What job do you think is the best?

[Allonblack]

Well having just returned from a 5 year reunion at an Ivy:

1. Most of my friends went IB->PE, they made an attending-like salary while working 90 hours a week for 2-3 years and are leaving for corporate strategy, tech or business school (to put off life for 2 years and possibly get married) and looking at 70k a year salaries. There are very few high finance jobs outside of plugging away at excel, which is done exclusively by new grads. 1 or 2 are looking at long finance careers. They are the ones with very stereotypical finance-bro-y personalities and connections, more than any other distinguishing characteristic.

2. One person has a very trendy tech start up with prominent VC backing. Who knows where it will go. Kid is a genius, but definitely a little weird and not very social.

3. Engineers are still plugging away.

4. Not friends with any lawyers, but I strongly believe that it's by far the worse career path.

5. Consultants all in B school minus 1 who opened up an indonesian procurement firm that works for the DOD and makes an attending like salary with room for growth.

6. 1 person I know is in sales and absolutely killing it selling the most boring back office enterprise stuff imaginable.

 

As for encouraging my future kids, this country by far rewards sales people better than anyone else if they're good at their job.

But nothing beats being handed the reins at a parent's company. Obviously medicine is not the best field for this.

 

As an aside everyone is dating the same type of people they were dating in college. The influence of money, in my view, is over-stressed.

 

[SValleyMD]

I would absolutely love my kids to go into medicine. The financial and job security is unmatched!

Yes there are some headaches but there are headaches and " bosses" (i.e, administrators) in all jobs.

You can still find really good and really easy jobs in medicine that pay ridiculous amounts of money for the work performed. Even just being a Hospitalist working 26 weeks a year can be super easy (especially in not managing the icu, specialist access) and h can still pull in >250 or 300k. If u find the right job...

My take is if you don't know what u want to do go into internal medicine. You have a ton of options from there. Otherwise if u want as much financial security, I think you pick a specialty that is needed by hospitals, that can't be replaced with midlevels, that requires specific skills and marry someone who is open to living in different locations. Still some good jobs out there.

I come from an affluent area. I have lots of very well educated friends in accounting, law, movies, business. I find their careers are a 1000x more stressful than mine even though I work long hours and deal with the sickest of the sick (interventional cardiology). They have deadlines they're hitting, quotas they have to hit, deals they have to close, financing they have to obtain. As long as I don't yell at someone or do something stupid I will always have a well paying job..

[RJ]

EniG wrote:

ruralhemonc wrote:

RJ wrote:

Oh boy. I am an ophthalmologist 7 years out in practice. I love the field, the technology, the lifestyle, the surgeries, the for the most part grateful and happy patients. Unfortunately, as a career I can’t recommend it. Practice opportunities are miserable in competitive areas and things are getting worse as more insurance consolidation takes place and ACOs take over. And I know I know- there a few fabulously wealthy LASIK and cataract cowboys- they are a small minority.

Retinadoc, you are a fellow and haven’t experienced real world pressure yet. As of 1/1/16, some retina surgical codes were cut up to 40%. I am friends with many retina docs in private practice and they are seriously worried about keeping the lights on (one was recently telling me that after the cuts, he makes exactly ZERO dollars on a urgent RD repair even on a patient with good insurance). Overhead is extremely high (my practice is currently looking at a new OCT machine- $90,000) and opportunities in good areas are nonexistent. Do yourself a favor and do GI. You will thank me later.

I am faithful WCI reader; I love reading discussions about how ER, anesthesia, surgery residents can moonlight (we can’t do that, unless you want to prescribe glasses at Walmart on Saturdays), as attendings do locums for a few years, increase work load/decrease work load (nope, we can’t do that either, for the most part no opportunity like that exist in ophthalmology). Hospitals don’t hire ophthalmologists (well, some are starting to), so this opportunity doesn’t even exist for us. We are limited to private practice (have you ever seen a $90,000 starting salaries for ophthalmologists? yep, seen that), academics, or VA.

 

Click to expand…

It’s amazing how many medical students want to do retina without having even shadowed a retina doc. I do suspect the reimbursement is largely behind it – I always tell them a lot can change with one year, and your point about surgical codes illustrates that. Thanks for sharing, this is very illustrative and explains why one of my ophtho friends in training recently opted away from retina (not that she would admit to the $$$ being the issue).

I do think that retina vs GI is a strange decision. But I think both IM and ophtho have a diversity of fields and lifestyles – would explore as many as you can and gravitate toward what you enjoy the most with little regard for $$ as it will be there in both fields (just manage your expenses in keeping with the WCI philosophy).

