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Advice on post-residency plans (second residency vs. subspecialty vs. gen peds)

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  • Advice on post-residency plans (second residency vs. subspecialty vs. gen peds)

    Hey guys! I posted about a year ago in a much worse mental state but your posts and advice helped me a lot and made me re-evaluate my goals and what I’m willing to do. I’m posting now because I am trying to decide on what is best to pursue after residency from a financial standpoint. I am 300K in debt, currently under the REPAYE plan. I registered for the PSLF program midway through my intern year, so I have about 2.5 years worth of payments already. Finishing a residency in pediatrics this Fall (finishing late due to retaking Step 3 and remediating a rotation in my intern year).

    I will preface by saying, I realized I don’t love my specialty. I don’t mind doing it, but financially, pediatrics was a terrible decision. I wish I did something higher paying but I had bad advice in med school (e.g. no financial advice) and was told to just follow my heart and I liked the specialty as a student. But I realize now that medicine is just a job for me, a means to an end. I want to maximize my earnings for the fewest hours possible, so I can make the most out of my life outside of work.

    Thankfully I do not need to worry about buying a home for my parents as I mentioned in my prior thread. So it’s just focused on building the best life for my spouse and myself and hopefully kids in a few years. I’m in the north east where salaries are lower, but I’m willing to move to other states or take jobs in smaller cities where pay is higher with lower cost of living. My biggest goal is getting the best lifestyle (nice house, nice car, taking care of my family) for the fewest hours worked so I can enjoy all those things.
    I read these three articles and based some of my thinking from these.
    https://www.whitecoatinvestor.com/intra-specialty-salary-differences-on-merritt-hawkins/

    https://www.whitecoatinvestor.com/double-your-income-primary-care-physician/

    https://www.whitecoatinvestor.com/fellowship-rarely-makes-sense-financially/

    Option 1: Second residency or fellowship. I know fellowship generally doesn’t make financial sense but from the numbers in the above article, it seems like doing a subspecialty in something like allergy immunology, or a second residency in radiology would provide enough of an income jump to justify the years of training and make me come out better overall. Assuming that gen peds really only pays 120-180K and radiology and allergy immunology both give me incomes around 300K or higher for the same amount of hours worked. I'll probably have better work life balance. I also liked both fields from rotating through them. Plus, the extra 2-4 years of training would count towards my PSLF if I decide to use that program. The biggest downside to this is the extra years of training and that it's not not guaranteed I’ll get into a radiology program or allergy immunology fellowship as both are very competitive.

    Option 2: Go for private practice gen peds and give up on PSLF. I have a friend who’s a partner in private practice earning 220K/year in gen peds. And as per the articles above, I know that I can make up to 500K a year if I’m able to work hard and find the right private practice gig in a smaller city outside the northeast. And owning a practice, where I can have control and set my own hours/income is nice and even if it’s hard work I’d be working for for myself.
    The downside to this is that I’m worried I would be working like a dog to maintain that income. I know from the above articles intra-specialty salary difference are much higher than inter-specialty and it is possible to make >300K/year as a general pediatrician. But if I’ll be working much harder for 300K in gen peds, versus getting 300K doing 40 hours/week in radiology or allergy. Then a different specialty makes more sense.

    Option 3: Move away from clinical medicine altogether. There’s a 2 year fellowship in clinical informatics I'm considering, and I’ve heard there’s many options in pharmaceutical, insurance, health administration and other industries. But the pay seems to be all over the place when I look online, without any guarantees of income. Plus, starting salary would probably only be 120k-160k and I'd need to work my way up over a few years to get the higher income. I've heard consulting lifestyle is rough too. But if one of these options has the potential for good pay for the hours worked, I have no issue leaving clinical medicine behind me.

    If anyone has pursued any of the above or thoughts, I'd really appreciate it. Or if I should be considering something else, let me know.
    Last edited by Peds; 06-03-2020, 05:12 AM. Reason: Size

  • #2
    Option D....go to a community in need. Start your own gig. Hire 4-5 mid levels. Take advantage of tele health. Hustle for 5 years and see where that gets you. Growing the business will be the intellectual stimulation that well babies don’t give. If having doubts now I wouldn’t double down and get deeper into the training abyss.

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    • #3
      Originally posted by Sundance View Post
      Option D....go to a community in need. Start your own gig. Hire 4-5 mid levels. Take advantage of tele health. Hustle for 5 years and see where that gets you. Growing the business will be the intellectual stimulation that well babies don’t give. If having doubts now I wouldn’t double down and get deeper into the training abyss.
      Thank you, that definitely makes the private practice option look more appealing. How much could I realistically expect to earn if I do the above? Would it be similar hours to working as a full time radiologist or private practice allergist?
      My spouse and I have considered building our own business in the past, so we don’t have to rely on or work for someone else for our income. It’s nice to have full control and not have someone else profiting off of your hard work.
      And I’m definitely a creative person by nature, that’s why I don’t like the drudgery that is gen peds clinic or most of medicine, but the building a business part would def make it more appealing.
      The only thing is that work life balance is still key to me and I’d want to cut down on hours after a few years. I don’t want to be hustling for more than 4-5 years if possible. After that 9-5 M-F is the goal. High income with long hours is nice but I want to pursue the option that will give me the best income for the hours invested.
      Last edited by zeppelinpage4; 06-03-2020, 02:48 AM.

