Question for the physicians on here...

[brandino29]

What is your specialty, why did you choose it, and would you change it if you could?


I'm in my first year of med school (non-trad student, went back at 30 after having worked a number of years in public health) and I'm trying to narrow down my options for residency.  What drove me to go back to school was an interest in primary care but after having gotten started, done well in my first half year, and really enjoying some aspects like gross lab, I'm starting to think I'd prefer something surgical.

A big part of it is that I like the idea of being hands on and being able to treat an acute condition and see immediate results.  Another part, being completely honest, is that I've realized I'm so close to having the opportunity to make a lot more money that I'd be crazy not to do it.  I'm also doing well academically and in the gross lab I've realized I'm much more interested and dedicated to school than most of my classmates -- and there's something that bothers me about the idea that I would opt to go to into the lowest paying field while many of them would end up earning double or more my income, yet they are no smarter or harder working than I am. 

I'm really interested to hear from you all as the mustachian type.  It's evident that many (most...all?) of my classmates have no concern for money, about half are from well-to-do medical families and the rest seem to be living it up on student loans expecting big paychecks at the end of the day.  The bigger paycheck is certainly part of the reason I decided to go back, but not to live in a McMansion, drive BMWs, and hire a lawn care service, rather I wanted to help secure my family's financial future while following a dream I've wanted to pursue since a child.  So I want to make a difference in people's lives, I want to enjoy my career, but I also want to have a healthy work-life balance and spend time with my family.  Have you all found that balance?

[frugaldrummer]

I went into Family Practice because I enjoyed the variety, and I like the diagnostic challenges.  Have worked urgent care (lots of suturing, broken bones, occasional dislocations, lots of colds and flu, early appendicitis etc).  That allowed me to work part-time while my kids were young and hone my diagnostic skills. 

Now I have a small private practice doing holistic medicine (based in science, not pixie dust).  Enjoy it tremendously, but make less than I would in a traditional job. 

Pros of Family Practice - flexibility, if you find the right niche you can pursue almost any part of medicine (general surgery, derm, OB, psych, endocrine, emergency, addiction medicine, etc)
Cons - relatively poorly paid (for medicine) and most jobs today in big organizations seem designed to prevent you from practicing good medicine.

My ex is a surgeon in a GYN subspecialty.  Pros:  he makes a lot more than I do, while maintaining a relatively nice lifestyle for a surgeon (works for a large HMO, very little night call in his subspecialty, lots of vacation)  Cons - it was never feasible for him to work part-time, lots of stress (more malpractice suits and deaths associated with surgical specialties, even though he's VERY good at what he does). 

You won't know for sure what you love and are good at until your third year rotations..  But pay attention to lifestyle and flexibility as well as salaries

[Oiseaubleu]

I'm an academic hospitalist. If I had to do medicine all over again, I wouldn't.

Don't get me wrong, I love patients and thinking about medicine. But I'm also a mom of 3, and the hours (even in academia) are really tough.

I also chose med school at 29, after a liberal arts degree and several years of other jobs (law firm, lab tech). I went because I wanted to do something tangible and useful. I did well in school, and could have chosen another road, but I felt old already graduating at 33 and didn't want a longer residency or a fellowship. I chose IM because I enjoyed the conversations with patients and the diagnostic challenges. I wasn't from a well-off family, but money was far from the first consideration for me.

Does it irk me that some of my less noble classmates earn 3x my salary? A bit, I'll admit. But what has been far harder is the toxic environment of modern medicine, which is not patient centered and has so much paperwork. I also did not anticipate how much I would want to stay home with my kids (I was not a mom before residency). So, I am embracing a lower expense lifestyle (currently about 40k/year expenses for my family of 5) and looking at early retirement.

My advice would be to consider if you have other options than medical school at all. Don't be afraid of primary care, but have an exit strategy.

[studentdoc2]

MD/PhD student here (first two years of med school completed; working in PhD currently; planning to go back to 3rd year in summer 2016). My situation is slightly different in that my MD is paid for by scholarship through my program, so I don't need to worry about paying back a quarter million in loans after I graduate.

I've been giving a lot of thought to specialties lately, especially with the goal of finding ones that would allow me to work full-time for ~10 years and then shift to part-time work/semi-retirement. Currently, my favorite potential specialty is emergency medicine, although my clinical/research interests align more with pediatric hem/onc. I've also heard many good things about work/life balance among pathologists, although pathology isn't my cup of tea.

I'm interested to hear what others have to say!

[thingamabobs]

Choose something that you enjoy. Your classmates will earn more than you but they will in in residency/fellowship for more years, enduring q3 call schedules.

Have you seen this? http://www.bestmedicaldegrees.com/salary-of-doctors/

I chose EM. I liked the pace of the work, definitely hands on and the shift work allows me to have 3-4 days off in a row several times a month. Things that I hope will change in the future, but unlikely to, Press-ganey surveys, caps on malpractice, health insurance.