Click to expand…

What amazes me is that we doctors (or soon-to-be) assume the worst in our colleagues. The reason why a lot of people and patients think that we are in it for the money and lose respect is because we propagate that belief ourselves. We see someone going for competitive specialties and assume they are doing it for the money. You may be surprised to find out that the 2 fields have a lot in common, procedural based, long term patient relationships, outpatient lifestyle if so chosen etc. Why retina? It’s very procedural/surgical and I find the retina more attractive. We all started with something that sparked our interest to trigger the shadowing or the electives, so yes, it is possible to want to do something without shadowing first.

Do I look at potential income and lifestyle in my future choice? Absolutely just like every other professional. Would I accept a full time position for 90k after 6 years of residency/fellowship training? Absolutely not! I care for my patients a great deal and I hope to become one of those physicians who is remembered for the good work by patients but I also need to care for my family and myself, and asking fair compensation for busting my butt in school since high school, all the ongoing sacrifices, delayed gratification and mountain of debt is absolutely fair. Nobody does anything for free, so why should I/we?

Click to expand...

Thanks for your perspective. Having said that, it is a student's perspective and no matter how smart and dedicated you are, you haven't dealt with all the BS associated with practice of medicine nowadays.

"Do I look at potential income and lifestyle in my future choice? Absolutely just like every other professional. Would I accept a full time position for 90k after 6 years of residency/fellowship training? Absolutely not! I care for my patients a great deal and I hope to become one of those physicians who is remembered for the good work by patients but I also need to care for my family and myself, and asking fair compensation for busting my butt in school since high school, all the ongoing sacrifices, delayed gratification and mountain of debt is absolutely fair. Nobody does anything for free, so why should I/we?"

Great points above. WE ALL feel that way. Unfortunately, there is CMS, insurance companies, ACOs, predatory practices praying on new associates, medical boards with their MOCs and DOCs, PQRS, ungrateful and litigious patients, etc., etc., etc.

[DoubleMDs]

At this point it's hard to imagine what else I would do, probably something finance related. Our kids will be strongly discouraged from going into medicine though unless maybe as a PA or the like. Definitely think orthodontics would be way better then call and potential lawsuits.

[ruralhemonc]

EniG wrote:

ruralhemonc wrote:

RJ wrote:

Oh boy. I am an ophthalmologist 7 years out in practice. I love the field, the technology, the lifestyle, the surgeries, the for the most part grateful and happy patients. Unfortunately, as a career I can’t recommend it. Practice opportunities are miserable in competitive areas and things are getting worse as more insurance consolidation takes place and ACOs take over. And I know I know- there a few fabulously wealthy LASIK and cataract cowboys- they are a small minority.

Retinadoc, you are a fellow and haven’t experienced real world pressure yet. As of 1/1/16, some retina surgical codes were cut up to 40%. I am friends with many retina docs in private practice and they are seriously worried about keeping the lights on (one was recently telling me that after the cuts, he makes exactly ZERO dollars on a urgent RD repair even on a patient with good insurance). Overhead is extremely high (my practice is currently looking at a new OCT machine- $90,000) and opportunities in good areas are nonexistent. Do yourself a favor and do GI. You will thank me later.

I am faithful WCI reader; I love reading discussions about how ER, anesthesia, surgery residents can moonlight (we can’t do that, unless you want to prescribe glasses at Walmart on Saturdays), as attendings do locums for a few years, increase work load/decrease work load (nope, we can’t do that either, for the most part no opportunity like that exist in ophthalmology). Hospitals don’t hire ophthalmologists (well, some are starting to), so this opportunity doesn’t even exist for us. We are limited to private practice (have you ever seen a $90,000 starting salaries for ophthalmologists? yep, seen that), academics, or VA.

 

Click to expand…

It’s amazing how many medical students want to do retina without having even shadowed a retina doc. I do suspect the reimbursement is largely behind it – I always tell them a lot can change with one year, and your point about surgical codes illustrates that. Thanks for sharing, this is very illustrative and explains why one of my ophtho friends in training recently opted away from retina (not that she would admit to the $$$ being the issue).

I do think that retina vs GI is a strange decision. But I think both IM and ophtho have a diversity of fields and lifestyles – would explore as many as you can and gravitate toward what you enjoy the most with little regard for $$ as it will be there in both fields (just manage your expenses in keeping with the WCI philosophy).

