Kevin, M.D. - Medical Weblog

Most pcp's don't realize that it doesn't end when you get out. Besides paying back loans, time to partnership, buy-in cost, office overhead are all vitaly important. I'm buying into a partnership right now and its killing me. I havn't seen a profit in 18 months!
 

If you are paying anything more than the depreciated value of your hard assets, you are getting fleeced. The value of a "practice" independent of the building other tangible assets is nothing.
b
 

You know what I am going to say--You were aware going in--suffer for the wealth will ome!
 

Dear dum-dum,

How would a 21 year old biology major know anything about health care finance and office overhead? Or even a 3rd year medical student?

A similar thing happens with law school graduates. They pay a large sum to go to school and only a fraction get the tony jobs in big firms. The rest are tossed aside to fend for themselves or work below their training. Do you think they knew those cold statistics before they signed up?

Lastly, how does one plan financially for an event more than 10 years away. I suspect not even an omnicient genius like yourself could do that.
b
 

b, I don't know why you felt a need to call someone dum-dum. If that is where your verbal skills education has brought you, then so be it.

To answer your questions, yes, you knew what it was like. Did you enter and graduate completely blind to reality?. Didn't your parents, family members, friends, advisors or anyone at all you know have even one idea? I imagine the truth is that they did. They most likely shared them with you and you refused to listen or believe them.

Your attitude seems consistent with this new age doctoring that is ruining the best profession in the world. You guys are making it very hard for anyone to respect you.
 

"To answer your questions, yes, you knew what it was like. Did you enter and graduate completely blind to reality?. Didn't your parents, family members, friends, advisors or anyone at all you know have even one idea? I imagine the truth is that they did. They most likely shared them with you and you refused to listen or believe them."

This may come as a shock to you anon but they don't teach business in med school. With the exception of people already in medicine, "friends, parent's, family memebers, advisors" would have little clue as to how the arcane business of medicine works. Trust me on this, this is not a straightforward US business model. You are not making and selling widgets to the needy masses. Don't get me wrong, I love my job. I hate the business in medicine though. Personally, I think you are naive as to the reality of the situation.
 

PS: They also don't teach business in residency. One of the reasons docs are such easy targets for unscrupulous business types.
 

Since I started medical school, the U.S. system went from a mix of private indemnity and public insurance to the system today where most private indemnity has been replaced by managed care. Few people have ever had the experience of paying their bills and filing their own claims, and the default access is now the ER which, for many more than in the past, is followed by absconding on their obligations, all facilitated by EMTALA. Sorry, but those events defy any rational projection that even the best informed pre-medical student could have predicted.

If the best predictors of future events are past events--Santayana, anyone?--then past events would have given the motivated student the encouragement to go into medicine. Not now, though.

And for those silly souls who believe that reported annual salary is the only indicator of the place of a profession in comparison to other professions, the real and opportunity cost is vastly higher in medicine than for any other profession, a fact that statistics do not reveal and that needs to be weighed against the compensation. Salaries matter, just as they do for everyone else.
 

You know, I wanted to be a medical doctor once. But then I learned a thing or two and decided that I'd have to be crazy to want to be an MD.

So I chose pharmacy, for many, many reasons, mainly related to quality of life.

I didn't care to put my life on hold until I was 30 (or more!). And then what kind of life can you truly have? If you were to compare the average breakdown into hours and compensation, docs don't make more than your average retail RPh in any meaningful way by almost any metric save gross income. Broken down into take-home pay on an hourly basis, docs are making less than your average retail RPh. This doesn't take into account the metrics that measure quality of life outside of income: stress, outside hobbies, free time, family life, etc., all of which are more important than how much money you bring home on a yearly basis.

The extraneous crap that docs have to put up with besides demanding patients is quite amazing. After malpractice insurance -- ridiculous in and of itself, given that malpractice payouts are going down and not up while insurers are charging more for no measurable reason -- debts accrued while in school, residency with its 80 hour weeks while making a pittance, and then the stress of having a job that you can never leave at the office?

