re: Any MDs here?
« Reply #1 on: December 31, 2017, 07:09:52 PM »
Have you checked out the White Coat Investor or Physician on FIRE blogs? They discuss the unique situation of the massive student debt, earning little, and then earning a crap-ton that is unique to doctors. You may get something out of those posts.

Abe

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Re: Any MDs here?
« Reply #2 on: January 01, 2018, 04:02:33 AM »
Hi, I'm a surgeon and am doing a fellowship right now. My wife is a family physician in practice for 4 years. We waited until she was done with residency and had two years of experience before having a kid. We have friends who went through med school and/or residency with 1-2 kids. You are right that you're looking at nearly at 8 years of training depending on what specialty you choose. I'd say it's easily another 10 years after that before you can consider retiring, depending on your loans and how frugal you stay. The salary is high, and so are taxes. However, if you live a resident's lifestyle on an attending salary, the loans are manageable. We live in California, with very high rent, and are doing fine with saving for retirement. Think of it as a house mortgage that gives you skill and salary rather than shelter. Most physicians don't retire early because they either don't want to, or mis-manage their wealth by living extravagantly. It isn't because of loans.

My friends with kids (and I) feel like we had to rely heavily on our spouses' infinite patience, because time with the children was limited (especially when they sleep so early!). Compared to residency, medical school is a cakewalk. Even during my last year of residency, I didn't get to spend as much time with my son, and am making up for that now.

thingamabobs

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Re: Any MDs here?
« Reply #3 on: January 01, 2018, 09:13:27 AM »
I think being here puts you ahead of the game financially compared to probably 90-95% of other pre-Med/Med students. Looking back, its amazing that theres no instruction on how to manage loans, budgeting, saving for retirement. They always just tell student, dont worry, youll make more than enough to cover loans. But never talk about preparing for emergencies, spending less, paying loans down fast. So, going in with an mmm mindset is great!

My current spiel to students is planning on paying off loans 5 years post residency, maximizing any retirement savings options available during residency. I think paying off the loans early goes a long way to relieve the anxiety of having loans as well as feeling restricted in how you practice medicine.

Agree with reading WCI also Drwisemoney (the blow is now managed by her sister since her passing).

hops

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Re: Any MDs here?
« Reply #4 on: January 01, 2018, 09:28:40 AM »
You are right that you're looking at nearly at 8 years of training depending on what specialty you choose. I'd say it's easily another 10 years after that before you can consider retiring, depending on your loans and how frugal you stay. The salary is high, and so are taxes. However, if you live a resident's lifestyle on an attending salary, the loans are manageable. We live in California, with very high rent, and are doing fine with saving for retirement. Think of it as a house mortgage that gives you skill and salary rather than shelter. Most physicians don't retire early because they either don't want to, or mis-manage their wealth by living extravagantly. It isn't because of loans.

I agree with Abe about the loans. Disclaimer: I'm not an MD but my wife is. She's a few months away from finishing her fellowship and has been stressed about her loans for the better part of the last decade. I'd be lying if I said I don't also find her debt stressful, but she's gathering offers now for her first attending job and our worries are finally starting to fade. Even if she decides to remain in academic medicine, where the pay is lower than in private practice, she'll make enough that we should be able to knock out the loans in three to five years while living below our means.

We won't have kids until she's been an attending for a few years and our lives (financially and time-wise) are more stable. She's had an easier schedule in fellowship than she ever did during residency, but even now there are occasionally weeks when we're basically ships in the night. One of her former classmates, who was already a father upon entering school, dropped out after realizing how many milestones he'd probably miss and returned to his previous career. More of her colleagues started families in residency than in medical school, because they wanted to be more geographically settled (and earning a paycheck) first.