Click to expand…

What amazes me is that we doctors (or soon-to-be) assume the worst in our colleagues. The reason why a lot of people and patients think that we are in it for the money and lose respect is because we propagate that belief ourselves. We see someone going for competitive specialties and assume they are doing it for the money. You may be surprised to find out that the 2 fields have a lot in common, procedural based, long term patient relationships, outpatient lifestyle if so chosen etc. Why retina? It’s very procedural/surgical and I find the retina more attractive. We all started with something that sparked our interest to trigger the shadowing or the electives, so yes, it is possible to want to do something without shadowing first.

Do I look at potential income and lifestyle in my future choice? Absolutely just like every other professional. I care for my patients a great deal and I hope to become one of those physicians who is remembered for the good work by patients but I also need to care for my family and myself, and asking fair compensation for all the ongoing sacrifices, delayed gratification and mountain of debt is absolutely fair. Nobody does anything for free, so why should I/we?

Click to expand...

"You may be surprised to find out that the 2 fields have a lot in common, procedural based, long term patient relationships, outpatient lifestyle if so chosen etc. Why retina? It’s very procedural/surgical and I find the retina more attractive."

Thanks for the explanation and lecture, MS3 (4?). The above quote speaks for itself, but I'll avoid shooting fish in a barrel.

[EniG]

ruralhemonc wrote:

RJ wrote:

Oh boy. I am an ophthalmologist 7 years out in practice. I love the field, the technology, the lifestyle, the surgeries, the for the most part grateful and happy patients. Unfortunately, as a career I can’t recommend it. Practice opportunities are miserable in competitive areas and things are getting worse as more insurance consolidation takes place and ACOs take over. And I know I know- there a few fabulously wealthy LASIK and cataract cowboys- they are a small minority.

Retinadoc, you are a fellow and haven’t experienced real world pressure yet. As of 1/1/16, some retina surgical codes were cut up to 40%. I am friends with many retina docs in private practice and they are seriously worried about keeping the lights on (one was recently telling me that after the cuts, he makes exactly ZERO dollars on a urgent RD repair even on a patient with good insurance). Overhead is extremely high (my practice is currently looking at a new OCT machine- $90,000) and opportunities in good areas are nonexistent. Do yourself a favor and do GI. You will thank me later.

I am faithful WCI reader; I love reading discussions about how ER, anesthesia, surgery residents can moonlight (we can’t do that, unless you want to prescribe glasses at Walmart on Saturdays), as attendings do locums for a few years, increase work load/decrease work load (nope, we can’t do that either, for the most part no opportunity like that exist in ophthalmology). Hospitals don’t hire ophthalmologists (well, some are starting to), so this opportunity doesn’t even exist for us. We are limited to private practice (have you ever seen a $90,000 starting salaries for ophthalmologists? yep, seen that), academics, or VA.

 

Click to expand…

It’s amazing how many medical students want to do retina without having even shadowed a retina doc. I do suspect the reimbursement is largely behind it – I always tell them a lot can change with one year, and your point about surgical codes illustrates that. Thanks for sharing, this is very illustrative and explains why one of my ophtho friends in training recently opted away from retina (not that she would admit to the $$$ being the issue).

I do think that retina vs GI is a strange decision. But I think both IM and ophtho have a diversity of fields and lifestyles – would explore as many as you can and gravitate toward what you enjoy the most with little regard for $$ as it will be there in both fields (just manage your expenses in keeping with the WCI philosophy).

Click to expand...

What amazes me is that we doctors (or soon-to-be) assume the worst in our colleagues. The reason why a lot of people and patients think that we are in it for the money and lose respect is because we propagate that belief ourselves. We see someone going for competitive specialties and assume they are doing it for the money. You may be surprised to find out that the 2 fields have a lot in common, procedural based, long term patient relationships, outpatient lifestyle if so chosen etc. Why retina? It's very procedural/surgical and I find the retina more attractive. We all started with something that sparked our interest to trigger the shadowing or the electives, so yes, it is possible to want to do something without shadowing first.

Do I look at potential income and lifestyle in my future choice? Absolutely just like every other professional. Would I accept a full time position for 90k after 6 years of residency/fellowship training? Absolutely not! I care for my patients a great deal and I hope to become one of those physicians who is remembered for the good work by patients but I also need to care for my family and myself, and asking fair compensation for busting my butt in school since high school, all the ongoing sacrifices, delayed gratification and mountain of debt is absolutely fair. Nobody does anything for free, so why should I/we?