[happy]

So I want to make a difference in people's lives, I want to enjoy my career, but I also want to have a healthy work-life balance and spend time with my family.  Have you all found that balance?

Pretty well, see my journal @ Happy Aussie Downshifter.
To be honest, I like the medical part of my job, but admin/red tape/resourcing/ politics/ ridiculous working conditions and expectations etc make it tiresome and are the motivator for me to retire.
I'm not prepared to disclose my specialty for reasons of anonymity. I didn't find it til I took a job as a"fill in" after touring Europe  in a combi van for 10months ( Aussies did that in the 1980s).  I liked it and it made sense to me and suited my personality.

Advice:
1. You  need to try at least a few things out before you decide
2. Apply some self knowledge: are you a thinker and like time to think (internal medicine/?psych), do you like working with your hands, lots of money and long hours (surgery), like variety/ fast pace - family med, but if you like a bit of adrenalin ED/rural/remote retrievals.
3. Think about money vs satisfaction trade off
4. Think about the shape of the working day/week - do you want shift work, part-time work etc

And lastly and most importantly, keep the MMM faith…. minimise student loans, keep your savings rate high and get FI as soon as you can, then if/when the shine wears off you can get out. Medicine offers that opportunity more than lots of other jobs, so don't waste the gift.

[brandino29]

Thanks for the insights, guys.  I go back and forth with family med, it is much more appealing to me than internal med and seems like there is a lot of potential for flexibility and variety.  I'm looking forward to doing some shadowing with my mentor in the next couple of months who is a very energetic, well-liked family doc.  I've wondered though if it will feel incomplete, like I'm unable to treat someone myself and simply stuck referring most of my patients to specialists (side note: when I went to do my check up to start med school with my family physician, she was very excited to hear that I was going to school then she proceeded to spend the next 20 minutes telling me not to go into family medicine and to do anesthesiology. A few days later I ran into a friend of mine who is an oncologist and I told him what she said and his first words were "Don't do anesthesiology, those guys are assholes." Haha.)

My advice would be to consider if you have other options than medical school at all. Don't be afraid of primary care, but have an exit strategy.

I'm sorry to hear that you are not happy in medicine.  I really hope it doesn't happen to me, I don't expect it to as I feel like I'm going in with a good idea of what to expect.  I spent 5 years working in public health, working with physicians, nurses, hospital administrators, and even some clinical stuff.  Those experiences are what drove me to pursue medicine.  I do like the idea of an exit strategy and it's largely why I've considered family med.  I have a lot of experience in health policy and worked at a county health department for several years and I've always thought that if clinical medicine didn't go the way I hoped I could fall back into health policy, which I enjoyed enough, just wasn't a big fan of sitting at a desk or in meetings 40 hours a week. 

Have you seen this? http://www.bestmedicaldegrees.com/salary-of-doctors/

I've seen that sort of thing before, honestly it irks me though.  There's no doubt that physicians spend more time training, and most take out loans to do so (I'm taking out tuition loans but it's in-state at least) and work more than many folks.  But attempting to portray physicians as getting the shaft on pay is a bit ridiculous.  It reminds me of the annual medscape survey on physician incomes and it includes questions like "Do you feel well-compensated?" and "Do you feel rich?"  and by and large the answers are no.  If you make $400,000 a year and spend $400,000 a year, you probably don't feel rich.  And if you make $200,000 and you know many colleagues that you feel are no smarter or harder working than you are earning $400,000, you probably don't feel well-compensated either. On the other hand, I feel rich and we are living off less than $50,000 a year---but we also don't care about fancy cars, big homes, name brand clothes, etc. 

Sorry, I'm not trying to poo-poo that whole thing, but I guess for me the point is that regardless of that argument, I do know that going back to school, even with 4 years of no income and 3+ years on a resident income, will drastically shorten our path to FI. 

Also, EM is up there on my short list!

Pretty well, see my journal @ Happy Aussie Downshifter.

Thanks! Will check it out. 

2. Apply some self knowledge: are you a thinker and like time to think (internal medicine/?psych), do you like working with your hands, lots of money and long hours (surgery), like variety/ fast pace - family med, but if you like a bit of adrenalin ED/rural/remote retrievals.

I always felt I was suited most for family med or primary care.  A few months ago though I took this medical specialty inventory test though (~100 questions on interests, goals, etc) and it came back overwhelmingly surgery (orthopedics, then general) and emergency medicine, with family med way down on the list.  At first I blew it off and then started to think about why and realized a lot of it makes sense (being hands on, being able to make a patient "better", seeing a variety of patient types). 

I'm really looking forward to starting my rotations just so I can see first hand and no more theoretical and see what I enjoy the most. 