Moving is one of the family-oriented issues to consider. If you're already coupled, is moving (up to 2-3 times) something your SO will be OK with? Will they still be OK with it once you have kids? Money-wise, are you already carrying student loans? How much would you be willing to take out for medical school? Some cautionary tales take out huge loans to terrible schools thinking they'll end up in a lucrative specialty, only to find they can only match into a lower-paid specialty. Would you be OK with that? You've probably already considered these things but it's surprising to me that some people don't.

poetdereves

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Re: Any MDs here?
« Reply #5 on: January 01, 2018, 11:00:03 AM »
My current spiel to students is planning on paying off loans 5 years post residency, maximizing any retirement savings options available during residency. I think paying off the loans early goes a long way to relieve the anxiety of having loans as well as feeling restricted in how you practice medicine.

This would definitely be the way I would go. Luckily, at the moment, my wife makes plenty of money to sustain us while I am in school and residency. We are also comfortable with the lifestyle we have and dont really see our spending inflating with a higher income. The only thing that would beef up would be our savings.

You are right that you're looking at nearly at 8 years of training depending on what specialty you choose. I'd say it's easily another 10 years after that before you can consider retiring, depending on your loans and how frugal you stay. The salary is high, and so are taxes. However, if you live a resident's lifestyle on an attending salary, the loans are manageable. We live in California, with very high rent, and are doing fine with saving for retirement.

My friends with kids (and I) feel like we had to rely heavily on our spouses' infinite patience, because time with the children was limited (especially when they sleep so early!). Compared to residency, medical school is a cakewalk. Even during my last year of residency, I didn't get to spend as much time with my son, and am making up for that now.

My DWs infinite patience and decent income would definitely be what sustained us through the process, unless we had children before I finished. She would be about 35 ish by then, but we never imagined being that old having children.

Currently we live in a LCOL city, but matching for residency could change that. Many of the doctors here went to school and matched for residency in the same town, so theres a chance I wouldnt have to move. That would probably be ideal, but I know its not something I can bank on.


Moving is one of the family-oriented issues to consider. If you're already coupled, is moving (up to 2-3 times) something your SO will be OK with? Will they still be OK with it once you have kids? Money-wise, are you already carrying student loans? How much would you be willing to take out for medical school? Some cautionary tales take out huge loans to terrible schools thinking they'll end up in a lucrative specialty, only to find they can only match into a lower-paid specialty. Would you be OK with that? You've probably already considered these things but it's surprising to me that some people don't.

These are all things we have thought about for sure. We are ok with moving and have done so a couple times already for both her education and mine. We dont really carry any debt besides our mortgage, which would make the loans easier for us to manage, but it is also nuts to think that my education will cost us more than our home. Its all a trade off though. The things I would know and the income I could make should definitely make it all worth it.

I will check out white coat investor and the other blogs mentioned as well!

pecunia

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Re: Any MDs here?
« Reply #6 on: January 01, 2018, 11:10:01 AM »
I don't like to deal with doctors, medicine or insurance companies, but I have the highest respect for those that give their lives to saving the rest of us.  You will be more than just making money.  You will be helping us.

Good luck!

Beriberi

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Re: Any MDs here?
« Reply #7 on: January 07, 2018, 10:23:36 AM »
A few thoughts (as an MD).  Many medical schools are reluctant to accept nurses.  Maybe not fairly, but it is not a common path.  This will limit your choices.

Let's do some math on the next 10 years taking 2 different paths. I'm going to use big round numbers, and make some assumptions, but I'm pretty sure I'll get it in the ball park.  We'll assume that you finish the BSN with no loans. It doesn't really matter because it probably  effects both scenarios equally.

2018: Finish BSN, go to work as RN.
Move to Alaska (or substitute other undesirable, high need area).  Sure, not everyone wants to relocate across the country, but this is equally as disruptive as moving for medical school. 
2018-2019 Income: 100k/year,  working a 40 hour week
2020-2022 Income: 150k/year, working 80 hour week (just like you would be doing in medical school)

From Jan 2018-June 2022: Total income $550k. 
From June 2022-June 2025, keep working like a resident - 80 hour weeks will bring in big overtime RN pay. Collect another $450k
Scale back (and work like an attending physician) in June 2025-Dec 2027. Move to a location that you love, even though the pay is crap.   $200k for 2.5 years of work.

