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Money...career trajectories...and existential crises...

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  • PhysicianOnFIRE
    replied
    "Welcome to the real world, she said to me... Condescendingly." -John Mayer

    I think most of us had dreams of changing the world at one point. We probably talked about our highest aspirations in our med school interviews. And we meant every word we said.

    I realized in the fall of my MS1 year that I was no longer a big fish. I went from 17 years of being a straight A student to being decidedly average, and it happened suddenly. Accepting the fact that I was average among an amazing peer group was actually pretty refreshing. I chose not to be a gunner, but rather to enjoy myself and my time, and find a career path that would make me happy and make me money. Looking back, I think that's when medicine shifted from "a calling" to a career. I don't feel bad about it; that's just reality.

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  • octopus85
    replied




     

    As interns none of them are spending time in a lab. But your program should have a blueprint on how to get started, how to get mentors, etc. Frankly they should’ve done that for you the second you matched and you should have been working on that when you matched.
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    Yes, and to be clear, they have - I've been talking with the appropriate people about fast-tracking into a fellowship, etc. I'm just not sure I want to do that. Thanks for the thoughts.

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  • Antares
    replied
    Finding a sense of meaning in life is among my top priorities too. I can get some of that from my work, and at moments when I have a harder time finding it, I feel that what I do is at a minimum honorable. Most of my sense of meaning comes from the rest of my life and from inside myself. After all, work may be important, but hopefully it’s only one part of life. Whether it was worth it or not, here you are. For many, this time of life is a low point; it tends to get better. But meaning in work has its limits. I’d really struggle more with this issue if I didn’t have, for example and in no particular order, a happy marriage, two great kids, my sense of gratitude for the infinite privilege of having a life here on Earth, my love of culture, creativity, art and reading, the grounding beauty of nature where I love to spend a lot of time, friendships to share and celebrate life with. And I’m sure I could go on far too long. Look for meaning. It’s all there to be found, even if this difficult particular moment is not one where it is easy to see.

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  • RogueDadMD
    replied
    You are 5-6 months into training and in what is often the busiest and least fulfilling year of training. So really nothing has changed for you.

    Where I work I am surrounded by MD/PhDs — our department and university actively recruit them. Lots of them fast track into fellowships also.

    As interns none of them are spending time in a lab. But your program should have a blueprint on how to get started, how to get mentors, etc. Frankly they should’ve done that for you the second you matched and you should have been working on that when you matched.

    I strongly recommend meeting with your residency director and department chair to discuss your career trajectory right now. Have them help you establish local mentors across the institution. If they value your research potential they will bend over backwards to help. Most programs that recruit MD/PhDs put in a lot of effort for this because you all are the ones with the highest likelihood to stay in research given your already demonstrated commitment.

    What you shouldn’t do is sacrifice being a good clinician. Your job in residency is to become a competent doctor, not win a nobel prize.

    A lot of the ones I meet seem to forget that until they get run over by high acuity and volume and can’t keep up.

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  • Bmac
    replied
    I think you have just completely summarized a lot of what explains the "entitlement" felt by many young physicians as they come out of residency and suddenly have to have a luxury car, expensive home, private school for kids, etc. This is why the WCI mantra of "living like a resident" for the first few years after residency is so important. A typical physician salary should allow one to have both a comfortable lifestyle and ability to save for an early retirement. But you probably cannot have the luxury car, the multimillion dollar home, private school, international travel and adequate retirement savings. Another WCI aphorism comes to mind, "you can have anything you want but not everything you want."

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  • Zaphod
    replied




    Thanks, all. Interesting takes on some things ?

    “Feeling guilty for shopping at Whole Foods” was a bit of hyperbole. Obviously we can easily afford it.

    No, didn’t get into any “trouble”. Maybe the dismal world view projected by my post was just coming from the nature of intern year.

