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Am I crazy?

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  • #16
    I am in private practice.  I work a full-time job seeing patients and another near full-time job running the business.  I love running a business!  A lot of Docs do NOT love running a business.  Private practice may not even mean running the business for you but working in any for-profit setting.  If you just love working in the community clinic, keep doing it.  I love going to developing countries and doing humanitarian work.  I pay my way to go and get paid in nothing but hugs, but I love doing it so I keep doing it.

    You will need to make sure you:

    1) Handle your money well.  Max out your tax-advantaged accounts, pay off debts, don't go into more debt.

    2) Don't let life-style creep get you.  You need to live within the salary you are choosing.

    3) Don't be envious of others who are making a lot more than you.  They made their decisions.  You make yours.

    4) Love what you are choosing.  (You have a million other options but it sounds like you love what you're choosing.)  Don't succumb to jealousy.

    You are going to do great!


    • #17
      Hi Beesee,

      Fellow pediatrician here. Probably also crazy:
      - Always wanted to do peds
      - Also did residency that mostly handled kids on Medicaid and Knee that had to be a piece of it going forward.
      - thought I would specialize but there sure isn't any economic incentive to do so in peds
      - the day I finished residency I had $344k in med school debt
      - DW makes about 50-60k ( whether she should work or be home with the 2 littles had been discussed on another thread)

      Here's my take: balance a job that pays well with one that satisfies your need to serve. I work for a large HMO. In my clinic 35% of kids are on Medicaid. I also see a lot of doctor and professor kids too. I am salaried and I work full time (only about 10% of our group works full time. A lot of these are working mothers, many of whom are married to other docs) and I've taken on some administrative roles that . many people dislike. I actually do like this part of the job and I get a little stipend for doing it. In 2017 I should make about 240-250k. I expect around 260 next year, so with DW's income we're over 300.

      So I make more than many primary care peds docs but I have insane debt. We also live in a pretty HCOL area and will probably stay due to family connections. Almost everyone we know owns a house (This has not always worked out well for them). I love the neighborhood we rent in, and we're paying below market value (although that's mostly dumb luck). I drive a car that is worth 1/3 of the SUV my medical assistant drives. We prioritize retirement (after much discussion) and student loan payments, realizing the 3-5yr WCI ideal is just out of reach (but probably not for you with "just" 200k in debt). We live in a university town. A lot of the younger docs in the town live in the new part with giant homes with no yards. We live in a slightly older section and have made a lot of friends who are not-yet-tenured faculty, veterinarians, engineers, and other professionals who do just fine but never expected to be "rich" so we don't feel any social pressure around them. Lots of Hondas in this group.

      So you should definitely do primary care. I don't think I could do any other part of medicine, this is definitely what fits for me. Look for a job that fits what you want to do but broaden your scope. It doesn't have to be a FQHC to make a difference in the lives of underserved kids.


      • #18
        I've got a post coming up soon called The Wealthy Pediatrician. I think you'll find it useful.
        Helping those who wear the white coat get a fair shake on Wall Street since 2011


        • #19
          If you like your field, it's best to stay. I've known others to switch fields and chase money. There's a price to pay for getting paid more with increased hours. Many end up miserable but stay in a job they hate. Life is too short. Make the best of what you have. Living in a high cost of living area can be tough. Just watch your expenses. And keep an eye out for any opportunities in your field.


          • #20
            As others have said if you love general peds then you should stick with it.  I Might at least look at jobs in a LCOL area for a few years after residency.  You might find you like it.  Lots of underserved patients in rural areas.  After your debt is paid off you will have the flexibility to move back home.  Just a thought.  I will echo what others have said you just can't compare yourself to others.  Your ortho classmates will make lots more money but they will work very hard for it and are much more likely to be the targets of insurance sales people. It is going to be very important for you to avoid lifestyle inflation.  I would wait a few years before buying a house and avoid expensive cars.  Fund every retirement option available to you.


            • #21
              Be careful with whom you compare yourself.