Income Jan 2018-Dec 2027: 1.2 million, no debt.


2018 Finish BSN, apply to medical school.
Apps go out in June, so spend the spring doing MCAT prep, taking test, filing applications, fall interviewing.  Cost $5k.
Work part time in 2018 in average RN market, make 30k.

2019 Accepted to medical school!  Work full time for half the year, make 30k.  Move somewhere.  Pay a lot of tuition.
2019-June 2023:  Lots and lots of medical school. No part time work allowed. Money only flows out.  Cost: 300k
From Jan 2018-June 2022: Total income -$240k

Now it's June 2022 - You match across country! Move ($5k).  Now you get a paycheck!  It's 45k/year.
June 2022-June 2025: Work 80 hours a week, total income 135k.

Yay! You're done! You get a new job as a Family Pracitioner (or Internal Med doctor, or Pediatrician).  You make $175k/year.  (Maybe 120k, maybe 300k).
June 2025- Dec 2027: Income $437k

Summary: Jan 2018-Dec 2027: 315k in debt (the interest will not be tax deductible),make $632k. 

Going forward, the physician job offers more annual income, but you've lost years of earning potential and accrued a ton of debt. Some smart mustache can figure out the compounding on the debt and the compounding on all the savings you start having when you are working as a nurse in 2018, but I'm gonna guess the difference is more than $1M.  My opinion is that medical school is rarely worth it for a late entrant, especially one that has the ability to work at a high paying job now.


donedeal511

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Re: Any MDs here?
« Reply #8 on: January 07, 2018, 02:04:08 PM »
Starting med school in August, married mid 30s with 2 kids. Some things to keep in mind.

It may be possible to work some very limited hours in med school and on the 2-3 month break between M1 and M2 .

Attend a public medical school. 30k/year vs 60k/ yr private

Moonlight during residency to increase your salary from 60k to 80+k

Choose a residency/specialty that you will be happy in but.... at an older age you will have reduced time to recoup cost so a higher earning speciality than FM/peds may be the way to go or apply broadly for primary care scholarships.

Here's my breakdown. Current PA making 150k/year

Cost to attend 35k x4 = 140k
Lost income 600k less pt work @ 40k/year = 440k
Lost income in residency 150k*4 - 80k*4=280k
Total costs = 860k round up to 1 mill given interest on loans

20 year career as physician @ 375k/year less 1 mill loss = 6.5 mill
28 year career as current PA @ 150k = 4.2 mill

Break even at about 5-6 years post residency

Granted this doesn't take into account compounding interest but those are 2 very different numbers.

Abe

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Re: Any MDs here?
« Reply #9 on: January 07, 2018, 05:21:44 PM »
Please note that you cannot moonlight during residency per ACGME rules unless your total time as resident + moonlighting is 80 hrs/week. I know that most programs prohibit moonlighting regardless.

The rest of your donedeal's advice is good.

For some first-hand experience:

I worked part-time the first two years of med school, which was public and thus quite cheap. The part-time job paid $30k/year, covering my tuition for those years. I do not think it is feasible to work part-time during the 2nd two years unless you are working ~100/hrs a week. That is especially true if you want to get into a high-paying, more competitive specialty. Some schools (including mine) prohibited paid work during those two years.

A better approach is accepting the lost income during med school + residency and making up for that by taking more call or moonlighting on weekends as an attending (which is allowed by most practices/hospitals). For example, I sometimes moonlight for 24hrs on a weekend for $2400 ($1500 after all taxes). This strategy will quickly pay for loans with much less aggravation. I have already paid my loans off, and just invest it for now.

Also note that income-based repayment may reduce the cost of loans substantially. I will be surprised if physicians going through a 4-year residency will pay the entire principal before the loan is discharged if they stay in non-profit or public sector positions. The caveat with the program is how long it will last (at least the discharging of the loans) since that part is clearly a huge give-away to rich people.