    “Status” was mentioned a lot – I don’t think that’s it, though (and I’m not an east coaster  ? And for the final “reward” to be “just a job” that pays an amount that requires me to still be careful with money makes me feel like it wasn’t worth it.
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    Yes well, this part definitely sucks. I also thought I'd be doing something great and useful for the world, imagine my disappointment in myself. But you get over it and learn to find even more meaning in other parts of your life. Then, every so often there will be a glimmer of goodness in medicine and practice that brings you back a bit to that idealism....then the next pt walks in and ruins it, but you learn to enjoy it when you can. Everything becomes at least partially or mostly a job at some point, impossible not to.

    Otoh, residency just is no fun at all. Luckily its not at a good representation of real life doctoring. You can do whatever you want there. Of course an academic job is likely to be much closer to residency, which is so crazy.

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  • octopus85
    replied




    I’m still not clear what happened to the high flying research that promised to be your fulfilling career. If that’s available and what you want to be doing, then go do it.
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    Well, nothing concrete "happened" - it was part of my MD/PhD, and now as an intern, there isn't time/resources. I'm considering a research-track fellowship, but realizing that the end result of that would be a poorly-paying academic job (replete with long hours, fierce grant competition, and lots of stress)....makes me think that's not what I want to be doing.

    Leave a comment:


  • RogueDadMD
    replied
    It’s actually okay to let your career define parts of who you are, as long as it’s letting you fulfill what you want to be.

    I’m still not clear what happened to the high flying research that promised to be your fulfilling career. If that’s available and what you want to be doing, then go do it.

    If you want to make a ton of money, go live somewhere rural for 5 years. A friend of mine went to Alaska out of training doing peds endo. She’s only a year older than me (I am 37) I and is basically able to retire if she wants.

    If you want money and fame together then you may need to look for avenues other than medicine. Most famous doctors are famous for things that have nothing to do with taking care of patients.

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  • AlexxT
    replied


    The amount of blood, sweat, tears, hours, and life I put into this training just doesn’t seem commensurate with it being “just a job”.
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    I agree with that sentiment completely.

    But here's the good news:  At 250k a year, you're earning more than 4 times the mean and median US incomes (56k and 59 k). Those are household incomes.  You need to add your spouse's income to get an accurate comparison.   I try to remind myself every day how fortunate I am to have everything that I have, despite that fact that so many others around me seem to have much more and achieved it by working so much less.

    Short version:  Don't be sad that you can't afford whole foods;  be grateful that you can afford the supermarket and don't qualify for food stamps and the food bank.

    Leave a comment:


  • octopus85
    replied
    Thanks, all. Interesting takes on some things

    "Feeling guilty for shopping at Whole Foods" was a bit of hyperbole. Obviously we can easily afford it.

    No, didn't get into any "trouble". Maybe the dismal world view projected by my post was just coming from the nature of intern year.

    "Status" was mentioned a lot - I don't think that's it, though (and I'm not an east coaster  :P ). I'm not a social person, and don't really care what others think. I just thought my work would have some profound meaning to the world, and realizing that the impact is pretty minor (whether I'm a hospitalist, specialist, or academic) is probably just catching up to me. Doing a fellowship doesn't seem like it will provide the sort of "deep meaning" that I feel like I need.

    I think AlexTT captured my feelings best: "I think what you’re trying to say is that you expected that as a doctor you would be making so much money that you would be able to buy whatever you wanted to without thinking about it, have a fancy, glamorous lifestyle,  and that you would be able to retire whenever you decided you wanted now.  Now you found out that you’ll be earning 250k a year and that you won’t be able to have the life you imagined."

    That's it, entirely. Maybe it's just growing up and realizing that reality. The amount of blood, sweat, tears, hours, and life I put into this training just doesn't seem commensurate with it being "just a job". I've done nearly nothing but eat/live/breathe medicine and training for medicine for.....forever. And for the final "reward" to be "just a job" that pays an amount that requires me to still be careful with money makes me feel like it wasn't worth it.