[frugaldrummer]

You might find that you enjoy emergency medicine - lots of variety, the opportunity to do some "immediate fix" stuff like suturing or fixing dislocated shoulders (nothing more immediate and satisfying than hearing that "clunk" when a shoulder goes back in place :)  ).  When I worked urgent care it was a nice combination - I got a lot of follow-up like a regular primary care physician, but saw a lot of interesting "urgent" stuff too.

I think you're right about relativity.  I didn't work for part of my marriage (illness, plus kid stuff).  We were fine on my ex-husband's $300 k salary.  We lived in a modest but beautiful house in a wealthy beach community - but my ex was focused on how much MORE people around us made, how much MORE stuff they had.

Now I make a third as much, but live in a beautiful larger home in a more middle-class neighborhood.  I'm happier here in a less pretentious community. 

I suggest you also look into the Institute for Functional Medicine and see if you can attend one of their conferences.  Some of the smartest people in medicine I have ever encountered, on the cutting edge.  Very worthwhile.

[Left]

Not a doc myself, but see enough of them to know that you shouldn't pick the job because of the money aspect alone. The ones that do make a lot and aren't happy. The ones that like their work, would do it even without the "high" paycheck, still paid very well.

I don't know how other people feel, but anyone capable of being a good doctor is smart enough to make the same money doing something else, so deciding on what you'd enjoy doing first and money second. Seeing how they "could" have opened a "pharmacy" from the garage, and make the same money, I don't see becoming a doctor as being equal to making money since making money can be done doing anything else for the same amount.

My sister is happy being a doc, I'm happy not. She'll make more than I will after she finishes residency/fellowship, I'll be FI/ER when she does. We can decide who is happier then.

[brandino29]

You might find that you enjoy emergency medicine - lots of variety, the opportunity to do some "immediate fix" stuff like suturing or fixing dislocated shoulders (nothing more immediate and satisfying than hearing that "clunk" when a shoulder goes back in place :)  ).  When I worked urgent care it was a nice combination - I got a lot of follow-up like a regular primary care physician, but saw a lot of interesting "urgent" stuff too.

I was talking with a friend who is a 3rd year surgery resident a few weeks ago and he sort've seemed to be ruing the idea of surgery.  (He's been working his ass off, probably only seem him a handful of times since he started residency when I saw him quite regularly when he was in school).  He mentioned a friend of his who was just finishing her internal med residency had signed a contract for a local 'doc in a box' urgent care for around $200,000 a year.  He seemed to suggest that the route he was taking wasn't quite worth the extra $100,000 in pay. 

I also attended a family med interest group a couple of months back and up until that point I hadn't known that lots of family med docs work as full-time ED or as hospitalists.  Afterward I started thinking that if I were to go the EM route, it might be smarter to go family med just to have the additional flexibility. 

Pros of Family Practice - flexibility, if you find the right niche you can pursue almost any part of medicine (general surgery, derm, OB, psych, endocrine, emergency, addiction medicine, etc)

Frugaldrummer, do you mind expanding a little bit about what you mean here?  One of my big questions about family med is just how much hands on, surgical, interventional stuff they get to do. 

[Snow White]

Hubby is a retired Ophthalmologist and he said he would make the same choice again.  He graduated with no university or medical school debt though and that is harder to do now.  I am a retired RN and we've always lived way below our income level (naturally frugal) and we were both able to early retire. 

Your working life is too long even with early retirement to not do something you enjoy so choose based on what makes you happy and supports the kind of lifestyle you want.

[thingamabobs]

Never said that physicians were getting the shaft. Just pointing out that you can get to the same place financially without having to go that route. Obviously a mustache an who follows this path will be better off than those that earn 400k and spend 400k. The example of the physician vs teacher salary also applies to primary care vs. specialist, you start earning a real salary years before they do and being mustachian will have no problem accumulating a stash.

I think there is a lot of dissatisfaction which the medical field because so much is being taken out of our control. Medicare is cutting repayments, rest of insurance companies follows suit. Must have EMR compliance, Nevermind that the systems are terrible, expensive, slows the work flow. Doesnt help with communication between the pcp, hospitalist, specialists, or er since no systems talk to each other. Our pay is being tied to satisfaction surveys which are pretty ridiculous and is tied to worse outcomes which they are discussing further tying payments to. Ask your attending how much goes into defending admissions to the hospital.

[Spork]

Choose something that you enjoy. Your classmates will earn more than you but they will in in residency/fellowship for more years, enduring q3 call schedules.

Have you seen this? http://www.bestmedicaldegrees.com/salary-of-doctors/

I chose EM. I liked the pace of the work, definitely hands on and the shift work allows me to have 3-4 days off in a row several times a month. Things that I hope will change in the future, but unlikely to, Press-ganey surveys, caps on malpractice, health insurance.

Not a doc but from a medical family.  While my observations are one-off and are from a different generation of doctors... this little slide show is spot on.  I have never seen someone work more hours/day or days/year.