My God, it's a wonder anyone chooses to be a doctor.

Med school certainly wasn't for me, and I wouldn't recommend it to anyone -- except maybe a hopeless idealist -- unless they knew exactly what they were getting into in terms of financial, personal, and emotional commitments. You would have to either be ignorant of the costs associated with being an MD, or just plain crazy. There is no amount of glamour that would make up for the lack of family life, inaccurate, negative stereotypes, and the stress associated with being an MD. (Again, my opinion.)

You guys are welcome to your fancy letters after your name. I'll take my PharmD and JD (the latter paid for without loans by being a licensed, practicing pharmacist while in law school) and actually have a family life, hobbies outside my profession, and relative lack of stress.

It's not as glamorous as being on the front lines, but boy does it beat the crap docs have to put up with on a daily basis. I certainly respect MDs for what they go through, but there isn't enough money in the world for me to join their ranks, as appealing as that exclusive club might appear on the outside. (And as much as I truly enjoy spending time helping people which is actually the best part of my job.) I respect you guys all the more because I would never subject myself to it. In a way, I guess it's like being the trash guy. No thanks, but props to you for doing a nasty job. :P

And a note on business. I love business; I love medicine. I love the business of medicine. It's what I write about in my relatively prodigious spare time.* We didn't have to learn much of business in pharmacy school. Just basic, one-semester management classes, basic macroeconomics, basic healthcare finance, and a single law course. Most of the kids in those classes weren't interested in the material; they just wanted to pass. While it's an attitude that I understand -- though I can't relate -- I don't think it's a healthy one, and I think most of the med students would probably feel the same if they had to take B classes in addition to their normal courseload. I think it is something that should be taught in med school -- because it apparently isn't according to the comments -- so these kids know what they're *really* getting into when they're done. Though I suppose at that point it'd be too late to drop out in terms of being able to pay off massive student debt.

I don't think you can go into medicine today as a doctor, nurse, pharmacist, whatever, and not have at least a basic understanding of the dollars and cents that makes your business^Wpractice run and expect to make a good living** at your chosen profession.

There will come a time when the number of doctors starts decreasing due to all the crap that they have to put up with. For your sake, I hope the time comes soon and salaries once again start to increase to match the aggravation you guys have to put up with. Truly.

*compared to you poor MDs ;)
** good living meaning overall quality of life, not raw earnings
 

Where are all these greedy, unappreciative, demanding patients you all refer to? I mean does that really happen to any significant degree, any where other than your minds?

I know not one person who has ever treated any Dr. with anything other than respect. If you have a bad patient occasionally, well welcome to the world. Every single person alive gets to experience rude people now and then. What of it?

Do you think your so high on the throne, that you should never ever experience what the rest of us do? Life is full of assholes, we all come across them. By far the majority is not that way. If you honestly believe every patient you have is an unfair, demanding asshole, you should look inside yourself for the answer. Its most likely there.
 

Everyone on the planet has to adjust their lifestyle to their income. If you don't have the money, you don't buy the $500,000+ house. (Note that I'm not saying you don't EARN it...most people, however, likely feel underpaid at their jobs.)

One specialty's residency program at our local teaching hospital includes on its website a page devoted to "selling" prospects on our community. Lots of photos of mini-castle houses, golf courses, country clubs. They seem to be promising riches and leisure. If the field can't deliver on that promise, isn't part of the problem here false advertising from your own medical programs?
 

Apparently you missed the part where I'm not a doctor. But I do listen to patients all day complain about their docs. (Usually when something happens that they weren't expecting.) How they didn't do X, how they did Y, but not fast enough, how it's somehow their fault that Z occured (like running out of refills the Sunday before they're going on vacation, or something equally assinine), but most of the time it's usually about how they can't get in to see the doc, or how the office is always so busy. The complaints have a particular tendency to start when when an insurance company doesn't cover a particular med, or a copay is higher than expected -- something about docs being "rich." (Yeah, I don't see the connection, either.)