              1. I'm one of the lowest paid specialists in my hospital, and when I sit in the physician lounge or walk through the physician parking lot, it's hard not to feel a little dissatisfied when having lunch with those (and there are several) who make 4x or more what I do and whose vacation homes are (literally) 6 times bigger than my one-and-only house.

              2. I live in a LCOL area, took a job with a lot of time off, and earn more per hour of work than the majority of those in my field, so when I talk to my residency friends, I feel quite satisfied.

              3. I am confident I am paid more than any of my closest 20-or-so non-medical friends from high school or college (including several engineers, lawyers, etc).  When I talk to them, I feel downright fortunate.


              I think you already know your options for a major financial boost- move to a LCOL area, do a neonatology fellowships, pick up a second job for the first few years to bolus your savings, etc.  But, in terms of contentment, perhaps you could get a lot of mileage out of just spending more time with non-medical friends?




              • #22

                Pediatrics and have fallen in love with primary care pediatrics, especially in my continuity clinic where I see an underserved population that is probably 99% Medicaid. Fortunately everyone in Pediatrics gets paid on the low end so most fellowships are a wash. I do have colleagues doing second residencies in better paying fields and I can’t help but feel jealous of the pay, though I absolutely love this field and feel lucky that this is my job.
                Click to expand...

                There is a myth that pediatricians are the starving artists of the physician world. People who are poorly paid choose to be poorly paid.

                Just because you love the community clinic in your residency does not mean that is the type of practice that you have to lead for the rest of your life to have a rewarding career. We all went through residencies and many of our patients were uninsured or flat out poor. That does not mean we did not like seeing them and yet at the same time we were paid a fixed amount and did not realize that seeing only such patients forever is not feasible.

                I have few friends who are pediatricians who make good money. One is in Primary care employed by a health system. One is a sub specialist in pediatrics in PP in Florida. My child's pediatrician makes good money and sees a mix of patients - poor, middle class and rich.

                Your spouse makes only $50K. You can easily make $250K and live in your HCOL provided you plan it well. You need to get a job that pays decently and that means seeing a mix of patients, including better paying ones. If you choose not to do it, you might still have the anxiety attacks at 45, since at that time you will have kids and their expenses ( most likely).

                And finally I am tired of all the BS advice of doing a job that makes you happy when you get up and keeps a smile on your face. Those are most likely said by people who already have the money in the bank. They may be envious of your lifestyle but if they were to be given a chance of switching to your $150K, no one will do it. Many will talk the talk, but not walk the walk.

                I am not asking you to take a high stress job but choose one that will support your future family comfortably. Taking care of the underserved is nice but is not your mission in life unless you are called Mother Teresa. It is the job of our government. You need to find your work, lifestyle and income balance going forward.

                Good luck.





                • #23
                  I think it's only natural to covet. We're physicians. A majority of our peers are also physicians. As a result we have a distorted view of reality. I'm in a field where I will probably start out making 350-400k working 40 hours a week with essentially no call and no emergencies. The other day I heard about an ENT friend who was going to join his father's practice and start at 750k. I couldn't help but feel like a failure but I also acknowledge what a ridiculous sentiment that is.

                  A lot of people will say that you make far more than the average American and you should be grateful, but for obvious reasons that's an unfair comparison. The average American is not a highly intelligent, driven, high achiever who has spent 30 years and 200k+ on getting to this point.

                  The thing to focus on is that you will live incredibly well with what you have. The things people buy with all that extra money rarely gives them much happiness and a lot of those things give more heartache than we care to admit. Boats, mansions, and vacation homes are things that it's always better to have friends with than to own your own.

                  My SO and I currently make a combined 100k a year in an MCOL. There are very few things that we cannot afford on that. We travel often (domestically and internationally), live in a nice apartment complex, and we're still able to save. In the grand scheme of things you will be very happy with what you're going to make. If you stretch it as far as you can and follow a lot of the principles espoused over here you will be far ahead of many of your peers despite earning less.


                  • #24

                    Click to expand…


                    Just because you love the community clinic in your residency does not mean that is the type of practice that you have to lead for the rest of your life to have a rewarding career. We all went through residencies and many of our patients were uninsured or flat out poor. That does not mean we did not like seeing them and yet at the same time we were paid a fixed amount and did not realize that seeing only such patients forever is not feasible.
                    Click to expand...

