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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.
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.
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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