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  • trajectories...and existential crises...

    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?

  • #2
    i'm confused. you hinted at your wife making serious money then, enough to feel comfortable buying a luxury car for cash.

    now you say she's making MORE money, you're a resident so add $50-60k to that, assuming that as MD/PhD you don't have crazy debt, and you feel guilty shopping at Whole Foods?

    also you seem to have jumped from being a scientist being flown around by pharma in medical school and working with VC to planning a career as a community based hospitalist?

    something about your post doesn't quite add up. did you get in some kind of trouble?


    • #3
      Also dont get it. Sounds like you were sucked in to the lifestyle and allowed the glitz/glamour trick you into believing things were much rosier than they were, and now just have woken up to reality. Just feeling fancy isnt actually fancy, some things are just facades.

      Also dont get why you didnt stay where these opportunities are instead of a standard residency. Cant you just work for one of these companies?

      P.S. Growing up very poor, I also assumed I would never have to think about money much less worry about it or plan how to make sure I have enough. Reality just is not very friendly.

      Also moved from a vibrant world city medical school with tons o fun to the city where footloose is set. It was traumatic, it still is if Im forced to think about it. Get out after residency, its that simple.


      • #4
        I don’t quite follow either. All I can say is if you have an idea that might make you happier, don’t hesitate. Life’s short and it’s easy to ge sucked into well-paying tedium.
        My Youtube channel:


        • #5
          Doesn’t sound like the Hospitalist route is up your alley as many can feel like a kicked around resident. Some couldn’t care less and make 300k and ski half the month. I get the sense you’ll care.

          Pick a fellowship imo


          • #6
            Your angst is not about money; it's about status.  We are all status seekers.  Money is  a pale substitute for true  high status. You likely grew up on the east coast where people are most status conscious.


            • #7
              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.

              Good for you!  You just saved yourself from a life of misery and living beyond your means.  Lots of doctors don't figure that out until it's too late.

              Now read the rest of this website and learn how to save and invest so you can get closer to your goals.

              I would also like to point out that academic medicine isn't so great either, and that every American graduate of an MD schools studied in a University med school, including all the ones that end up in small towns.   I went to a plain vanilla med school.  Where I work, there are lots of docs like me, and lots who went to Harvard, Yale, etc..  We all ended up in the same place.

              If you have kids, that will probably become your focus, and all thoughts of a globe trotting , glamorous life will be forever banished.



              • #8
                Is it the money or the prestige that you envisioned having and are now grieving?


                • #9
                  Seems like you're wrestling with the fact that the prior life trajectory of glamor and prestige didn't necessarily continue.  I'm sure you could go back to realize the cinematic ending to that story, but more importantly I think you and your wife need to sit down and talk about your goals and priorities.  You stated that your quality of life is generally better.  Is there anything more important?


                  • #10
                    Feels like a mild presentation of bipolar.... and what's wrong with being a hospitalist?


                    • #11
                      Identity crisis. There's nothing special about being in health care. It's just a job. Let your identity be with family, friends, and hobbies.

                      Reminds me of the quote: "Some days you're the fire hydrant, other days you're the dog"

                      The sooner you accept that you'll be the fire hydrant instead of the dog (patients, corporate beat counters, etc.) the better off you'll be.


                      • #12
                        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.


                        • #13
                          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.


                          • #14
                            Go watch Avenue Q; you’ll feel better.


                            • #15
                              WCICON24 EarlyBird
                              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.