Current M1 here. I am a city person but from what I heard, jobs in big cities do not pay you well. I am an average student and not aiming for ultra-competitive specialities like neurosurgery. Realistically speaking, what specialty would allow me to bring home $300K/yr after tax working in a big city or the suburb area of SF/boston/nyc, while also has good work-life balance?
Which specialty pays you well in urban area like nyc/boston/sf
- Thread starter Jan192020
- Start date
- Joined
- Oct 27, 2017
- Messages
- 138
- Reaction score
- 132
Derm
less lifestyle Rads, Anesthesia
no lifestyle, anything surgical will get you at 300k even in big cities
less lifestyle Rads, Anesthesia
no lifestyle, anything surgical will get you at 300k even in big cities
The answer is not going to be different in terms of rank order than if you asked the same question anywhere else in the country. The big cities have markets that are relatively more saturated for physicians than for rural areas. But the top earners are still going to be the surgical subspecialties. Lifestyle specialties like derm are still going to be lifestyle specialties.
The other consideration is that if you want to go into internal medicine or something that's not traditionally considered a cushy lifestyle, then you could look into concierge medicine. The higher the price tag, the higher the credentials have to be (in general) but it's an option.
The other consideration is that if you want to go into internal medicine or something that's not traditionally considered a cushy lifestyle, then you could look into concierge medicine. The higher the price tag, the higher the credentials have to be (in general) but it's an option.
- Joined
- Jul 15, 2017
- Messages
- 865
- Reaction score
- 1,611
Realistically speaking? No specialty will get you this, particularly as in some of the cities you name you'd be looking over $400K/year pre-tax for that salary. The closest you'd get would be in an outpatient surgical subspecialty or dermatology practice that is outcompeting the wide competition.
You want a good lifestyle in a desirable city while making more than the average physician. Pick two of those things and compromise. Also note that NY and MA are close to the bottom of the list for physician salaries by state.
- Joined
- Jun 28, 2010
- Messages
- 847
- Reaction score
- 604
Not much use trying to predict compensation now if you're an M1 now. Compensation can change significantly even in a few years and especially in 7-10 years from now (the amount of time you from now when you would be expected to be an attending). For example, the compensation gap for primary care and specialists on a per hour basis is already smaller than it was several decades ago and it's possible that CMS will continue to increase reimbursements for primary care services down the line (and at the same time reduce reimbursements for many specialists) until the pay difference is even smaller. And statistically speaking there's a very high chance that the specialty you are interested in during M1 won't be the specialty you end up doing.
$300k after tax would equal $430-$450k pre-tax. While more senior physicians can make those amounts in big cities now in many specialties with reasonable workload, the new attendings right out of residency/fellowship will have to work longer hours and see higher patient volumes to make that much. So probably would not count on having good work-balance AND making that much right out of training.
In big cities, more physicians work in academic medicine which generally pays a lot lower, especially straight out of training. And most PP groups will try to take advantage of the new grads too. And there's a lot more competition to attract the wealthier cash-paying patients so don't expect to have a large panel of cash paying concierge patients right of of training.
The other option would be to do telemedicine which basically allows you to live anywhere. Right now telemedicine tends to pay a bit lower than the average salary in the corresponding specialty (and the difference is a lot lower for procedural specialties since you obviously can't do procedures over telemed) and the patient volume often isn't high enough to balance out the high supply of individual providers and health systems trying to get in telemedicine so it's hard to count on it as your full time job. However that may change 10 years for now. Radiology may be able to do telerads full time now, but many suspect the job market for rads is going to be much tighter in the coming years with AI advancements or outsourcing telerads to foreign countries reducing the need for radiologists.
Last edited:
- Joined
- Jun 8, 2008
- Messages
- 2,500
- Reaction score
- 3,875
Investment banking.
- Joined
- Apr 14, 2019
- Messages
- 33
- Reaction score
- 23
Haven't the high compensating fields not changed over the past decade? Numbers might have changed but it seems like the order hasn't.
- Joined
- Sep 21, 2010
- Messages
- 12
- Reaction score
- 7
The 10 Highest-Paid Specialties
- Plastic Surgery $526,000 (up 10%)
- Orthopedics/Orthopedic Surgery $511,000 (steady)
- Cardiology $459,000 (up 5%)
- Urology $427,000 (up 2%)
- Otolaryngology $417,000 (down 8%)
- Radiology $413,000 (down 3%)
- Gastroenterology $406,000 (down 3%)
- Oncology $403,000 (up 7%)
- Dermatology $394,000 (down 4%)
- Ophthalmology $379,000 (steady)
Last edited:
- Joined
- Apr 7, 2017
- Messages
- 742
- Reaction score
- 410
this is the brutal but real truth as someone from one of the cities on your list, big cities are not worth it to live in unless you are independently wealthy or you really think losing over half your income is worth it to say you're from city X. You dont have to go full on rural middle of nowhere with population of 300 to get the things you want but certainly not a big city
- Joined
- Jun 7, 2010
- Messages
- 3,130
- Reaction score
- 10,125
This x100.