[Zaphod]

ruralhemonc wrote:

RJ wrote:

Oh boy. I am an ophthalmologist 7 years out in practice. I love the field, the technology, the lifestyle, the surgeries, the for the most part grateful and happy patients. Unfortunately, as a career I can’t recommend it. Practice opportunities are miserable in competitive areas and things are getting worse as more insurance consolidation takes place and ACOs take over. And I know I know- there a few fabulously wealthy LASIK and cataract cowboys- they are a small minority.

Retinadoc, you are a fellow and haven’t experienced real world pressure yet. As of 1/1/16, some retina surgical codes were cut up to 40%. I am friends with many retina docs in private practice and they are seriously worried about keeping the lights on (one was recently telling me that after the cuts, he makes exactly ZERO dollars on a urgent RD repair even on a patient with good insurance). Overhead is extremely high (my practice is currently looking at a new OCT machine- $90,000) and opportunities in good areas are nonexistent. Do yourself a favor and do GI. You will thank me later.

I am faithful WCI reader; I love reading discussions about how ER, anesthesia, surgery residents can moonlight (we can’t do that, unless you want to prescribe glasses at Walmart on Saturdays), as attendings do locums for a few years, increase work load/decrease work load (nope, we can’t do that either, for the most part no opportunity like that exist in ophthalmology). Hospitals don’t hire ophthalmologists (well, some are starting to), so this opportunity doesn’t even exist for us. We are limited to private practice (have you ever seen a $90,000 starting salaries for ophthalmologists? yep, seen that), academics, or VA.

 

Click to expand…

It’s amazing how many medical students want to do retina without having even shadowed a retina doc. I do suspect the reimbursement is largely behind it – I always tell them a lot can change with one year, and your point about surgical codes illustrates that. Thanks for sharing, this is very illustrative and explains why one of my ophtho friends in training recently opted away from retina (not that she would admit to the $$$ being the issue).

I do think that retina vs GI is a strange decision. But I think both IM and ophtho have a diversity of fields and lifestyles – would explore as many as you can and gravitate toward what you enjoy the most with little regard for $$ as it will be there in both fields (just manage your expenses in keeping with the WCI philosophy).

Click to expand...

Money may be there but there is a vast difference in what other opportunities are available to invest in your practice, branch out, etc...in the separate fields I'd imagine. You can always do something in every field, but some definitely lend themselves to it easier than others (control, outpatient, surgery centers, etc..).

[ruralhemonc]

RJ wrote:

Oh boy. I am an ophthalmologist 7 years out in practice. I love the field, the technology, the lifestyle, the surgeries, the for the most part grateful and happy patients. Unfortunately, as a career I can’t recommend it. Practice opportunities are miserable in competitive areas and things are getting worse as more insurance consolidation takes place and ACOs take over. And I know I know- there a few fabulously wealthy LASIK and cataract cowboys- they are a small minority.

Retinadoc, you are a fellow and haven’t experienced real world pressure yet. As of 1/1/16, some retina surgical codes were cut up to 40%. I am friends with many retina docs in private practice and they are seriously worried about keeping the lights on (one was recently telling me that after the cuts, he makes exactly ZERO dollars on a urgent RD repair even on a patient with good insurance). Overhead is extremely high (my practice is currently looking at a new OCT machine- $90,000) and opportunities in good areas are nonexistent. Do yourself a favor and do GI. You will thank me later.

I am faithful WCI reader; I love reading discussions about how ER, anesthesia, surgery residents can moonlight (we can’t do that, unless you want to prescribe glasses at Walmart on Saturdays), as attendings do locums for a few years, increase work load/decrease work load (nope, we can’t do that either, for the most part no opportunity like that exist in ophthalmology). Hospitals don’t hire ophthalmologists (well, some are starting to), so this opportunity doesn’t even exist for us. We are limited to private practice (have you ever seen a $90,000 starting salaries for ophthalmologists? yep, seen that), academics, or VA.

 

Click to expand...

It's amazing how many medical students want to do retina without having even shadowed a retina doc. I do suspect the reimbursement is largely behind it - I always tell them a lot can change with one year, and your point about surgical codes illustrates that. Thanks for sharing, this is very illustrative and explains why one of my ophtho friends in training recently opted away from retina (not that she would admit to the $$$ being the issue).

I do think that retina vs GI is a strange decision. But I think both IM and ophtho have a diversity of fields and lifestyles - would explore as many as you can and gravitate toward what you enjoy the most with little regard for $$ as it will be there in both fields (just manage your expenses in keeping with the WCI philosophy).

[EniG]

Wow, this is really something I have to think about. Thank you for your perspective. I certainly don't want to graduate after 5+ years of training + loans and make 90k. That's just ridiculous.

