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

[Dumpster Fire]

Can’t Take It With You

Social Distortion

I'll tell you something, baby, that's a fact
Never see a hearse with a luggage rack
All your money, your hard earned pay
It don't mean ************************, babe, at the end of the day

Can't take it with you, can't take it with you
Can't take it with you, can't take it with you
Oh no, you can't take it with you
Can't take it with you
Can't take it with you
Can't take it with you when you go

As sure as life, and the light of day
I'll tell you something I've heard them say
It don't matter, baby, what you're worth
Seems we all, we all go back to Mother Earth

Can't take it with you, can't take it with you
Can't take it with you, can't take it with you
Oh no, you can't take it with you
Can't take it with you
Can't take it with you
Can't take it with you when you go

Work all your life, you've become a slave
There ain't no spending when you're in the grave
Even if it's raining, thousand dollar bills
Think of me, baby, in your mansion on the hill

Can't take it with you, can't take it with you
Can't take it with you, can't take it with you
Oh no, you can't take it with you
Can't take it with you
Can't take it with you

What you or anyone will never get again is time, no matter how  much you make.  Enjoy your time, it's the one thing that is not guaranteed on this earth.   You and your wife are doing well.  Anybody can order Opus One.  Not everyone knows good wine or can say they have obtained that knowledge by enjoying themselves (or whatever floats your boat).  Salt away enough to retire without worries and hopefully you'll make it there, but enjoy everyday in case you don't.  Trust me you don't want to ever play the "what if" game, you'll never stop.

[FIREshrink]

It's a wonderful thing to be able to see the human being in front of you as your raison d'être. After that, nearly everything else falls into place (finances, liability protection, life and career satisfaction). It might take some work to get there, but it's worth it.

[Moomoo]

I, too, had an existential crisis when I finished my residency.  I thought to myself, I climbed all these mountains to finally attain what essentially was just a "job".  It seemed the payoff was so disappointing, hollow.  I looked out on the horizon and saw no other mountains to climb.  Of course looking back on it, I was short-sighted and just plain wrong.  I learned that there's plenty of other peaks to summit.  Perhaps not as daunting, perhaps not in medicine, perhaps not so "in your face" but they're out there and with enough motivation you can find them and scale those as well.

[Dont_know_mind]

Internship was the worst year of my life. Some days in internship I really wished I was the janitor or something else with less pressure and responsibility.

Being a university student were the best years of my life.

At the end of internship, a reasonable number of my colleagues moved from medicine to managing consulting and tech ventures (I graduated in the late 90's and it was around the tech bubble). A few of them returned when the tech bubble burst. I am really glad I kept with medicine. I am really happy with my job now. It just got better after internship for me. And I really loved it when I got out of the mainstream teaching hospital system.

Not sure why you think your income is capped to 250k/year. Maybe look at different specialities and if income is important to you do one of the higher paying ones.

If you feel quite depressed though, perhaps see someone. Physician suicide and depression do occur. Don't self-prescribe SSRI's or anything else. At least see your F.P. Ask around and see someone (F.P, Psychiatrist, Psychologist) if you need to. You are definitely not alone in terms of finding internship depressing and if you're clinically depressed, there probably are plenty of other doctors out there who have been in that situation also.

[Arkad]

octopus85 wrote:

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.

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That is a fact.  However, you will have a potentially profound impact on a number of individuals during your career. Anyone who has been on the patient side of the equation knows that and sometimes it takes having that experience as a doctor to remember it.

[Neuro]

I am reading through the replies on this post and am somewhat saddened by the responses. As an academic physician, I like my job and look forward to work every day. Its just not the research, but the mix of seeing a wide variety of patients, being involved with teaching and a being part of a community which is quite fulfilling. Yes, there are times when its not pretty - but I really feel I have a chance to make a difference everyday. I am not interested in taking an early retirement or doing something else. My trainees out in the real world are for the most part very happy with what they do.

I think you are bummed out in your intern year and also it represents a big change from what your prior situation was. Remember, a lot of how you go though life is about expectations. Hang in there, try to have a balance outside work and try hard to figure out what motivates you. Being in Medicine is still one of the best professions and if you can find your niche, you will feel fulfilled.

 

[nolamd84]

This is why I refused to think of a job out of residency as a "reward" for hard work in medical school and residency. I did the best I could in medical school and residency to pursue hobbies, develop relationships and in general live my life. I didn't feel disappointed in the pay out because I was already living a fulfilling life - now its just a more comfortable one.