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      • #4
        I have no clue.. saying something like that is a lot easier said then done And it’s usually said from guys like me who have sold out and taking the employed paycheck as we grumble and gripe

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        • #5
          Would never do a second residency . 5 years of rads training is a ton of lost income potential and its unclear if you actually like the field or just see it for perceived dollar signs which may or may not hold true in the future .

          perhaps some more introspection . You can have a great lifestyle and easily pay off your debt as a pediatrician .

          I think most non proceduralists in general have a good amount of free time to enjoy all their fancy crap they can afford so I wouldn’t use that as a criterion much .

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          • #6
            zeppelinpage4
            What was your take on the prior post?

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            • #7
              Also I don’t know any rads that work 40 hours a week or that it is easy. You should do more research into what the fields actually entail before you consider a life changing decision and forgoing literally hundreds of thousands of income .

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              • #8
                PP peds is going to be the fastest way for you to start earning a six figure salary. I would not double down on training, you say you didn't like residency. No need to do more training. I vote: pp peds and assess other careers. Consulting and pharma are alternative careers. You can scope out the opportunities in this realm while you are earning your general pediatrician salary. This really isn't your fault or even the fault of your mentors. So many in academic medicine only know academic practice. It's easy to get wrapped into this vision as a medical student.

                Edit: The mgma gen peds salaries are a touch higher than you have listed. 2019 median was ~230k. What numbers do you see in your area?
                Last edited by oysterblues; 06-03-2020, 06:06 AM.

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                • #9
                  I'm not a physician but there seems to be an overemphasis on income. Are you interested in anything? Being engaged in your work will propel you through the hours. Trust me, at my busiest as I was careening towards burnout I would spend my commute adding up how much I was making that day, week, month. It's not sustainable. Likewise, even in ROAD specialties, those who work less make less. Correct me if I'm wrong but there are few exceptions.

                  What are the options for rural peds? I have no idea about this but I know there are many perks to going rural for FM. We recently visited some friends who went ultra rural and it's evident he will have incredible status being the doc in town. They live in one of the nicest homes in the community and paid somewhere around 1x income for it. There were so many bonuses that went along with it he's not even started the job and they feel like royalty. If you are truly open to living anywhere, your income goes much further in smaller towns and I suspect there's more status that comes with it too.

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                  • #10
                    I’m not sure if you’ll ever be happy in any specialty. I’d probably focus on reaching financial independence.

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                    • #11
                      Originally posted by CordMcNally View Post
                      I’m not sure if you’ll ever be happy in any specialty. I’d probably focus on reaching financial independence.
                      The primary objective is not to work.
                      Work/life balance is not desired. I am not sure life will be satisfying. Desire for “enjoying things” is overrated in life satisfaction in the long term.

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                      • #12
                        Don't do any more training searching for happiness, get to work and read some happy philosopher posts.

                        You should easily be able to pull in $200k in general peds working outpatient only for a "non-profit" hospital system while still qualifying for PSLF. Heck, our hospital system would also give you $80k in loan repayments over 4 years. You can do just fine financially in general peds.

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                        • #13
                          Don't do an additional specialty. If you don't like medicine, that's probably not going to change. Do some PP work as discussed above or work for a 501c3 for PSLF purposes and start a side project with real estate, etc. You may find you like doing both things together, and perhaps medicine more when not doing it on resident hours

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                          • #14
                            I want to maximize my earnings for the fewest hours possible, so I can make the most out of my life outside of work.

                            This is probably, at some level, the goal of everyone. Taking the opposite, I want to work as much as possible for the least amount of money is nonsensical - one one has ever said that.

                            And as per the articles above, I know that I can make up to 500K a year if I’m able to work hard and find the right private practice gig...

                            I would not be so sure of that. I doubt that there are many pediatricians earning $500k per year. Yeah, they may exist, but from what I am reading, it's not likely going to be you. (Not trying to be mean-spirited, just realistic.)

                            I would investigate the allergy/immunology fellowship idea. Do they earn more? Do you like that subspecialty? Radiology was an easy 9-5 job 30 years ago. Today, it's quite a grind. Yes, you will earn more (much, much more likely to hit $500k than being a pediatrician) but you will earn it. Can you match into derm? Might be quicker route to higher earning and better lifestyle than rads.

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                            • #15
                              Originally posted by VagabondMD View Post
                              I want to maximize my earnings for the fewest hours possible, so I can make the most out of my life outside of work.

                              This is probably, at some level, the goal of everyone. Taking the opposite, I want to work as much as possible for the least amount of money is nonsensical - one one has ever said that.

                              And as per the articles above, I know that I can make up to 500K a year if I’m able to work hard and find the right private practice gig...

                              I would not be so sure of that. I doubt that there are many pediatricians earning $500k per year. Yeah, they may exist, but from what I am reading, it's not likely going to be you. (Not trying to be mean-spirited, just realistic.)

                              I would investigate the allergy/immunology fellowship idea. Do they earn more? Do you like that subspecialty? Radiology was an easy 9-5 job 30 years ago. Today, it's quite a grind. Yes, you will earn more (much, much more likely to hit $500k than being a pediatrician) but you will earn it. Can you match into derm? Might be quicker route to higher earning and better lifestyle than rads.
                              Agree with the sentiment, though not sure this is totally right. Many docs, likely yourself, truly enjoy practicing medicine and its something they would do for less than they could make otherwise (Academic medicine is basically built on this). This gent's situation is a bit different. If you don't like medicine, maybe time to look elsewhere.

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