[frugaldrummer]

    Pros of Family Practice - flexibility, if you find the right niche you can pursue almost any part of medicine (general surgery, derm, OB, psych, endocrine, emergency, addiction medicine, etc)


Frugaldrummer, do you mind expanding a little bit about what you mean here?  One of my big questions about family med is just how much hands on, surgical, interventional stuff they get to do. 

Although Family Physicians that do obstetrics, c-sections, appendectomies and cholecystectomies are a lot rarer now than when I graduated, all of that is still part of your training and there are still plenty of rural areas where you could do those things, or at least assist at surgery.  As I mentioned, in urgent care I did lots of suturing, casted a lot of broken bones, fixed dislocated shoulders and thumbs, read my own xrays (yes, they would be sent to the radiologist later for confirmation, but it's amazing how many things they could miss that I could find when I had the patient in front of me and knew just where to look.)

If I was interested I could get trained to do botox and lasers and make money doing basic cosmetic dermatological stuff.  Or if I enjoyed psych I could go to work in a center treating addicts or eating disorders.  A very large part of my current practice consists of treating thyroid patients (a topic I am passionate about) and patients with other autoimmune disorders.

Family physicians are trained with a wide variety of skills and with interest and sometimes additional training can often emphasize one area of medicine or another. 

[frugaldrummer]

Also - just one thing to consider, that Ive thought about a lot in the past:

Medicine can still be a great career if you love it, enjoy what you do, and find a comfortable niche.  I don't regret the choice.  I'm passionate about it and find great satisfaction in my work.

But from a monetary standpoint - it's entirely possible that if I had worked two jobs for 7 years in my twenties, and banked all but the minimum needed to live on - then just worked one ordinary job - financially I might have come out about the same.  The hours in training are very long (70-100 hours/week), and if one was earning an extra $30k in a second job for 7 years and living on rice and beans to save half of the income from your first job - you might easily save up say $350 k over that time.  Depending on one's student loans, it could take another 10 years for the graduated physician to catch up to that point.

[mozar]

Just saw an article about an anesthesiologist robot, so may be less of a future there...

[Spork]

Just saw an article about an anesthesiologist robot, so may be less of a future there...

What in the world is an anesthesiologist?  [ They replaced them all around here with CRNAs.  One anesthesiologist is on staff and floats between rooms. ]

[brandino29]

I think there is a lot of dissatisfaction which the medical field because so much is being taken out of our control. Medicare is cutting repayments, rest of insurance companies follows suit. Must have EMR compliance, Nevermind that the systems are terrible, expensive, slows the work flow. Doesnt help with communication between the pcp, hospitalist, specialists, or er since no systems talk to each other. Our pay is being tied to satisfaction surveys which are pretty ridiculous and is tied to worse outcomes which they are discussing further tying payments to. Ask your attending how much goes into defending admissions to the hospital.

First, sorry if I came off as snarky about the pay thing, it's just one of those things that bugs me, like those articles that you read about some high earning family bitching about how hard it is to get by when the problem is not the economy or taxes but they're own moronic selves. 

Anyway, I'm interested to hear you say that as an ER doc.  I've thought for a while that I don't ever want to own my own practice exactly because of all the administrative red tape, but I've always assumed that salaried physicians like ER or hospitalists wouldn't have to deal much with that end of it.

Family physicians are trained with a wide variety of skills and with interest and sometimes additional training can often emphasize one area of medicine or another. 

We had a lecture and demonstration a while back by an orthopedic surgeon who does something like 500 knee replacements a year, a handful of hip replacements, and nothing else, and I recall thinking that it would be sort of sad to be stuck seeing the exact same types of patients, doing the exact same procedure, day after day after day.  Though I have no doubt the guy is loaded.  I very much like the idea of being a jack of all trades sort.  I get frustratingly bipolar about it in my head though when I start thinking too much.  It goes something like "but if I go into family medicine, I'll never get to do major surgery, I should go into orthopedics!  But then if I go into orthopedics, I won't get to do any cardio procedures, but I don't really want to go into cardiothoracic surgery and 7 years of residency, maybe I should go into general surgery.  But then I've heard even general surgeons are having to specialize ever more and so I'll get stuck just repairing hernias or whatever. Maybe I should just go into ER.  But then if I go into ER and decide I don't like it, it's not like I can open my own practice or do something very different.  Maybe I should just do family med."

[brandino29]

Your working life is too long even with early retirement to not do something you enjoy so choose based on what makes you happy and supports the kind of lifestyle you want.

Great way to put it.  I actually get mad at myself at times when I start feeling like I have to go into a high paying specialty out of principle.  My wife and I lived wonderfully well with lots of saving before I started school and our combined incomes were less than $100k -- why do I suddenly need $400k?

[LRM]

I am in PA school and currently on rotations. I know I'm not in medical school, and there are  differences between the two jobs.

