How important is a specialty's median salary?

[Turf Doc]

I'm very curious as to the thoughts from financially-savvy mid-to-late career physcians here (or earlier.)

Most people here understand the role of money; not just in buying that new Porsche, but also in having the ability to choose want you want to do with your life: work less, vacation more, retire early, etc.

Everyone agrees that it would be a poor decision to go for neurosurgery only because they make a boatload, but what about the very real discrepancy in specialties that are closer in lifestyle?

For anyone who's a pediatrician (really just lower paid physician in general), was it worth it once it becomes "just a job" or is it not "just a job?" What would an extra 100k per year mean to you - does it matter?

For those in higher paying specialties - ortho, rads, derm etc, what would 100k (or more) LESS mean to you? Does it matter? If in med school the specialty was known as lower (or the lowest) paying - would you still have pursued it?

What role did your projected salary have in choosing your specialty? Did you regret putting too much or not enough emphasis on that aspect of your choice? What about if you had 400k of debt vs. if you had nothing?

I'd love to hear everyone's thoughts on this

- a med student (yes i realize my username is misleading)

[GastroMastro]

Median is meaningless. In my field the starting salary ranges from 160-680 among specific people I know. So yeah.

[Turf Doc]

Median is meaningless. In my field the starting salary ranges from 160-680 among specific people I know. So yeah.

Yeah, when I mean median im really just referring to average... of course there's some psychiatrists making more than orthopedic surgeons for example, but for the purposes of my post it doesn't seem helpful to talk about that. Mainly because I assume that if we can control for everything (living in LCOL, doing PP successfully, working a lot) the ortho guy will make more than the psychiatrist.

I don't think its fair for people to say that money doesnt matter since a psych can make more than an ortho if doing that requires a 99th percentile psych income and 1st percentile ortho income with a completely different lifestyles.

[Panscan]

In basically all fields of medicine there are ways you can make a lot of money if you make the right moves and make it a priority. Obviously its easier to do that in certain fields such as an ortho thats very busy but I think the general concepts of being financially literate and business minded can be more important than what specialty you pick. There are FM docs who have set ups that a lot of orthos would be jealous of from a financial standpoint.

I've heard a lot of stuff about psych residents absolutely wrecking from a financial standpoint moonlighting wise, which I don't think most people would expect. Also for attendings it seems like there are lots of opportunities.

Most important concept of all is to get your money working for you.

Salary is important and you should consider how the specialties position is changing but it's one of many things that matter.

People also don't understand present value of money or for example how 1 dollar now is worth more than 1 dollar in 5 years. Lots of training pathways that require multiple years of research and then multiple years of training for little to no gains in salary ( there are even some IM subspecialties that get paid less than hospitalists/general internal medicine). I understand people have interests and things they want to do, but to me I could never do something like that from a financial standpoint. However I am thankful there are people that make those sacrifices.

[CordMcNally]

Salary plays a part but it's important that you find out the worst parts of a particular field (at least for you) and make sure you can deal with those aspects in a healthy way day in and day out.

[Eye3md]

I believe a lot of it relates to “you don’t know what you don’t know”. My salary has ranged from $200k to 7 figures. When I made $200k, I thought I was rich. If you’d told me I could do something to earn another $100k, I would’ve jumped at it. That also may have had something to do with the huge amount of med school (and other) debt that I carried at the time. But, if I never made more than that amount, I would’ve never known any difference and felt like I was doing very well (financially).

[Notsobad]

1). You can’t be really good at something you don’t like.
2). You can’t excel and make a lot of money if you are not good at it.
3) the economics of many specialties can change dramatically over the course of a career. There have been dramatic changes in reimbursement and in ancillary income and business practices that have been devastating, or a boon to various specialties in the past 25 years. So whichever specialties are killing it more may not be the place to be in 10 years. Who knows? Do what you think will get you out of bed in the morning.

[Tim]

Quartiles and median within each specialty is relevant. The specialty range is significant.
Line them all up and you have some expectations that might be reasonable.
The the variability within a specialty might be greater than which specialty.