MrThatsDifferent

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Re: Any MDs here?
« Reply #10 on: January 08, 2018, 12:33:54 AM »
A few thoughts (as an MD).  Many medical schools are reluctant to accept nurses.  Maybe not fairly, but it is not a common path.  This will limit your choices.

Let's do some math on the next 10 years taking 2 different paths. I'm going to use big round numbers, and make some assumptions, but I'm pretty sure I'll get it in the ball park.  We'll assume that you finish the BSN with no loans. It doesn't really matter because it probably  effects both scenarios equally.

2018: Finish BSN, go to work as RN.
Move to Alaska (or substitute other undesirable, high need area).  Sure, not everyone wants to relocate across the country, but this is equally as disruptive as moving for medical school. 
2018-2019 Income: 100k/year,  working a 40 hour week
2020-2022 Income: 150k/year, working 80 hour week (just like you would be doing in medical school)

From Jan 2018-June 2022: Total income $550k. 
From June 2022-June 2025, keep working like a resident - 80 hour weeks will bring in big overtime RN pay. Collect another $450k
Scale back (and work like an attending physician) in June 2025-Dec 2027. Move to a location that you love, even though the pay is crap.   $200k for 2.5 years of work.

Income Jan 2018-Dec 2027: 1.2 million, no debt.


2018 Finish BSN, apply to medical school.
Apps go out in June, so spend the spring doing MCAT prep, taking test, filing applications, fall interviewing.  Cost $5k.
Work part time in 2018 in average RN market, make 30k.

2019 Accepted to medical school!  Work full time for half the year, make 30k.  Move somewhere.  Pay a lot of tuition.
2019-June 2023:  Lots and lots of medical school. No part time work allowed. Money only flows out.  Cost: 300k
From Jan 2018-June 2022: Total income -$240k

Now it's June 2022 - You match across country! Move ($5k).  Now you get a paycheck!  It's 45k/year.
June 2022-June 2025: Work 80 hours a week, total income 135k.

Yay! You're done! You get a new job as a Family Pracitioner (or Internal Med doctor, or Pediatrician).  You make $175k/year.  (Maybe 120k, maybe 300k).
June 2025- Dec 2027: Income $437k

Summary: Jan 2018-Dec 2027: 315k in debt (the interest will not be tax deductible),make $632k. 

Going forward, the physician job offers more annual income, but you've lost years of earning potential and accrued a ton of debt. Some smart mustache can figure out the compounding on the debt and the compounding on all the savings you start having when you are working as a nurse in 2018, but I'm gonna guess the difference is more than $1M.  My opinion is that medical school is rarely worth it for a late entrant, especially one that has the ability to work at a high paying job now.

This is bloody brilliant.

happy

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Re: Any MDs here?
« Reply #11 on: January 08, 2018, 04:16:45 AM »
As an Australian physician ( hence lacking some local context knowledge), I agree with BeriBeri.
If you are serious about FIRE, optimise your nursing position, work hard, save hard. There are some nursing positions that pay well, and unlike medicine overtime is paid and paid more. You'll come out ahead and probably less stressed.  MD is only really worth it if you plan to keep working on a longer timeframe, ie>10 years.

poetdereves

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Re: Any MDs here?
« Reply #12 on: January 08, 2018, 08:34:18 AM »
A few thoughts (as an MD).  Many medical schools are reluctant to accept nurses.  Maybe not fairly, but it is not a common path.  This will limit your choices.

Going forward, the physician job offers more annual income, but you've lost years of earning potential and accrued a ton of debt. Some smart mustache can figure out the compounding on the debt and the compounding on all the savings you start having when you are working as a nurse in 2018, but I'm gonna guess the difference is more than $1M.  My opinion is that medical school is rarely worth it for a late entrant, especially one that has the ability to work at a high paying job now.