Before I went to PA school, I thought for SURE I would become a dermatology PA. I worked in dermatology before school. I never saw myself working in any kind of general practice. My first rotation was rural family medicine and I was shocked how obsessed I became with it. So many procedures! So much ortho! So much derm! Management of complex disease that truly challenged me.
 
My next rotations were in three specialties: OBGYN, surgery, and orthopedics. I was super bored in both OBGYN and surgery (slow service), which shocked me. I'm still in school and don't know what job I'll take, but I am seriously considering family medicine because I always felt challenged and seeing patients never felt routine like in a specialty.. "Oh my twentieth pelvic exam today."

Bottom line: I think rotations will help you out a lot!

[brandino29]

Thanks LRM.  That's interesting to hear.  I guess I could be completely surprised what does or does not interest me as I get started with rotations.

On the one hand I feel like I'm getting ahead of myself spending so much time thinking about it right now in my first year of school, on the other I know just how quickly time passes and fall semester of 4th year is going to be upon me (hell, in just 2.5 years) and I'll need to know for sure what I want to do by that point so I don't end up floundering around during residency application/interview.

Good luck finishing school! 

[FuckRx]

I did family med after med school. I had a tough time choosing between ED and OB, I'm a dude so I think it would have been tough going into OB. I didn't have the grades to get into a good ED program so I went with family. Perfect choice for me, would I choose it again, yes. Would I choose medicine again? That's a different story and doesn't relate. I love the patient care, the one on one, man you can't compare that to anything else out there. I did regular family med for a little bit with a panel of patients and hell no that wasn't for me so I did urgent care. I order CT's and MRI, US's and do lac repairs, abscess drainage, remove FBs from all sorts of interesting areas and get to hear great stories. I love the fast pace. I did some per diem stuff at local urgent cares and made like 70-80/hr. then signed up with a bigger group. started with 160k but then once you get seniority (i've been out of residency like 7 years) i made a base of 250k as an urgent care. and i picked up extra shifts last year and cashed out some vaca and made 400k... before taxes but taxes aren't really that bad compared to other countries so i dunno how much i took home but maybe like 220? i haven't done the taxes yet.
I get to do pediatrics, geriatrics, ED, OB, adolescent med etc. My buddies do ortho, radiation onc, I have a neurosurgery friend and a shitload of FP buddies, 1 ophtho, 1 cards friend oh and a ton of ED buddies (they are hilarious and a hard working group, holy shit I dunno how they do it... brilliant docs). My rad onc friend makes the most... cool mill a year. the neurosurg dude makes more but takes home less because he works for a larger group. my ortho buddies in private practive that are younger are making like 200ish right now, the big practice dudes are making like 450k before tax...dunno what my eye friend makes.. the family docs make like 200k minimum before tax...
hope this helps. one more thing. for me I always wanted to do surgery. but once I did my 3rd year rotation and scrubbed in I knew right away that the OR was not for me. just a personal thing. I really liked the FP rotations but didn't like the hand holding and drug pushing of the family doc. Whoever posted that they opened their own FP practice doing holistic medicine...now that's something special and unique, good for her/him. sorry for lengthy post (all the numbers are before tax unless i said otherwise)

[brandino29]

Love it, FuckRx.  Interesting stuff to hear. 

I'd previously "settled" on family med with the intention of working some in the ER/urgent care if possible to get more hands on procedural stuff but then as I got into gross lab I realized that I am much more particular, focused, and dedicated (and demanding) than a lot of my fellow classmates.  That made me start to reconsider and think about something surgical--as I said above, partly because I really like the anatomy aspect and partly because it started to bug me that certain classmates would end up making shittons more money than I would.

I definitely need to let go of the second part of that.  And I'm back to thinking that I could definitely do the things I want to do clinically in family medicine (maybe even more so if I do some international work occasionally) while still being able to balance family and other interests in life (running, cycling, travel).

Though, as I also said above, it's hard to be so close to knowing I could earn so much money and opt to go a different route. 

[Abe]

Surgery resident here, my wife is one year out of family medicine residency. She likes her clinic, and on her average salary alone we have a ridiculous amount of money, more than we could possibly spend. If you are interested in surgery because of the idea of operating and making tons of money, you will likely end up unhappy. Why did I choose surgery? The variety of cases we see, the treatment of more acute issues, and then finally operating itself. It is a rough, long journey and you must really want to do it because otherwise the training will crush you. Everyone at my relatively non-malignant program (including me) have wondered, at some point, "what we are doing with our lives?!" Focusing on the light at the end of the tunnel and the fact we are helping a lot of people along the way keeps us going. The money does not; there are other ways to get a similar salary that are less painful.