                    If you were my resident I would advise you to really mull over this before settling into a career in underserved primary care.

                    It is among the noblest thing a doc can do, but I already have med school friends who wanted to save the world in FP working in the poorest neighborhoods and who have already given up and are doing urgent care full time. A career in primary care has many challenges and working Medicaid/uninsured pts adds to those challenges it doesn't take them away. Sad but true.


                    • #25
                      You said your husband won't make more than $50k unless something wild happens. Perhaps he should make something wild happen.

                      In a high cost of living area, lots of jobs pay more than $50k per year. If he can boost his income, perhaps you'll be less conflicted about taking a lower paying job in peds.


                      • #26
                        I second the moonlighting recommendation. I wish I worked more early on in my career. Extra dollars saved early + compounding does wonders. Just finishing residency you're used to working a bit more anyway.

                        For medicaid population, be an employee of large system with commercial pricing power (pediatric monopoly). Then the $/RVU averages up due to commercial rates. Or own a hyper-efficient medicaid mill..

                        Also, one can be a good doctor while keeping productivity up, so focus on being an efficient productive doctor as well.


                        • #27
                          is it expected that all docs earn $300k now?  dang, things have changed since i went to medical school.




                          • #28
                            A few people above used the word covet.  Considering the first post, that's apt.

                            If you feel particularly covetous of your colleagues/classmates, or just other docs with a higher income in general, you're probably never going to shake that.  You have to make the choice to either pursue a higher income specialty, job, area, etc. now, or choose to live with what you have and somehow convince yourself to be happy about it.

                            If you're going to covet your peers income, things, vacations, etc., at least in the biblical sense of the word, it could ruin your life.  No matter how rewarding your career is.  You could find yourself one day becoming a spendthrift to try to keep up, ruining your financial future, looking to divorce your spouse, or just being tremendously regretful and unhappy in general.


                            • #29
                              Life is full of trade-offs, although many appear unaware of this fact.

                              1. The decision you make about your first job post-residency is not a life-long commitment!  Lots of people start off in one setting and move to another or even go back for fellowship.  Someone I know spent his first several years of practice on a Native American reservation.  He saved a lot of his income (northing to spend it on) and had most of his loans paid off.  Once he got used to it he loved it, honed his clinical skills and is now back in primary care pediatrics in an academic setting

                              2. Agree with others who say to work hard/moonlight early on.  The money saved will have many years to compound.  This will get harder when/if you have kids.  Excelling where you are may lead to other, more lucrative opportunities (medical director, "easy" moonlighting opportunities, etc)

                              3. Don't worry so much about everyone else.  Already your peer group (other pediatric residents) isn't going to do that well financially and if you end up in a community health center like setting the other docs won't be making much either.

                              4. Accept you may have to work until "usual" retirement age. Liking your job will make that easier

                              5. Social security replaces a lot higher % of income for those who work many years at not so high paying jobs


                              • #30
                                no you aren't.

                                i've come to realize that job satisfaction is what matters the most.

                                i turned down private practice jobs to work in the academic system which essentially cuts your earning potential a significant amount. The difference in salary between between what i turned down and what I took my first year was 70K. but i know myself and know what would not burn me out. i needed flexibility in seeing patients, teaching, and doing program building for residents and students. for me it was an acceptable sacrifice to be happy with what i do and know that i can do for many many years.

                                i'm probably more stressed out about our financial situation now that my wife has finished fellowship, than when she was still in training. with more money, people naturally end up doing more things that incur costs (kids and associated daycare costs just to mention a few). but at least we don't have to worry about our job satisfaction and having an unsatisfying job on top of other general financial concerns we all have.

                                but like some of the posts have said, perspective wise, especially working with underserved patients, i feel extremely fortunate that i have this opportunity...especially i come from that low SES background and it's hard to escape that set up. So that sort of perspective and mindfulness i keep with me and try to follow the sound financial advice on this website to help me enjoy my later years of life.