I appreciate the time you took to break the math down! I know its all ball park figures, but coming from someone with a bit of experience it all seems close to me. Since I havent started as an RN yet I forget the earning potential I have if I am willing to work where they pay well and work as many hours as I would be putting into med school. It changes my net worth by a lot more than I realized if I optimize the income potential. I would also have a hard time with so much debt if I got in, and I also agree that it seems harder for people to move from nursing to med school.

You'll come out ahead and probably less stressed.  MD is only really worth it if you plan to keep working on a longer timeframe, ie>10 years.

This is something I go back and forth with because at this moment in my 20s I think I would love to be working longer than 10 years if I went MD, but once I am 50 and missed huge chunks of my kids growing up while I was in school and residency I may feel differently.

Giving up the idea of MD would also give me more time and money to further my nursing specialties and increase my income if I wanted to, without the huge burden of med school debt and a heavy time commitment. Part of me wonders if its a pride thing and thinking that I wont be happy until I reach the top and have the chance to learn more and more. Working in the ED now I see so many things I wish I could do and envy the doctors that have so much knowledge. I just dont want to spend my nursing career constantly wishing I could do or know more. I guess that is something more about my personality that needs to change rather than my job goals.

ooeei

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Re: Any MDs here?
« Reply #13 on: January 08, 2018, 09:01:52 AM »
I'm not involved in the medical field at all, but have you considered becoming a Nurse Practitioner?  It seems like a good middle ground between RN and MD. With healthcare costs continually rising using Nurse Practitioners as a substitute for doctors to keep costs under control seems to be gaining popularity, and I imagine this trend will continue.

I have no idea what education is involved with that or what the work life is like, but it seems like a good route if you want to be "more than an RN" without putting your life on hold for 10+ years.

Quote
Starting salaries for nurse practitioners increased dramatically between 2015 and 2016 according to a report published by Merritt Hawkins, a national healthcare industry staffing firm that recruits physicians and advanced practice registered nurses for a large number of healthcare organizations throughout the country.

The highest average staring salary offered to NPs reached $197,000 in 2016 an increase of more than 50% over the top offers in 2015. The report went on to reveal that a skyrocketing demand is the primary factor behind rising starting salaries, with nurse practitioners recognized as the 5th most highly sought after advanced healthcare professional in 2016.

Not sure on the validity of the source since it's a staffing firm, but take it for what you will.

http://www.graduatenursingedu.org/salaries/

Dr Kidstache

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Re: Any MDs here?
« Reply #14 on: January 08, 2018, 10:57:10 AM »
Another MD here. Truest advice I ever heard when considering medical school was that if there was anything else that you would enjoy doing, go do that thing instead.

The path to medical practice is like dropping out of the world and into a long, dark, wildly expensive tunnel. Your life gets pared down to the barest essentials: sleeping, eating, hoping to get a chance to pee, trying to see your family occasionally. You'll miss birthdays, holidays, hobbies, social groups. 7-10 years later, you pop out of the other end making a decent salary to tackle the 6-figure debt and having a tiny bit of control over your life again.

Don't get me wrong, I loved medicine and could not imagine doing anything else when I was going through my training. But it was also brutal and I was never under the illusion that it was a profitable enterprise. All the more so when I became disabled from an accident early in my career (get disability insurance!)

You'll have a BSN. That's an extraordinary amount of earning potential and career flexibility just at that level of training. FWIW I didn't earn more than the charge nurses in the ER until after I was an attending. I recommend trying nursing for a while and see if it might be a better option for your family.



Case

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Re: Any MDs here?
« Reply #15 on: January 08, 2018, 11:30:28 AM »
So, I have been working in the medical field as and EMT for a while and I am finishing nursing school with my BSN soon and will continue working at the hospital where I am currently employed. It is an academic medical center, and I have really been thinking that I would love to continue school and possibly become an MD. I have met all prerequisites for school, but would need to take the MCAT before applying. The doctors I work with highly recommend me and many of them have gone on the same path I am looking at. (9 of the ER doctors were previous RNs). They all suggest it was the best decision they have made, but I am already close to thirty, so I would be near 40 by the time I finished med school and my residency. They some of the NPs there (including a couple spouses of MDs) also say they wish they would have gone on to med school to gain more autonomy and training than they got being NPs. It would push my FI date back by a lot, but I also can imagine being in a more fulfilling position if I would continue school, so I am not necessarily opposed to that.