[retinadoc]

RJ wrote:

Oh boy. I am an ophthalmologist 7 years out in practice. I love the field, the technology, the lifestyle, the surgeries, the for the most part grateful and happy patients. Unfortunately, as a career I can’t recommend it. Practice opportunities are miserable in competitive areas and things are getting worse as more insurance consolidation takes place and ACOs take over. And I know I know- there a few fabulously wealthy LASIK and cataract cowboys- they are a small minority.

Retinadoc, you are a fellow and haven’t experienced real world pressure yet. As of 1/1/16, some retina surgical codes were cut up to 40%. I am friends with many retina docs in private practice and they are seriously worried about keeping the lights on (one was recently telling me that after the cuts, he makes exactly ZERO dollars on a urgent RD repair even on a patient with good insurance). Overhead is extremely high (my practice is currently looking at a new OCT machine- $90,000) and opportunities in good areas are nonexistent. Do yourself a favor and do GI. You will thank me later.

I am faithful WCI reader; I love reading discussions about how ER, anesthesia, surgery residents can moonlight (we can’t do that, unless you want to prescribe glasses at Walmart on Saturdays), as attendings do locums for a few years, increase work load/decrease work load (nope, we can’t do that either, for the most part no opportunity like that exist in ophthalmology). Hospitals don’t hire ophthalmologists (well, some are starting to), so this opportunity doesn’t even exist for us. We are limited to private practice (have you ever seen a $90,000 starting salaries for ophthalmologists? yep, seen that), academics, or VA.

 

Click to expand...

I feel you -- this realization is what has driven me to dedicate time to understanding personal finance.

[RJ]

This is from Medscape compensation report 2015. Surprising, isn't it?

[triad]

Being a dentist is pretty nice.  Most graduate at 26 years old and within a year make six figures.  Not mentally stimulating though and owning a practice has enough headaches.  On the plus side I work 30 hrs a week and make 300-350k/yr.

[RJ]

Oh boy. I am an ophthalmologist 7 years out in practice. I love the field, the technology, the lifestyle, the surgeries, the for the most part grateful and happy patients. Unfortunately, as a career I can't recommend it. Practice opportunities are miserable in competitive areas and things are getting worse as more insurance consolidation takes place and ACOs take over. And I know I know- there a few fabulously wealthy LASIK and cataract cowboys- they are a small minority.

Retinadoc, you are a fellow and haven't experienced real world pressure yet. As of 1/1/16, some retina surgical codes were cut up to 40%. I am friends with many retina docs in private practice and they are seriously worried about keeping the lights on (one was recently telling me that after the cuts, he makes exactly ZERO dollars on a urgent RD repair even on a patient with good insurance). Overhead is extremely high (my practice is currently looking at a new OCT machine- $90,000) and opportunities in good areas are nonexistent. Do yourself a favor and do GI. You will thank me later.

I am faithful WCI reader; I love reading discussions about how ER, anesthesia, surgery residents can moonlight (we can't do that, unless you want to prescribe glasses at Walmart on Saturdays), as attendings do locums for a few years, increase work load/decrease work load (nope, we can't do that either, for the most part no opportunity like that exist in ophthalmology). Hospitals don't hire ophthalmologists (well, some are starting to), so this opportunity doesn't even exist for us. We are limited to private practice (have you ever seen a $90,000 starting salaries for ophthalmologists? yep, seen that), academics, or VA.

 

[retinadoc]

EniG wrote:

Thanks for the plug. Would you mind expanding about any words of wisdom for us possible future ophthos (I am interested in retina too but have yet to work with a retina specialist). What portion of your time is spent on procedures and how many patients do you see on a normal day. What attracted you to the field initially?

Click to expand...

Attracted to the field by some mixture of the following: outpatient lifestyle (priority #1), clean surgery, good compensation. Now, that I'm actually doing lots of surgery, I'm blown away by the surgical technology and what is able to be accomplished when operating on the retina.

I am finishing fellowship now, but my future partners see about 50 patients a day 4 days a week and do about 5 major surgical cases on their OR day 1 day a week. During the clinic days, there are lots of 'minor' procedures: lasers and injections. My guess is the workweek is about 50 hrs, weekends generally off.

[EniG]

Thanks for the plug. Would you mind expanding about any words of wisdom for us possible future ophthos (I am interested in retina too but have yet to work with a retina specialist). What portion of your time is spent on procedures and how many patients do you see on a normal day. What attracted you to the field initially?