    Leave a comment:


  • Hatton
    replied


    Whether you play in the NBA or graduate from med school or law school, it isn’t what you make, it’s what you keep. The sooner you make the shift from a “spending current income“ to a “growing wealth” mentality the better.
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    Hank has said this well.  Try to focus on your net worth and not income.  Lots of flash in the pan types make a huge income but not everyone acquires true wealth.

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  • Hatton
    replied
    Sounds like you just grew up.  There are lots of people who will flatter you but you are just a commodity in the greater healthcare INC.  Lots of things are exciting and fun when you are in your 20s and early 30s  and it is normal to be excited about your future but it is also normal that some of those aspirations do not pan out quite as we envisaged them.

    Leave a comment:


  • Hank
    replied
    Go watch Avenue Q; you’ll feel better.

    Leave a comment:


  • Hank
    replied
    Whether you make $200K per year or ten times that much, you can’t spend 100+ percent of it. This sounds like you were confusing income with wealth and projecting a never ending trajectory of ever more income and prestige.

    Whether you play in the NBA or graduate from med school or law school, it isn’t what you make, it’s what you keep. The sooner you make the shift from a “spending current income“ to a “growing wealth” mentality the better.

    If you and your wife have a chance to invent, perhaps to start your own company, and to make it big (much bigger than a hospitalist’s salary), I’d say go for it. You only live once. But consider that there are docs who are talking about spending 5-8 times annual salary on a house in the Bay Area in another thread on this forum. They’ll have funds for little else and their net worth largely will hinge on whether one illiquid asset corrects back down to Earth.

    If a trendy city with lots to do is important to you, then go for it. Recognize that it’s a luxury good and you’re not earning every last dollar you could if you went for the very highest income in the lowest cost of living (and perhaps least desirable) location.

    The vast majority of docs don’t become billionaire medical device inventors. Most don’t create a network of imaging centers and sell out for hundreds of millions. However, if you work hard and focus on growing wealth you’re almost certain to make seven figures and quite possibly can make eight figures before you retire. You also can pay off student loan debt pretty quickly and get financial independence much sooner than the average Joe.

    It may be a blessing in disguise that you don’t need to keep up with the Joneses or worry as much about what other people think in your new location. I’d try to keep the hat to cattle ratio in perspective.

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  • hightower
    replied
    To me this sounds like you've become disillusioned.  I think a lot of people go through this when they reach their 30's and start to realize that they were somewhat starry eyed and overly optimistic in their 20's.  You were thinking as if you'd already become some sort of ultra prestigious, wealthy success story early in your career/training, then reality caught up with you and you realized that your life was actually pretty mediocre compared to your peers.

    That's life.

    This is why playing the "keeping up with the Joneses game" is a recipe for unhappiness.  It also explains how so many celebrities who have reached their prime end up becoming depressed and miserable later in life even though they are ultra-wealthy.  There will always be someone in a better position than you, no matter how far you make it.  There will always be younger, better looking people too.  It's time to just start counting your blessings.  You make more money than ~95% of Americans could ever dream of making.  You will have absolutely no worries about money at all.  Sure you can't go buy yourself private jets and 200k cars, but oh well.  You can easily save enough to walk into most new car show rooms and pay cash for a brand new car when you need one.  You can easily afford to save enough for 20% down on a very nice home in just about any neighborhood you want.  You won't be able to buy homes in Bel Air, LA or West Village, NYC, but again, count your blessings.  It could be a lot worse.

    Don't get caught up in the prestige obsession.  The only people that care about prestige are those who are insecure in their personal life and need to surround themselves with fancy names to feel good about themselves (narcissistic people like our president for example).  Be happy to be where you are.  Be happy to have your health and your young age.  Go live life and be happy.  Nothing in life is guaranteed, including life itself.

    Don't take SSRI's.  Go talk to a good psychologist instead.

    Leave a comment:

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