What are some things I need to consider? Have any of you had children while in med school? Are you still able to be as good of a parent as you want to be? Were you able to pay your loans quickly? Was you salary high enough to make those loans not seem so enormous? I just really want to consider my options and get advice from some financially savvy and family oriented physicians who have gone through the process.

My guess is that this route is only a good idea if the satisfaction derived from a career as a doctor is your top interest in life.  This is the same thing that would be considered for someone 10 years younger than you, but is even more important for you given the delayed time frame.  I would only consider this route if you are not interested in retiring early.  You can do the math yourself, but it would make little sense if you have passion at RE (FI is a different story), because you will likely be unable to do so for quite a while.  In addition to that, I think it would make little sense to invest so heavily in a career that you plan to eventually abandon early on.

Beriberi

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Re: Any MDs here?
« Reply #16 on: January 08, 2018, 02:32:30 PM »
Starting med school in August, married mid 30s with 2 kids. Some things to keep in mind.

It may be possible to work some very limited hours in med school and on the 2-3 month break between M1 and M2 .

Attend a public medical school. 30k/year vs 60k/ yr private

Moonlight during residency to increase your salary from 60k to 80+k

Choose a residency/specialty that you will be happy in but.... at an older age you will have reduced time to recoup cost so a higher earning speciality than FM/peds may be the way to go or apply broadly for primary care scholarships.

Here's my breakdown. Current PA making 150k/year

Cost to attend 35k x4 = 140k
Lost income 600k less pt work @ 40k/year = 440k
Lost income in residency 150k*4 - 80k*4=280k
Total costs = 860k round up to 1 mill given interest on loans

20 year career as physician @ 375k/year less 1 mill loss = 6.5 mill
28 year career as current PA @ 150k = 4.2 mill

Break even at about 5-6 years post residency

Granted this doesn't take into account compounding interest but those are 2 very different numbers.

I disagree with a lot of your numbers here, at least as they apply to a general population. While an average state medical school costs $35k, many people cannot choose their local medical school (I got into a top 5 program, but not my in-state - there is a lot of randomness in the process). You also need about $15k/year to cover living costs, so debt is around 200k, not 140k, even for a average school.

I don't believe there are any opportunities for interns (first year residents) to moon light. You are not usually fully licensced at that point.   In my institution (500+ residents) there was no moonlighting in house. I don't know anyone who was going out of house to work.  It seems like a really good idea when you are a medical student, but is nearly impossible to do in real life.  The risks are huge.  The easy money will be taken by hungry new residency grads. You can cobble together some ATLS teaching, but there is no way you are earning 40k/year x 3 years moonlighting.

$375k/year as an attending is a generous estimate. I could make that, but I am not going to work that hard, or with that much risk. Average specialist makes $316k. If you have a humane schedule or live in a desirable area, you will make much less.

It's an interesting conversation and I appreciate you adding to it.

DirtDiva

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Re: Any MDs here?
« Reply #17 on: January 08, 2018, 09:19:21 PM »
PA here, considered going to med school but decided that kind of 8-10 year sacrifice wasn't for me.  I have loved my job from day 1 and I've been paid well with a really nice schedule (currently work 8-3).   

You could consider NP/PA or nurse anesthetist training if you want more responsibility and autonomy.  However, you have many fabulous options with a BSN.  Travel jobs, any work schedule and specialty you can imagine, and you can go home at the end of the day without being on call. :)

I think ultimately, the answer lies in your response to the question: do you want, from the bottom of your heart, to devote your life to your career?  It's a calling in a way that most jobs are not.

Best of luck to you, whatever you may decide.