People go to high school and say they'll be happy when they get to college, then medical school, then residency, then fellowship, then that first job, then chief, then national speaker, etc. There's always something further if you focus on it. Just focus on the now.

 

[Craigy]

I'd vote for the SSRIs.

Sounds like you're entering your 30s and hit the dead end.

Even an MD job making $250k is typically going to be a dead end job unless you go out and start your own practice or form some new business.

Once your wife decides to retire, that avenue is closed forever.

You could make a career change, location change, but yeah for now you're stuck until you choose (wisely or unwisely) to dig yourself out.

[artemis]

octopus85 wrote:

If anything, some self-reflection has left me leaning away from research and fellowship and towards a calmer life somewhere where I can find meaning in nature, hobbies, etc. If I decide I want that, I’ll be upset at the wasted efforts I put into a more high-powered research-oriented career, but that’s obviously sunk cost.

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Not wasted at all!  You learned something about yourself, and that's never a waste!

[Kamban]

octopus85 wrote:

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.

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octopus85 wrote:

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.

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It was almost as if you had a prolonged drug high from which you have been brought back to earth.

As a PhD you rarely had to write a grant or worry about a salary. As a post doc or researcher those realities affect you. By doing PhD you almost became unaware you were just a medical student and after every student phase comes a internship with scut work that you were not prepared for. I see this in many international graduates who were high standing attending back home and are now a lowly intern in USA. But time passes quickly.

If you want, you can do a fellowship in the field you had done your PhD and then go on to a job in the pharma sector. If you want bench research that is available and so are openings in clinical trials. I get offers to join companies, especially smaller ones as their medical vice director or something like that. Looks good on paper but requires constant travel and meeting with FDA and other researchers conducting the trials. I hate travel being in a different hotel room every other night. And it is brutal if you have a spouse and children.

So be happy where you are now and do a fellowship. Things will start to become bright again in a few years.

[octopus85]

Dr.V. Investor wrote:

Personal experience, I live in a “not so trendy place”.  We have been criticized for “living in the middle of nowhere”.

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Hmm...I guess I should clarify that I would be VERY happy living in the "middle of nowhere". My comment on trendiness was that med-school-ville had an atmosphere of growth, excitement, and upward mobility, whereas residency-ville seems more staid and unambitious.

 

If anything, some self-reflection has left me leaning away from research and fellowship and towards a calmer life somewhere where I can find meaning in nature, hobbies, etc. If I decide I want that, I'll be upset at the wasted efforts I put into a more high-powered research-oriented career, but that's obviously sunk cost.

[The White Coat Investor]

octopus85 wrote:

I’m having a bit of an existential crisis (that at least partly relates to money), so I wonder if the wise minds here would weigh in.

When I was doing MD/PhD, I felt like the opportunities were endless. I had a research collaboration going on that had me flying across the country every week for access to “top secret” drugs I had negotiated access to from a pharma company. I was filing patent applications and publishing papers. My friends were taking leaves from med school to start companies and talking to VC people. They were having lavish weddings and driving luxury cars. My spouse finished an engineering PhD and got a high-flying job in med device R&D, where she quickly upset the place by bringing in (literally) millions in external funding as a 20-something-year-old new hire.

We didn’t live too lavishly, but we also didn’t give money much thought because it seemed like our future opportunities were so great that whatever expenses we incurred were just part of the game. Wife bought a new car (a reasonable one on the low end of the “luxury car” scale, and we paid cash for it…), because it really seemed like someone in her position needed to show success (all the VPs at her job had luxury cars, so…). Likewise, we spent on nice professional clothing, etc.

I’m certain there were med student peers who were juggling families while counting pennies. But, to us, everything seemed like the future was just so ************************ promising that we’d be silly to worry about money, now.

Then the match. I got interviews at top-tier schools, but will frankly admit that they’d be a stretch given my (average) board scores. I ended up at a reputable university program – probably a peer of my med school – but it seems much less glamorous. Went from a “trendy” city to a very un-trendy one.

Wife gave up her job to follow me, and quickly found a new job (making more money, even) – the new company is smaller, and fawned all over her (based on her prior experiences) – but the work she’s doing is “grunt work” and she isn’t challenged. More, she feels like her colleagues are many “notches” below her old colleagues (intellectually, socially, culturally, etc).