Physicians simply get crushed with taxes and big cities are the worst. Market saturation also makes it more challenging to get into a well-run private group with a solid partnership track which is where you can start to blow these salary numbers out of the water.
For San Francisco it's pretty easy to figure out what people are making since state salaries are all public record. I just pulled up a random UCSF IM assistant professor and they made $298k in 2019 including benefits. A full professor in the same year was $498k including benefits. Another assistant was $230k including benefits. For Ortho, assistant prof was at $522k, full at $635k. I'm sure there's a lot of variation; those were just the first ones I looked up.
So the answer holds: the same highest paid fields elsewhere are also high paid in the cities. Making $300k take home after federal and state and city taxes needs a $500k+ income. It's probably doable after some time, but starting salaries in those saturated markets will likely not be that high outside the most in-demand fields.
There can definitely be outliers. Someday I'm going to do an observership at UCLA to see how so many of their faculty are in the 7 figures!
- Joined
- Jan 25, 2007
- Messages
- 1,077
- Reaction score
- 1,962
Not gonna happen for you my man. 300k "take home" after taxes, benefits, retirement needs at least 500/year. You won't be making anything near that in a big city with a job with a good work-life balance.
- Joined
- Jun 28, 2010
- Messages
- 847
- Reaction score
- 604
The high average listed salaries for the traditional high-paying specialties like derm or the surgical sub-specialties is largely an illusion. If your only goal is to accumulate as much wealth as possible over your career these specialties barely come out ahead in the end (or maybe just even out or do worse) when compared to primary care specialties like FM. Their perceived advantage of making an additional $100-200k every year in practice (compared to primary care) may seem like a lot and you would think in a 30 year career would lead to significantly more wealth when making $500k per year than $300k. But these specialties have several major financial drawbacks that offset their higher salary so in the end you
1) Very high tax brackets - depending on the state you live in you're probably looking at the 45-50% marginal tax brackets (once you consider federal, FICA, and state/local taxes combined) so even an an extra $150k per year drops down to only an extra $75k yer pear. And as mentioned above tax rates are the often the highest in big cities.
2) Longer training time and thus less years making an attending salary and less time to capitalize on investment gains - specialist training is often around 3 years longer than doing general IM/FM especially when you consider that many take research years off during med school. That's 3 years of less attending income which might not seem like a lot in a 30-year career, but those early years of attending salary are crucial for any smart investor who understands the benefits compounding interest and wants to acquire a larger principle to invest. For example, the long-term return of the U.S. stock market averages close to 10% per year a good investor who can consistently beat those returns (even by a few percentage points) will come out way ahead if they have access to sufficient capital to invest in.
3) High malpractice premiums - this is a major issue in many of the high-paying surgical subspecialties like neurosurgery and also in OB/gyn, and the worst in big cities (where malpractice lawsuit risk is the highest) and especially in private practice. Premiums for high risk-specialties can reach over $200k per year which largely offsets a lot of the high income you may be making.
This video somewhat explains it () but basically if money is your goal you should find career that pays a high at an early age.
1) Very high tax brackets - depending on the state you live in you're probably looking at the 45-50% marginal tax brackets (once you consider federal, FICA, and state/local taxes combined) so even an an extra $150k per year drops down to only an extra $75k yer pear. And as mentioned above tax rates are the often the highest in big cities.
2) Longer training time and thus less years making an attending salary and less time to capitalize on investment gains - specialist training is often around 3 years longer than doing general IM/FM especially when you consider that many take research years off during med school. That's 3 years of less attending income which might not seem like a lot in a 30-year career, but those early years of attending salary are crucial for any smart investor who understands the benefits compounding interest and wants to acquire a larger principle to invest. For example, the long-term return of the U.S. stock market averages close to 10% per year a good investor who can consistently beat those returns (even by a few percentage points) will come out way ahead if they have access to sufficient capital to invest in.
3) High malpractice premiums - this is a major issue in many of the high-paying surgical subspecialties like neurosurgery and also in OB/gyn, and the worst in big cities (where malpractice lawsuit risk is the highest) and especially in private practice. Premiums for high risk-specialties can reach over $200k per year which largely offsets a lot of the high income you may be making.
This video somewhat explains it () but basically if money is your goal you should find career that pays a high at an early age.
- Joined
- Aug 27, 2020
- Messages
- 28
- Reaction score
- 16
What would job prospects/saturation look like in a suburb near a large city? I’m other words, I don’t have to live in the city, just in the area. How far do I need to work to see a good decline in saturation and bump in pay?
- Joined
- May 21, 2013
- Messages
- 3,910
- Reaction score
- 6,255
Easy, marry another high income earner to help carry the load. Pick a specialty that allows private practice. You will make more without other people benefiting from your hard work.
Really variable. Depends on the city. But from my experience over an hour away at least. In some cases significantly more.
- Joined
- Jul 15, 2017
- Messages
- 865
- Reaction score
- 1,611
I would estimate at least a 90 minute drive, likely (much) more on the east coast.
Where I'm at people will commute/move to a city about 20% of the size that is 140 miles away for a ~30-40% pay increase.
