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  • #31
    Originally posted by CordMcNally View Post

    Medicine can be a bit unusual as income doesn’t always grow with time. Some docs make the most fresh out of residency when they’re hungry end working more.
    Medscape salary survey seems to disagree (agree) with your (my) point.

    Overall, the compensation spreads between younger physicians and older ones were more pronounced in the specialties than in primary care. Average compensation for specialists age 40 and younger was $281,000, compared to $353,000 for physicians aged 40 to 69. In primary care, older physicians’ average compensation was $236,000, compared to $204,000 for younger ones.
    https://www.nejmcareercenter.org/min...-report-revea/

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    • #32
      Originally posted by Turf Doc View Post

      Even if not in real terms won’t the income increase purely due to inflation? Old mama salaries from like 10 years ago are a good amount lower. But the mortgage stays the same…
      You think CMS and insurance companies give you increased reimbursements based on inflation? Their goal is to reimburse you less each year.

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      • #33
        Originally posted by Goje View Post

        Medscape salary survey seems to disagree (agree) with your (my) point.



        https://www.nejmcareercenter.org/min...-report-revea/
        As I said, it can be unusual as income doesn't always grow with time. That means that you shouldn't count on it. There isn't as much for career advancement in clinical medicine as there is in other occupations. Many careers require experience to reach certain levels. Once you're an attending physician, there is very little in the way of experience that will increase your clinical income. I'll speak towards EM and when we hire. We don't care if you're fresh out of residency or have been practicing for 20 years, the compensation will be similar.

        Edit: Long story short, a physician shouldn’t stretch their housing budget by banking on future increases in income.

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        • #34
          Originally posted by CordMcNally View Post

          As I said, it can be unusual as income doesn't always grow with time. That means that you shouldn't count on it. There isn't as much for career advancement in clinical medicine as there is in other occupations. Many careers require experience to reach certain levels. Once you're an attending physician, there is very little in the way of experience that will increase your clinical income. I'll speak towards EM and when we hire. We don't care if you're fresh out of residency or have been practicing for 20 years, the compensation will be similar.

          Edit: Long story short, a physician shouldn’t stretch their housing budget by banking on future increases in income.
          I agree and with the use of midlevels that seems to be increasing at warp speed it would make me more cautious as a new doc starting out. Not saying physicians won't always be needed and valued but supply vs demand plays a large part in opportunities and compensation.

          Comment


          • #35
            Originally posted by CordMcNally View Post

            As I said, it can be unusual as income doesn't always grow with time. That means that you shouldn't count on it. There isn't as much for career advancement in clinical medicine as there is in other occupations. Many careers require experience to reach certain levels. Once you're an attending physician, there is very little in the way of experience that will increase your clinical income. I'll speak towards EM and when we hire. We don't care if you're fresh out of residency or have been practicing for 20 years, the compensation will be similar.

            Edit: Long story short, a physician shouldn’t stretch their housing budget by banking on future increases in income.
            The data I posted above is an AVERAGE. It shows that on average older (read: experienced physicians) earn 25% more than younger (read: less experienced) physicians.

            Extreme numbers are unusual. Anecdotes can be unusual. Averages are "typical." They are not "unusual."

            moving on ...
            Last edited by Goje; 01-10-2022, 01:35 PM.

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            • #36
              Originally posted by Goje View Post

              The data I posted above is an AVERAGE. It shows that on average older (read: experienced physicians) earn 25% more younger (read: less experienced) physicians.

              Extreme numbers are unusual. Anecdotes can be unusual. Averages are "typical." They are not "unusual."

              moving on ...
              Just curious but are you a physician? There are more things in medicine trying to decrease income than increase it. And experience isn’t one of the things trying to increase it.

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              • #37
                Originally posted by CordMcNally View Post

                Just curious but are you a physician? There are more things in medicine trying to decrease income than increase it. And experience isn’t one of the things trying to increase it.
                Last post on this topic.

                Numbers are numbers. Numbers don't have feeling, negative or positive, that you seem to base your argument on. The numbers show (at least for the year the survey was done) that older physicians make more than younger physicians, on average. If you want to see survey results for more years, you can easily Google it.

                If you really want to know even more about this, there is additional dimension we are not even considering here. That is pay over time. (The survey is pay at a time by physician age.)

                For the same specialty, you can look at medscape data for several years to see if there is salary increase over time. Alternatively, you could go to the bureau of Labor statistics and look at the data over time. In both cases, the question you want to answer is: was there a year over year salary increase that is higher than inflation? I bet you the answer is yes but I'm not checked this.

                ​​​​Now, OP needs to adjust average numbers to his/her/their specific speciality and desire to downshift, if any.

                Goje. Out.

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                • #38
                  Originally posted by Goje View Post

                  Last post on this topic.