The question becomes what it takes to achieve that level. A single number alone is simply a computation, the only thing it tells you is that medians are different.
All things being equal (huge over simplification), choose the higher median and hope.

[poose]

Turf Doc When I was in your shoes, median/average salaries that I found on Medscape or other sites were important. I was very aware I would be graduating with $250K in loans and wanted my future compensation to be at least that yearly. I chose electives partially based on the list of specialties above that income. I was lucky that I quickly fell in love with one of them and still think I have the best job in the world (radiology).

I have been in the situation of changing jobs with salaries that were ~$100K different. I was frustrated at the lower paying job because it turned out to be the same workload for less money. I have since found a great job fit (with the higher salary), so for me $100K did make a difference. It also allowed my wife and I to make a decision we never anticipated we would make-- my higher salary gave us steady income when she quit her job to be a stay at home mom. I think that's a luxury these days, and is well worth it.

However, my job switch was within a specialty; I would give up $100K to stay in radiology rather than switch specialties.

[billy]

Career length/avoiding burnout/liking (or at least not hating) what you do will get you in a better financial place than picking any specialty just for the money. If you loved family med for instance but hate anything procedural or hate not having a deep pt/dr relationship, you wont do well in a different specialty. Also within each specialty is a large range of incomes- some location based, some not. Lastly, as you get older, you'll find your priorities shifting. If you told me right out of residency I would have the chance to make over 200k more than what I make if I just took a decent call schedule, I'd say sign me up right now. Yet I keep declining that offer at my place...and I make more now as a 4 day a weeker than I did coming out of residency working a bad call schedule.

Yes, you should be aware of the average range of incomes you can realistically expect for working slightly more or less than residency hours. No, it should not be the only factor in your decision. Pick what you hate the least. Any dr can make enough to become wealthy. Some just have to save a higher percent of their salary or work a few more years to get there. But if you cant become wealthy after working 20 years in any specialty as a doctor, your income/specialty is not the reason why you did not become wealthy. Your saving/spending is.

[Tim]

“However, my job switch was within a specialty; I would give up $100K to stay in radiology rather than switch specialties. ”

Comp
Job/ sub specialty.
Location

$100k +/- is not going to move the needle for a physician that is content with the employment situation. Discontent with comp won’t drive a change if you rate 2 out 3 A++.
3 out 3 is paradise. Money is only a factor when the other two are equal. Pick a specialty that you will be content with the job/specialty for the long haul.

[FIREshrink]

I was a happy shrink well on my to FIRE when I made $135k my first year and I'm a happy shrink now making 3x that. We've always been able to save 35-50%+ of our salary regardless of how much we made so my opinion is that median salary is pretty unimportant and you should do what you love, which you'll naturally be better at and more successful at.

[jhwkr542]

Of course it's important, but I do think daily work is THE most important thing. If you don't like surgery, no amount money will change your unhappiness on a daily basis. The median is a good expectation of what you should make coming out. I think generally those numbers posted are low because many docs have ancillary sources of income through ownership that they probably don't ever list anywhere. I know I don't.

[PedsCCM]

I love pediatric critical care and would do it for less pay. There are many days where I can't believe they pay me to do the job. I wouldn't ever trade that for more money but a less satisfying job. Admittedly my specialty is on the higher side of pediatrics, but we still get paid significantly less than our adult pulm/crit colleagues.

If you consider peds at all - especially if you think about doing a fellowship - you should consider that all our fellowships, except hospitalist, are 3 years. That made me really consider whether or not to do a fellowship. I'm incredibly glad that I chose to.

[fatlittlepig]

I love pediatric critical care and would do it for less pay. There are many days where I can't believe they pay me to do the job. I wouldn't ever trade that for more money but a less satisfying job. Admittedly my specialty is on the higher side of pediatrics, but we still get paid significantly less than our adult pulm/crit colleagues.

If you consider peds at all - especially if you think about doing a fellowship - you should consider that all our fellowships, except hospitalist, are 3 years. That made me really consider whether or not to do a fellowship. I'm incredibly glad that I chose to.

U R a good doctor, thank you for taking care of our babies.