Maybe they keep their complaints to themselves in the examination rooms, I don't know. But there is quite a lot of hostility toward the medical profession in general on the part of the public. If you don't experience it, maybe you aren't listening well enough.

I'm not complaining about people. By and large I think they're funny and make the world a more interesting place, and as I said, interacting with them is the best part of my job. (And I bet they complain about rich pharmacists and the high price of drugs when they leave the pharmacy. ;))
 

RLJ, my nexium is 268.00 per month, my zelnorm is 234.00 per month. I have no prescription coverage. You can bet your sweet a** I complain about the price of drugs. Expecially when my neighbor who has lived with a man that is a supervisor at ford, for years, but she claims she is destitude (doesn't have to claim any of his income) and can get her nexium direct through Pizer for free.
 

Two corrections to above post. It's early and I haven't had coffee yet.

1. RJS

2. Astra Zeneca
 

"Where are all these greedy, unappreciative, demanding patients you all refer to? I mean does that really happen to any significant degree, any where other than your minds?"

1: The average ER has 30-50% rate of nonreimbursement by patients (not even throwing in the insurance companies here) Tell me how long would your business survive at that rate. Most ER's are by definition money losers for hospitals.

2: I deal with 1-3 a$$holes every shift (not occasionally). Not a once in a while thing. EVERY DAY. I understand ER's are stressful (so does the staff). Screaming that you are going to sue your incompetent doc at the top of your lungs doesn't help anything. I still love my job. Though I often think I would be happier practicing in New Zealand. I have come to the conclusion we Americans are a very self-centered people.

3: Why are you paying for nexium at the tune of 268.00 when you can buy prilosec OTC (42 pills) from costco, walgreens, or walmart for 25-30 dollars a month? It has a very similar profile as nexium and works by the same mechanism. Why are you venting at an RPH who has NO CONTROL OVER PRICING. If you have an issue talk to your insurance company and manufactorer (and good luck with that).
 

I buy nexium because that is what my GI Spec. says I need to take. I take 80 mg daily for Barretts esophagus with stricture and ulcer's and LGD. But, I can't keep paying that much money every month. Thats also why I take the zelnorm, and carafate. I guess his thinking is to push everything through before it hangs around causing reflux.
 

One more thing, I also had a failed open nissen fundoplication. I can't see where there is an alternative to taking these meds. I was born without a LES.
 

I understand where you are coming from. But, if you can't pay for the meds you can talk to the GI DOC (or PCP) to try to get the meds for free/cheap under the compassion program the company has. I would also talk to your GI doc to see if high dose prilosec could replace the high dose nexium. Of course I am NOT a GI doc. Maybe a lurker GI doc on this site could elaborate.
 

"I deal with 1-3 a$$holes every shift (not occasionally). Not a once in a while thing. EVERY DAY. I understand ER's are stressful (so does the staff). Screaming that you are going to sue your incompetent doc at the top of your lungs doesn't help anything."

On the other side, it's also unbelievably frustrating how you guys cover up for the jackasses in your own stable. I was caught in an ego battle between a specialist and referring doc while undergoing a series of biopsies. Here I was, scared out of my wits that I might have cancer, and these two guys were bitching about each other right in front of me, each one dissing the other's knowledge and recommended course of treatment. The specialist wouldn't send test results to the referring doc...the referring doc accused the specialist of not giving straight answers. Eventually I asked the specialist if I could talk with him, and offered to pay him a consult fee for the time. And he sends me a termination letter. For Christ's sake!

Point being, there are jerks everywhere. Some of them are patients, some of them wear scrubs. You deal with them as best you can and don't expect any special rewards for your efforts.
 