                  Numbers are numbers. Numbers don't have feeling, negative or positive, that you seem to base your argument on. The numbers show (at least for the year the survey was done) that older physicians make more than younger physicians, on average. If you want to see survey results for more years, you can easily Google it.

                  If you really want to know even more about this, there is additional dimension we are not even considering here. That is pay over time. (The survey is pay at a time by physician age.)

                  For the same specialty, you can look at medscape data for several years to see if there is salary increase over time. Alternatively, you could go to the bureau of Labor statistics and look at the data over time. In both cases, the question you want to answer is: was there a year over year salary increase that is higher than inflation? I bet you the answer is yes but I'm not checked this.

                  ​​​​Now, OP needs to adjust average numbers to his/her/their specific speciality and desire to downshift, if any.

                  Goje. Out.
                  I'll take that as a no regarding my physician question. The point and my whole premise is that I don't think recommending the OP to stretch their housing budget and rely on future increases in income is a wise move. We don't know much about the OP's job. I'm assuming it is likely an academic job. It could be a partnership track position with an expected increase in income in a few years. Either way, I wouldn't advise the OP to bank on future income increases when looking for a house, especially when both are on the lower end of physician pay and there could be a possibility that one may want to stay home when/if they have kids. Just trying to give the OP reasoning behind my disagreement.

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                  • #39
                    Originally posted by Turf Doc View Post

                    Even if not in real terms won’t the income increase purely due to inflation? Old mama salaries from like 10 years ago are a good amount lower. But the mortgage stays the same…
                    No. There has been no increase in reimbursement to account for inflation. Making more money has been accomplished by simply working harder and/or more efficient. The same work for an orthopaedic surgeon paid more 10 years ago than it does today. TJA medicare reimbursement has decreased by an annualized 1.7% since 2000.

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                    • #40
                      Originally posted by CordMcNally View Post

                      You think CMS and insurance companies give you increased reimbursements based on inflation? Their goal is to reimburse you less each year.
                      i thought the same but ENT Doc mentioned there was some inflation component in reimbursements in a separate thread a while back?

                      Comment


                      • #41
                        Originally posted by abds View Post

                        No. There has been no increase in reimbursement to account for inflation. Making more money has been accomplished by simply working harder and/or more efficient. The same work for an orthopaedic surgeon paid more 10 years ago than it does today. TJA medicare reimbursement has decreased by an annualized 1.7% since 2000.
                        I realize that it comes from efficiency and working more but in nominal dollars, many specialties are making much more on a gross basis than they were 20 years right?

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                        • #42
                          The RVU for services is determined by CMS. The conversion factor for my group is based on market data and 60th% percentile. We were tracking 2-3% increase but froze 2020. Certainly not keeping up with inflation but the conversion factor has increased over my 8 years.

                          CMS may decrease RVUs so stay tuned.

                          Comment


                          • #43
                            Originally posted by Turf Doc View Post

                            i thought the same but ENT Doc mentioned there was some inflation component in reimbursements in a separate thread a while back?
                            “Inflation adjustment”. Besides, don’t look at one part of the reimbursement fee. Medicare has been way behind inflation for decades. Private insurers will laugh at you if you call them and say you want a 7% inflation adjustment increase.

                            Comment


                            • #44
                              Originally posted by StateOfMyHead View Post

                              I agree and with the use of midlevels that seems to be increasing at warp speed it would make me more cautious as a new doc starting out. Not saying physicians won't always be needed and valued but supply vs demand plays a large part in opportunities and compensation.
                              Some. High tide and low tide raises all boats. With all Medscapes "warts" (self reporting and small sample size for many specialties) it is consistent.
                              The top ten and the bottom ten are relatively consistent. To see major changes you have to look at decades which might be more business model driven than supply and demand. A huge demand for PCP in under served and rural areas. Don't see them moving much. Midlevels I would call a business model change. I haven't seen warp speed changes in specialties.

                              For physicians it is a higher floor and lower ceiling in compensation. The intra=specialty ranges are huge. Due mostly to the business model of the physician as opposed to sheer volumes or work.

                              Comment


                              • #45
                                Originally posted by IlliniGopher View Post
                                The RVU for services is determined by CMS. The conversion factor for my group is based on market data and 60th% percentile. We were tracking 2-3% increase but froze 2020. Certainly not keeping up with inflation but the conversion factor has increased over my 8 years.

                                CMS may decrease RVUs so stay tuned.
                                Well yes, RVU is set by CMS (actually the RUC) which is a rather questionable process and off topic for this thread. Short version, depends on specialty and is a zero-sum game year to year for MCR (winners and losers), and private insurers tend to follow suit based on MCR.

                                OP if you are in fact tied to area, do your research and are convinced you both could find other positions, buy the house. Though I agree with Tim the details are scant on this great deal you are getting.

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