[drstarter33]

interesting thread..
I am a UK-based psychiatrist + university academic with a research programme that I manage.
Where I went to med school (India) - psychiatry is looked down as the least preferred option as it remains the lowest income generating specialty outside the West. I come from a middle income family of no medical background; further, being one of the two best outgoing students of my class I was strongly advised against Psychiatry.
But I kept my head down and did what I thought would suit my interests and personality. I have never regretted it even for a single day. I am very happy with my career and I have managed to put some of my entrepreneurial ideas to action, resulting in higher than average income earned by my peers. In fact, I can confidently say I earn as much as if not more than my cardiologist/intensivist peers.
The most important factor for choosing your specialty must be your imagined vision of your personal life 15 years down the lane.

[chasesfish]

Also - just one thing to consider, that Ive thought about a lot in the past:

Medicine can still be a great career if you love it, enjoy what you do, and find a comfortable niche.  I don't regret the choice.  I'm passionate about it and find great satisfaction in my work.

But from a monetary standpoint - it's entirely possible that if I had worked two jobs for 7 years in my twenties, and banked all but the minimum needed to live on - then just worked one ordinary job - financially I might have come out about the same.  The hours in training are very long (70-100 hours/week), and if one was earning an extra $30k in a second job for 7 years and living on rice and beans to save half of the income from your first job - you might easily save up say $350 k over that time.  Depending on one's student loans, it could take another 10 years for the graduated physician to catch up to that point.

I really wish they would tell this story to more med students or aspiring med students, this isn't a choice about money.   I have a fairly unique perspective on this since I'm married to a Dr (the four legged furry-type), but personally chose a career in finance after undergraduate.  In this career, I also occasionally get to see the earnings of physicians:

Six Years after my undergraduate, I was earning the same gross income as a Family Practitioner, but without the student loan debt.  It would have taken the FP at least five years to start earning this income (4 years med school + 1 residency).

After 11 years, I am earning an income + investment earnings that equal what the surgery specialists earn.  This is in line with the 4 years med school + 7 years residency/fellowships.   When you start factoring in my earnings + investment income and compare it to a MD's earnings less student loan payments, I should win.

All this being said being said, my route wasn't easy either.  I put in plenty of 60-80 hour weeks in an industry where most people put their 40-45 in a check out.  However, I had the benefit of being paid like a resident for the first five years and not having the student loan debt.

[brandino29]

I really wish they would tell this story to more med students or aspiring med students, this isn't a choice about money.   I have a fairly unique perspective on this since I'm married to a Dr (the four legged furry-type), but personally chose a career in finance after undergraduate.  In this career, I also occasionally get to see the earnings of physicians:

Six Years after my undergraduate, I was earning the same gross income as a Family Practitioner, but without the student loan debt.  It would have taken the FP at least five years to start earning this income (4 years med school + 1 residency).

After 11 years, I am earning an income + investment earnings that equal what the surgery specialists earn.  This is in line with the 4 years med school + 7 years residency/fellowships.   When you start factoring in my earnings + investment income and compare it to a MD's earnings less student loan payments, I should win.

All this being said being said, my route wasn't easy either.  I put in plenty of 60-80 hour weeks in an industry where most people put their 40-45 in a check out.  However, I had the benefit of being paid like a resident for the first five years and not having the student loan debt.

As I was finishing up undergrad in pre-med I was actually discouraged by a number of practicing physicians from going the medicine route.  In retrospect, it probably had a lot to do with why I decided not to do it at the time.  Also in retrospect and with 10 more years of life experience, I'm realizing that likely what drove those physicians to discourage younger generations from pursuing it was that they went into it more for the money than for the work/lifestyle.  Then discovered they were working way too hard for pay they could have made many other ways.  Specifically, I remember one younger physician being very discouraging about my goals and suggesting I go into finance or business instead.

As I consider it now, maybe I'm again falling prey to this mentality as I'm feeling the pull to a higher pay specialty simply for money, while not considering the life I want to lead or the career I want to have along the way.

[brandino29]

Surgery resident here, my wife is one year out of family medicine residency. She likes her clinic, and on her average salary alone we have a ridiculous amount of money, more than we could possibly spend. If you are interested in surgery because of the idea of operating and making tons of money, you will likely end up unhappy. Why did I choose surgery? The variety of cases we see, the treatment of more acute issues, and then finally operating itself. It is a rough, long journey and you must really want to do it because otherwise the training will crush you. Everyone at my relatively non-malignant program (including me) have wondered, at some point, "what we are doing with our lives?!" Focusing on the light at the end of the tunnel and the fact we are helping a lot of people along the way keeps us going. The money does not; there are other ways to get a similar salary that are less painful.

Abe, out of curiosity, what's your personal experience been with the 80 hour resident limit?  I've heard lots of different things, some say it's a myth, others say to take it with a grain of salt but it's roughly what to expect, and others have no complaints at all.  Any difference between your residency and your wife's? 

[happy]

As I consider it now, maybe I'm again falling prey to this mentality as I'm feeling the pull to a higher pay specialty simply for money, while not considering the life I want to lead or the career I want to have along the way.