"On the other side, it's also unbelievably frustrating how you guys cover up for the jackasses in your own stable"

I fail to see how your "example" shows anybody was covering up anything. For Christ sake they were arguing right in front of you. Or is your idea of "coverups" just because of what you have heard second hand? Before you reply google your state's Medical Board and see how it works. I think you would be surprised.
 

"RJS, my nexium is 268.00 per month, my zelnorm is 234.00 per month. I have no prescription coverage. You can bet your sweet a** I complain about the price of drugs. Expecially when my neighbor who has lived with a man that is a supervisor at ford, for years, but she claims she is destitude (doesn't have to claim any of his income) and can get her nexium direct through Pizer for free."

First of all, you have my sympathy. Secondly, as someone above said, Prilosec is available over-the-counter, and is also available as a generic behind-the-counter. Nexium is what we call a "me-too" drug -- something Big Pharma does to evergreen their meds so they can continue to make money after the first, novel patent has expired.

An acquaintence of mine was an AZ drug rep for a while, and one of his drugs was Prilosec, and then it was changed to Nexium as the end of Prilosec's patent protection approached. He told me that comparisons between the two drugs were done with 20mg of Prilosec compared to 40mg of Nexium, and that's why Nexium was "more effective." It was intentionally done deceptively to make Nexium look more appealing to physicians.

Beyond this, Nexium is probably the most expensive PPI on the market. AcipHex, Protonix, and Prilosec are all less expensive in my experience.

While I'm not aware of anything that's a close analog of tagaserod, you may wish to call up Novartis and take advantage of their patient assitance program which should help your monthly expenses some. Maybe some of the docs reading here can come up with a better idea.

"Where are all these greedy, unappreciative, demanding patients you all refer to? I mean does that really happen to any significant degree, any where other than your minds?"

I worked a very short shift today (temp fill-in for someone else). In the 3.5 hours I was there, we had two complaints from patients about their doctors that I overheard. One specifically called his a "primadonna who doesn't like to work on Fridays."* This is a very normal occurrence. You can bet your sweet ass there's a great deal of enmity towards the health profession and doctors. Usually more from the uneducated types -- as a rule it comes from the uneducated, lower-income demographic.

* I happen to personally know this doctor. She gets prescriptions filled at our pharmacy once in a great while. She's a wily woman, and an incredibly hard worker, and she's also a lot of fun to talk to. There's a good chance she simply opted to take Friday and make it a long weekend. (The horror!) We sent her an electronic refill request today (Saturday) and we had authorization not 90 minutes later, so she's obviously working even if she's not in the office. The ignorance is mind-boggling, really. Doctors aren't machines, but people don't seem to understand this. Or if they do, they just don't care. Jealousy, I wonder?
 

To sum up, physicians want even more money, but want to keep their patients from recovering what most of them make in less than 2 years if they screw up. Sounds fair.
 

To the patient who can't afford her Nexium and Zelnorm -

Go to the drug company websites for those medicines; there will be links to their drug assistance programs, and they will likely have 800 numbers you can call to find out what's available to you.

I just had to go through this for the drug Lyrica, which my insurer won't cover. Pfizer does have discounted prices for people who have no drug coverage (but do have medical insurance); they offer about a 25% discount, and you can still have a moderate income to qualify.

And call around to the pharmacies in your area and get price quotes. These are the prices I got for thirty 300 mg Lyrica capsules: Walmart-$62, Target-$64, my local grocery store-$77; and CVS-$80. It really pays to shop around.

Even if your specialist won't help you, still let him/her know how much you are paying. I've sometimes had doctors who had no idea how much certain drugs cost. I think there are still some with the mentality of 'The patient will only have a $20 copay, so who cares how much the drug is.'
 

"To sum up, physicians want even more money, but want to keep their patients from recovering what most of them make in less than 2 years if they screw up. Sounds fair."