Objectively, we’re better off. I’d have liked to jump to a higher-prestige tier of school, but I realize I should be grateful to have matched where I did. Some of my med school peers jumped to Stanford, UCLA, etc, but I realize that others in our group got sent to rural community programs. My wife has a less stressful job making more money. We have a nicer house, and generally better quality of life. But it feels like things are no longer limitless – I feel like we very abruptly hit the limit.

Before, we never thought about money. There was enough of it to do what we needed, and we assumed lots more was coming in the future. I suppose that’s still true, but we seem to have hit the sudden realization that me being a hospitalist at a community hospital and making $250k/yr may be the end of our upward trajectory. My wife has wanted to semi-retire once I start practicing, but the idea of our “final” income being ~250-300k/yr has us rethinking that. Obviously we can live very comfortably, and we know we should be extremely grateful for the good luck, mentoring, and hard work that got us here, but this never felt like it was supposed to be the end of the ride, as it were. We never endeavored to be mega-millionaires, but we thought we’d easily get to the point where we could spend without worrying too much. As it stands, we feel guilty shopping at Whole Foods.

Is this a case of “more is never enough”? Should I be seeking out CPA or a SSRI prescription?

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Lots of people like emergency docs in that situation. Until they realize their final raise is the one they got when they walked out of residency.

[Dr.V. Investor]

more important question, is your wife happy with her current life?

Personal experience, I live in a "not so trendy place".  We have been criticized for "living in the middle of nowhere".    We miss nice restaurants, nice museums, parks, etc.  But, we are both so busy working and handling kids, those activities are left for the weekend anyway.  we can easily afford fine dining or shows or random spontaneous trips to NYC since we do not do it that often.

I am happy with the trajectory of salary though I do not expect it to keep rising. No Jones to keep up with here.  We have adapted to the life here and we do not regret living here.  We keep debating to stay here for over a decade or not, that is still unknown.

Nothing wrong with being a hospitalist, you will be surprised of their earning potential for those willing to take extra shifts. I assume  you are both young, a lot can change.  Nothing needs to be set in stone- where you will settle or where your salary will be.

 

 

 

 

[q-school]

Get used to loading the trucks. We are just commodities once we are employed by hospital/insurance/va.



I’m just kidding. But I was talking to the radiologist and his big moment of disillusionment was when he realized that in real life (private practice) people just wanted his report.

They just needed to cut and paste his interpretation into their note so they could meet some elements of note criteria the hospital wanted. They were not calling for his opinion. They just needed the note in place.

Decades ago I briefly had a chance to write a big chapter in a seminal textbook. This was when we eagerly saved our meager earnings to buy textbooks that would last for years as the authority on a subject. Had a long talk with wife because it was essentially a commitment of enormous time and a promise to be a slave / i mean designated junior faculty rising star and do all the crap so a senior faculty member could expand their star even further. It would mean less time with family than I was giving at the time, but I was brainwashed into the mentality and had already had nine clinical years plus research.

In my experience , a lot of what you hope is not up to you. You can help your cause but these things are more often a lot of luck and a lot of relations. There are a few people so brilliant (and usually self centered) that they force he world around them to change. Because you are here asking, I know you are not that self centered. So the question really is surrounding what you really want.

PhD may be a sunk cost at this point. You can always transfer to different place if you think you made the wrong decision. Juggling two careers will continue to be difficult. Need to try and be on same page.

Field of hospital medicine is new. Hard to know what types of research will come through hospital medicine that would be stimulating for PhD. Certainly you can be a trailblazer as that field develops. However many PhDs in my experience prefer to learn things in depth—master of nothing rather than be somewhat good at everything. If money is not an issue, perhaps that is how you address whatever is causing your misgivings.

Maybe you are older and different place than your fellow interns? Maybe still making adjustments? Hard to be in a place where you are a mature professional adult and everyone treats you like a temporary worker. Hard to adjust to almost everything being out of your control. Anyways, best of luck. Everyday is one day closer to finish line.

[RogueDadMD]

Well then to summarize — I think you are going through normal intern blues.

The clinical work will be more enjoyable in a year, and by then you will have a better sense of whether you want to continue on a research trajectory.

You know the doctor whose work I loved to  read the most?  As much as I love WCI — not him.

Michael Crichton. He graduated from  Harvard medical school but never got a license or did a residency.