As a medical downshifter of 20 years, I still feel this pull from time to time. For me, I think its the  greedy inner child who craves power and social status. For you it might me something else. Being a slightly more wise adult I've learnt that more money, stuff and work and social status do not make me happy.  Having space and time is more important to my well being. 

You are here on this forum, so I assume you've figured this out for yourself. I periodically have to stop and self administer face-punches when I am tempted… you may need to learn this skill.

Of course if you are practicing frugally in order to become enormously wealthy, then you can ignore this advice. I suspect there's a few people on this board whose main aim is to get/have more money that they could possibly burn through ( at their frugal rate anyway)… at some point its just greedy.   If thats how they want it, so be it, it doesn't bother me, but IMO its missing a lot of the core ideology of mustachianism.

[lifejoy]

Hi! My DH is almost done his internal medicine residency in Canada, and he's going to specialize in nephrology. PM me with specific questions if that background can help you :)

[Abe]

Part of why my program is good is they have hired several PAs to make sure we stay under 80. I have rarely been over except when we have overnight Saturday call, and it has always averaged under since next weekend is off. My average is about 70-72. Programs without PAs are considerably more stressful and have harder time staying under. My wife never came close to 80 hours in her program except on inpatient rotations, and even then stayed under.

[milesdividendmd]

I'm a cardiac Electrophysiologist and I love it. But it is a very long road, at least 7 years post med school.

I think it makes sense to follow your bliss, but if you like one speciality a little more than another and the pay is less and the work is harder, then don't overstress the non monetary and lifestyle aspects of your choice.

At the end of your internship year you will probably hate whatever you chose for a little while, (but that passes too. )

From a strictly cold hearted cost benefit analysis, anesthesia, ER, optho, and derm are all good choices (short training, good salary.)

[PathtoFIRE]

Pathologist here, and wife is a psychiatrist.

Obviously both of our fields are a little different from what undergrads/med students think of as "medicine", but we both are very happy. I would add psych to milesdividendmd's list actually, 4 year residency, there are a lot of different setting to find your niche, and she is getting constant recruitment material with good salaries, light call, and from places all over the country (although usually outside major metropolitan areas). And I would say that psych is somewhat immune right now from reimbursement cuts, or at least I don't hear her or her colleagues ever complain about that. Pathology is a little different, we are definitely feeling the heat of reimbursement cuts, but other than that, we are not directly affected by a lot of what I hear physician complaining about. EMR's are great for us, and there's very little paperwork we do that isn't truly essential. I would highly recommend any medical with an open mind taking at least one pathology rotation just to see, I kind of feel like I'm getting away with something having chosen it, the salaries are subspecialty level (albeit at the low end unless you are a real entrepreneur), I have an incredible amount of flexibility in my time and how I handle my work, and I just can't relate to a lot of the complaining I see from other physicians.

[thingamabobs]

Here's another lovely little tidbit... http://getbetterhealth.com/why-would-any-doctor-accept-medicaid/2015.01.26

While I believe majority of people go into medicine with the intention helping, we would also like to be adequately compensated. But if you just finished working 80 hours a week and saw this, how would that make you feel?

[MustachianMD]

I am an academic EM physician for the most part I love it. I do lament the good old days of paper charts when I spent more time with my patients than I did with the computer. For newer grads, this is less of an issue because they never knew the "good ole days" plus you can always hire a scribe which is just as good in my opinion.

What I love about EM is the variety, the procedures, the even the social aspects of care. We see where the system fails and have the potential to help people get care that they otherwise cannot get. I chose academia and took a 50% pay cut because your career is really a marathon (yes, even those of us looking for FIRE) because to me it is the best to see a resident develop into an amazing clinician or help them through a difficult airway or emergency procedure. I also like doing other things- teaching, public health interventions, global health, EM system development, financial literacy education, etc. I have the time to do this as an EM physician given all my free time.

Yes, FM can do EM in some places, but it is less common in larger cities and you will not get the same training we do to prepare you. This is in no means a slam, I worked with several great FM guys that worked in the EM, they are great friends and clinicians but we definitely bring a different skill set. So if you are interested in EM, I would focus on getting into an EM residency program.

Of course there are many downsides. The shift work when you are young is nice, but it can be brutal as you get older, especially with children. Night shifts take a bigger toll on me now than they did 10 years ago. You will also work holidays and weekends. And the social nightmares, drug seekers, etc can really grind you down.

In your case, I would just keep and open mind. Work hard, but find some free time to do the things you enjoy, get involved in some organizations to see what you like to do outside of just hitting the books. If you have questions about EM, feel free to PM me.

[brandino29]

Thanks for the reply MustachianMD.  A couple of questions, if you don't mind. 

When you say you took a 50% paycut to do academic EM, where does that put you?  My default guess for typical EM salary is around $200k, is that low in your experience or are you earning around $100k?