Fair it is. And for irony, consider what the states generally think is reasonable liability coverage for Joe Sixpack who has a far greater chance of maiming you with his pickup on a Saturday night than the doctor who will be waiting for you in the ER when you roll in the door.
 

And it IS saturday night tonight. My state's liability limit is 15/30K. Of course only 2/3 of drivers have insurance. It is easy to go after docs they have insurance.
 

It's easy to go after docs? How many times have you done it? Got tens of thousands laying around to sue a doctor with?
 

I wanted to thank you guys for all your suggestions about nexium and zelnorm. I will certainly check into some of this. I have an EGD in 2 weeks so maybe I can talk serious to my doc. then. I appreciate this info!
 

Dear dum-dum,

My dad was a salesman. I grew up two blocks from the projects. I went to college on scholarship and owe >$100,000 in debt. After being out of residency 5 years I live in a community of renters, some of which are section 8. The price of my house was $115,000 because I bought a fixer-upper. I drive a 1997 honda civic and get my clothes from JC Penneys. My "family and friends" were blown away that I did so well in college and told me to do whatever I could. Very few people that aren't doctors know the economic realities of medicine. Additionally, very few acadmic physicians do either.

Your assumption that "we all knew what we were getting into was wrong". If I wanted to go be a plumber after residency, I couldn't do it. There was no other job I could do to make enough to pay off my debt. Some would call this indentured servitude.

Perhaps my verbal skills aren't very good, but my analytical skills clearly exceed yours. Please continue to ignore reality. I'm sure its working great for you.
b
 

"Got tens of thousands laying around to sue a doctor with?"

I am sure you do counsler if you think you have a case.
 

b, I'm not the dum-dum..Atleast not the one you're addressing here but that title could be debateable in reference to me..

I have been reading here for many months now. I had no idea things in the medical profession were so screwed up until then. I wish instead of patients and doctors being on seperate sides of this that we could all fight together to solve some of these problems. But, how? I wish I had the answers, but I'm afraid i don't.

Like you, many of us patients are also angry at the same people you are. Namely, patients and attorney's who file frivialous lawsuits. It has certainly effected the way physicians view their patients, who for the most part don't deserve the distrust that we know our Drs. have for us. In turn making us apprehensive causing us to lose respect for them. Where in the hell is the answer?
 

Physicians constantly claim that the average debt load is over $100,000. Where does this number come from?

There appeared to be only a couple of public schools in the Top 25 of the latest US News ranking of med schools. Its in-state tuition cost was under $12,000/yr. Is every other public school this inexpensive? Or do you all just choose to go private?
 

Tuition may be the least expensive cost if you are going to a well-supported state university and are eligible for in-state rates and can gain admission as a state resident. Texas schools were once like this as were California schools. But getting into a U.California school as a non-resident is very difficult and non-resident tuition is often deliberately prohibitive to discourage out-of-state applicants. (Univ. of Colorado once had the distinction of having the highest tuition rate in the nation, over $30,000, for non-residents; at that time residents were charged about $4,000/year at the same school). So choosing a low-cost in-state school is sometimes not an option. My own home state of Pennsylvania has pretty expensive state resident rates for its state-affiliated schools, all of which are technically private and independent anyway (U. of Pittsburgh, Milton Hershey-Penn State, Temple Univ.).

These days, with living costs, fees, tuition all considered, most state university students' budgets well exceed $25,000 per year, and private independent schools can be double that. There isn't much financial aid available in the way of scholarship or grant money, having a part-time job that generates a meaningful amount of income is almost impossible with a full-time med school schedule. The military HPSP program is one funding option (which is not a free ride, believe me). So most students borrow heavily. And to that you can add any existing undergraduate debts, which themselves can be formidable. I would say $100,000 is a modest debt.
 

"Like you, many of us patients are also angry at the same people you are. Namely, patients and attorney's who file frivialous lawsuits. It has certainly effected the way physicians view their patients, who for the most part don't deserve the distrust that we know our Drs. have for us."

I agree 100%.

I was very fortunate to have an excellent relationship with a periodontist a few years ago (for two gum graft procedures). This man actually gives his home phone number to patients! I had to use it once, too, on a Sunday, due to a bleeding problem. Talked first to his wife, who was extremely nice, and then the doctor, who made a few suggestions that I could try but also offered to open the office for me. A few hours later, of his own accord, he called me back to see if his suggestions had worked (they did). After the procedures were over, I thanked him for being so helpful, and he thanked me for being a good patient. (Cue "Kumbaya"...)

I recommend that doctor to others every chance I get. Don't know if he's wealthy or not, but he sure seemed to enjoy his work, and his staff seemed to love working for him.
 

Tuition may actually be less than half of the amount borrowed to cover medical school. Unless you are lucky enough to be able to attend a school close to home and can live with family, living expenses can top $20,000 or more, which is had to be included in the amounts borrowed. Student housing ain't free!

Just as in undergraduate- it cost about $13,000 per year at my state school: tuition was $5,000 per year, and the room/board was $8,000.

There are some public schools with relatively modest tution, but not most. The only one in my state (University of Maryland) now costs around $18,000 per year, and again, that's just the tuition. A lot of private schools cost $30,000, and some even top out at around $40,000 or more per year.

Factor in undergraduate debt (mine was about $25,000), living expenses and interest, and there are those who student loan debt might easily top even $200,000 by the time they're done.

For someone with no undergraduate debt, attending a cheap state school, and living with their parents (or a spouse who is working), they might get away with a debt of $50,000. But that's a rare exception.
 

So in other words, in order to live the way you want, you have to take on more debt? If that's the choice you made, why should people feel sorry for you when you have to pay that debt off?
 

I lived in a roach-infested studio in the worst section of St Louis. We had break-ins, rapes, muggings, and carjackings daily. I drove a 15 year old used ford that broke down monthly. And today? I am $250,000 in debt due to student loans. So don't give me that "to live the way you want" crap. I am out and working now and I live with my elderly mother to save money. I do not own a house or a car or a boat or any of those trappings people assume doctors all own. I have a bedroom and a gerbil. The condescending commentary implying that student doctors/doctors live the high life applies only to a select few.
 

He is a clueless idiot doc, why waste your time.
 

Your $250K in student loans. Where did you go to school and why did you choose it? What were you grades? You made those choices, didn't you?

And I don't know about the high life, but your average salary is $150,000, and $250K if you're a surgeon. That puts you in the top 1% of all American earners. For that to be the average, it must be more than just a "select few".
 

The only school I got into was a private out of state school. I did not have a choice. And as a primary care doctor? I am salaried at $120,000. That is the avergae for where I live, and I live here to take care of my elderly widowed mother. My student loan payments are $3000 a month. You need to stop generalizing. Some of us docs came from poor families and are in a bad way financially, yes by choice, because we love the profession and helping people. Call me in 30 years when I write my last student loan check...then I will feel like the top 1%.
 

"The only school I got into was a private out of state school. I did not have a choice."

Why was that? Were your grades not high enough to get in to your local public in-state institution? If that was the case, whose fault was that?

And if you're paying $3000/mo on student loans, then you've chosen a pretty aggressive payoff plan. But you're still the top 1% right now, whether you feel like it or not.

If you feel like you have it bad, how do you think those who don't have free room and board and have to support a family on less than 1/3 of what you make feel.
 

Dear dum-dum,

It is clear that you aren't interesting in sharing information and you are just trying to bait us. Great attitude. i'm sure that will benefit you in the long run.
b
 

" But you're still the top 1% right now, whether you feel like it or not."