While I understand that EM receives a lot of additional emergency specific training that FM doesn't, I've thought a big advantage to doing FM and working in an ED is that if I didn't like it, I'd have plenty of other options, whereas I feel like once you go the EM route, your options are limited if you decide you don't want to work the ED anymore.  In FM, you could go on to hospital medicine, private solo practice, a large group practice with shared call, etc -- though in most cases the money is likely to be less.  Do you feel like there are fall-back options for EM that I'm missing? 

For whatever reason, the thought of working holidays has never bothered me, especially if I have a reasonable work schedule otherwise, i.e. plenty of down time.  Certainly that may change as my daughter (and future children) grow. 

I've also wondered if academic medicine would be for me.  I actually did give a lecture to a 1st year med school class a couple of years ago (I have an MPH and was working as an epidemiologist at the time) and really enjoyed it.  See --- this is my problem, my interests are just too broad.  It would be nice to know definitively that this is what I want to do, whatever this is.

[frugledoc]

If you like hands on but don't want to be a surgeon then gastroenterology is a great specialty.   

Pros:
Lots of challenging and enjoyable procedures
Decent salary in the US (I'm a UK NHS doctor)
Wide variety of outpatient problems (liver, IBD, functional etc)

Cons:
Getting blood vomited all over you at 3am
Commonly seeing young people die from alcohol related problems, and the ruin it leaves for their families
Getting shit on you

Brief list only.

[MustachianMD]

Brandino,

Most of my current grads are getting offers in the mid 300K up to 400K range. Salaries will range quite a bit by region.

There are many options for EM grads that later decide not to do EM. Most I know will continue to do EM, but some work doing additional things like wound care/hyperbarics, urgent care, observation unit medicine (kind of like a hospitalist), others specialize (toxicology, critical care, palliative care, international medicine- working for an NGO), a good number go into administration as well. Major cities or other highly sought after EM jobs usually will not hire a FM trained physician, so it limits your options.

Holidays have not been a major issue for me, but anticipate that it may become more of one as my son grow up as well.

I like academic medicine because I enjoy seeing that light bulb turn on (someone grasping a concept) and like sharing great cases with residents/students. I also, have an MPH, I use to teach an international health research methods course at a prior med school I worked for, hoping to restart that in the future where I currently work. If your interests are broad EM may just be for you.

[rmendpara]

Also not a doctor, but tons of family and extended family in various specialties.

Most who are recently graduated/practicing have said that for most people it really will never be a very financially rewarding profession. Of course, this came from an ophthalmologist completing a fellowship, but even he mentioned he doesn't expect to make more than 250k starting, and maybe 300-350k as his career goes forward. This is great money, but it's a lot of hard work and a ton of risk. Also, for someone thinking about med school, you can't exactly plan out your specialty that well. It depends on a lot of test scores, interview skills, the crazy match process, etc. Of course, if you end up in something that is extremely well paid (orthopedics, pain, dermatology, etc), you will make a top 1% salary, but that's not the majority and a lot of luck is involved.

There are some real trade offs between personal satisfaction, lifestyle, compensation, etc, so talk to people in each practice to get a feel for how they feel about prospects in those dimensions... while taking into consideration your own preferences.

[Abe]

I would say that a physician who isn't able to make their career financially rewarding is probably spending too much. As I've mentioned before, my wife is just starting as a family physician in a big city with a competitive field (took her 6 months to get her job) and even her starting salary is more than enough for a family to live on. True we're not going to be buying yachts a la Wolves of Wall Street, but definitely can live well without much difficulty. This is the MMM forum, after all! But yes, the work is hard and sometimes is not fun. Overall though, almost all physicians will end up with a decent job and make a lot more money than they need. Regarding the large student loans: one of my friends paid off his loans in less than 4 years. His secret? No fancy car unless debt-free.

[hops]

Obviously both of our fields are a little different from what undergrads/med students think of as "medicine", but we both are very happy. I would add psych to milesdividendmd's list actually, 4 year residency, there are a lot of different setting to find your niche, and she is getting constant recruitment material with good salaries, light call, and from places all over the country (although usually outside major metropolitan areas). And I would say that psych is somewhat immune right now from reimbursement cuts, or at least I don't hear her or her colleagues ever complain about that.

Yep, psychiatry offers plentiful opportunities for a great work-life balance. There's also a shortage of child psychiatrists in several parts of the country and that pays more handsomely than you might imagine (while also leaving you time to teach, if you're so inclined).

[jabber]

About to start Anesthesia PGY2, here, and would answer the OP with a recommendation for high wage to training year ratio: EM, Anesthesia, Psych, Path, Etc.  Look for 3 to 4 yr residencies that land 50th percentile or better on the salary surveys.  Grow where you are planted.  There are ways to be happy in any specialty, but not ways to shorten training years.