Not true. Probably not even the top 5% even. Subtract the variable-interest HEAL and other loan payments and you probably arent even in the top 20%. And don't forget that while you were borrowing and not working while in medical school, you made no contributions to personal savings or retirement plans. Too bad that those contributions, now forgone, would have earned you substantially greater returns than most of the later and more accelerated contributions you will have to make so that someday you can retire. Oh don't forget, no defined benefits or company participation; retirement is 100% on your dime. Hope the late start doesn't get you down too much (Anonymous moron 3:56 p.m. hasn't thought of that though, too busy pimpin' poverty).

"Why was that? Were your grades not high enough to get in to your local public in-state institution? If that was the case, whose fault was that?"

Who says grades are all that make up an admissions committee's decision? Maybe he isn't the desired sex or race or whatever for the committee? Maybe he was honest in his interview and said he wanted to do surgery, and the committee was seeking family practitioner wannabees. Acceptances are not just an exercise in intelligence and stamina, sometimes it comes down to luck, good and bad. Whose fault indeed, you idiot? Bakke didn't change anything, except for Dr. Bakke.


"If you feel like you have it bad, how do you think those who don't have free room and board and have to support a family on less than 1/3 of what you make feel."

Sorry, I missed that free room and board part. Where do you get that? Silly me, I paid real money for those things. Think what I could have saved. Have to support a family? Isn't that the normal thing for people to do when they choose to have a family? And why is it any more a doctor's choice to seek a higher-paying career, time and costs notwithstanding, than it is for someone to choose something else that pays less? Or, Anon. 3:56, are those who choose not to delay starting a household and family and enter the work force with lesser or at least lesser-compensated skills somehow "victims" of their circumstances and others are not? No one says you have to be an underappreciated and low-paid kindergarten teacher either. So enough with your pimpin' self.
 

"Not true. Probably not even the top 5% even. Subtract the variable-interest HEAL and other loan payments and you probably arent even in the top 20%."

You need to get a better understanding of just how much the average American makes.
 

The top 1% earn in excess of $374,000 per year.
The top 5% earn $150,000 or more
The median income in 2004 was somewhere around $43,000.

I don't think you are in a position to be preaching to me or anyone what they should be knowing about what others do or don't earn. Any doctor in practice is well familiar with earning less than the median, as that is the scale usually paid to house officers. You are living in a delusional world if you think doctors live all their lives in a cocoon of a high-income lifestyle.

You don't know what you are writing about. Why should I consider your advice?
 

wow...let the bitterness roll huh? well i'll say this: it seems to me that everyone who has ventured to give an opinion here is extremely jaded when it comes to the medical profession and at the same time extremely misinformed. The fact is that being a physician is a highly rewarding job, both emotionally and financially. There are some specialties that demand a significant amount of dedication and average a very high work load. But as some here pointed out, you do, in-fact, know what you are getting into. If you manage to stay awake or attend you medical business and management classes then you are aware of the problems faced such as overhead, healthcare finance, insurance problems/headaches, and yes the ever-burdensome debt situation created by the cost a quality medical education. These things are not new and with the exception of an unfortunate few, they rarely actually stop graduating physicians from becoming relatively successful and financial “well of”, so to speak. You also know what you are getting into as far work load and family time goes. People that choose to be cardio-thoracic surgeons know that they will be forced to make many sacrifices when it comes to time and stress. If family time is not something you are willing to compromise, such as the gentlemen that chose pharmacy (RJS) instead of medicine, then you can simply choose a specialty that has a much less demanding schedule. Something like what I chose, Radiology. I racked up 150,000 dollars in debt, kept my grades high so that I could have my pick of residencies, chose radiology, finished my residency and started out at about 200,000 dollars a year. I lived as thought I made 100,000 dollars a year, for about 2 years, after which I was debt free and in a lucrative career where my salary did nothing but increase. I work 5 days a week, sometimes 4. I get home everyday around 6 and spend the evenings loving my wife and planning a family. Many of my friends are doctors and, while they’ve chosen different specialties, they have all managed to not let the debt incurred have a damaging affect on the life that they live. And well one friend is a surgeon, and works long hours, and another is a anesthesiologist and works about 6 hours a day, we all knew what we were getting into. Anyone that says that they were not aware of the demands and/or downsides of the business must have been living in a cave through medical school, because at every corner there is a doctor waiting to tell you what a tough road you have ahead of you and believe me they go into great detail. And as far as docs wanting more money…yes and no. so are not happy in their practice because of a bad insurance situation or a compliance and freedom issue or lots of other things that may take away from salaries. But they simply want what is due to them. Anyone would agree that spending 7+ years in school learning how to make the lives of other humans better and longer deserves to be in the top 5% of the country. Those of us that have produced good situations for ourselves don’t just want more money, in all honesty I often give my services away for free because a patient maybe having financial problems and I don’t necessarily need their 500 dollars, but they do really need that MRI guided biopsy. So my point I guess is well I guess I don’t have a point, just trying to shed some light from somewhere not as angry as all of you seem to be…
 

Dear Anonymous 11:05 pm:

I am a 17-year old high school student going into my senior year with decent grades and slightly above average SAT scores, and I have always had aspirations of a medicinal vocation. I know that I have the ability to get a 4.0, but I haven't always applied myself and wasn't given a good picture of how serious high school was my first few years. I accredit this to my dad, who I live with, who makes around $30,000 a year as a welder and has no experience with college life. Needless to say, I am in the process of devoting huge effort to trying to polish my high school career as best I can with all the advanced classes I can take and a raise in GPA with the hopes of being accepted into a semi-prestigious school where I plan to be at the top of my class and major in pre-med(easier said than done, I realize, but bear with me).

I have a very close friend whose mother is a pediatrician and whose father, living in another state, is a cardiothoracic surgeon(my previous career dream) earning well in the upper half of six figures. Having spent considerable time with this person and having a fairly accurate insight into the more stressful, demanding side of the medical profession, I was wondering if you might give me any professional insight or advice as to some less-stressful, but equally lucrative specializations in the medical field such as your own.

Until meeting this person I was under the impression that so many suffer from-that all doctors have wonderful family lives, ample free time and still receive the huge financial benefits-I know that these things, factors of life which I have always hoped for, are attainable within the medical field, but I am not sure exactly which professions would fit the profile. I have always recognized that significant family time, truly enjoyable and mostly stress-free work are more important than overall earnings, and hope to find these things in a career. Having briefly perused some physician salary charts, I know that there is a huge range of salaries(noting the top $1,352,000 for ORS-Spine Surgery) and that not all of these specializations are so time-demanding, and was just wonering if you could offer any advice on the subject. Thank you for your time.
 

Become a drug or device rep. Work 4 hours a day. Sit back and laugh at all of the disgruntled docs. Make lots of money. Retire early.
 

This is an old thread, but I feel the need to add a few things. The problem isn't that a doc can or can not live a good life. The problem is that it is really not worth it to be a primary care physician. We need, primary care, and with an aging population, we will need even more Internal medicine primary care docs. The salaries are not going up (not even with inflation) due to decreasing payouts (insurance companies follow medicare, and with medicare, there is the Sustainable Growth Rate (SGR) to contend with). Therefore, the compensation, in real value is going down while the costs of the education, and overhead to practice are going up. At some point (some point soon) it will be unreasonable for a med school graduate to choose a primary care residency. These are very capable people. They can choose to do something else. If practicing medicine does not allow them to pay their debts, they will choose something else to do. Worse yet, when the word gets out about all this, we will not have the best and the brightest in medical school anymore. The shortage of doctors is on its way, and it is going to be very uncomfortable for all. The total amount of money spent on healthcare in the US is going up (much faster than inflation). I already discussed physician salaries. Where is the money going? This is really quite obvious: Big pharma. The cost of drugs is the one thing that doctors, insurance, and even medicare (part D) cannot control.