- Joined
- May 21, 2013
- Messages
- 3,910
- Reaction score
- 6,255
The problem is that while docs make really good money a lot of these cities also force docs and other high income earners outside of major cities in these suburb areas so these areas are also competitive as well and pay is lower.
- Joined
- Jan 6, 2013
- Messages
- 2,251
- Reaction score
- 3,241
There's other cities in the US with mostly equivalent cultural life to the ones you listed that have better pay to COL ratios. Maybe you should look into those...?
- Joined
- May 16, 2020
- Messages
- 1,670
- Reaction score
- 4,308
When you are too far to commute—say 1 1/2 to 2 hours away.
- Joined
- Nov 24, 2007
- Messages
- 8,340
- Reaction score
- 9,388
You could likely meet your income target in any of the higher paying specialties in a small city in the Midwest or South. Ideally you would join a private practice on a short partner track.
Having said that, you wanted a good lifestyle. So in order to make the income that you’re looking for in a lifestyle job really need to own the practice, own an ambulatory surgery center, etc. That way you could be collecting facility fees for the things that were being done there in addition to your income. Or else you would need to work part time in a really high paying specialty. That’s not as easy as it sounds because of the nature of many of the high-paying specialties.
If you drop your income target to a much more reasonable hundred thousand dollars less, you won’t have any problem finding what you want in most specialties pretty much anywhere as long as you get into a good job or practice, meaning better than average quality and/or payer mix.
Having said that, you wanted a good lifestyle. So in order to make the income that you’re looking for in a lifestyle job really need to own the practice, own an ambulatory surgery center, etc. That way you could be collecting facility fees for the things that were being done there in addition to your income. Or else you would need to work part time in a really high paying specialty. That’s not as easy as it sounds because of the nature of many of the high-paying specialties.
If you drop your income target to a much more reasonable hundred thousand dollars less, you won’t have any problem finding what you want in most specialties pretty much anywhere as long as you get into a good job or practice, meaning better than average quality and/or payer mix.
Last edited:
- Joined
- Aug 3, 2015
- Messages
- 66
- Reaction score
- 201
OP, you could check out this thread for some insight:
Here's one quote I appreciated-
"US East Coast in suburbs of Washington DC
Specialty: ENT (Otorhinolaryngology), 2 years out of fellowship
Deferred student loans during residency (5 yrs) + fellowship (1 yr) to the tune of $480K. Add in $240K from my wife's undergrad + grad school, so about $725K in loans when I started repaying as a new attending.
Currently in the first 2 years at a private practice earning base $200K/yr with bonus totaling about $50K/yr, although right now not earning much bonus due to dramatic decrease in patient and surgical volume. Theoretically, when we open back up and I make partner later this year, that number is likely to jump up to around $450-550K/yr.
When at full capacity, I work about 55 hours a week with 2 weeks of paid call per year at our large community (800 bed) hospital, which rivals my residency call in terms of volume, acuity, and complexity. I took a 3 week vacation before starting work in Aug 2018, and haven't really taken more than 4 days off at a time since then, although hopefully once we pay off our debts in about 4 years, I can ease up off the gas pedal a bit!
No kids (trying later this year after coronavirus is a bit better controlled, hopefully), 1 dog, renting a 2000 sq ft townhouse for about $3800/mo. We own both of our cars. Currently trying to live on about $2500/mo for living expenses, and the other $15K+ of my salary goes to student loans and estimated taxes (being self-employed is a real eye-opener, haha)."
Here's one quote I appreciated-
"US East Coast in suburbs of Washington DC
Specialty: ENT (Otorhinolaryngology), 2 years out of fellowship
Deferred student loans during residency (5 yrs) + fellowship (1 yr) to the tune of $480K. Add in $240K from my wife's undergrad + grad school, so about $725K in loans when I started repaying as a new attending.
Currently in the first 2 years at a private practice earning base $200K/yr with bonus totaling about $50K/yr, although right now not earning much bonus due to dramatic decrease in patient and surgical volume. Theoretically, when we open back up and I make partner later this year, that number is likely to jump up to around $450-550K/yr.
When at full capacity, I work about 55 hours a week with 2 weeks of paid call per year at our large community (800 bed) hospital, which rivals my residency call in terms of volume, acuity, and complexity. I took a 3 week vacation before starting work in Aug 2018, and haven't really taken more than 4 days off at a time since then, although hopefully once we pay off our debts in about 4 years, I can ease up off the gas pedal a bit!
No kids (trying later this year after coronavirus is a bit better controlled, hopefully), 1 dog, renting a 2000 sq ft townhouse for about $3800/mo. We own both of our cars. Currently trying to live on about $2500/mo for living expenses, and the other $15K+ of my salary goes to student loans and estimated taxes (being self-employed is a real eye-opener, haha)."
- Joined
- Jun 8, 2018
- Messages
- 381
- Reaction score
- 556
What if you were a telerad who could read quickly?
- Joined
- Dec 21, 2007
- Messages
- 2,077
- Reaction score
- 2,930
- Joined
- Jan 25, 2007
- Messages
- 1,077
- Reaction score
- 1,962
Telerad pays bottom of the barrel rates per study. It's rarely a good option and difficult to keep up the volume needed to achieve a good salary.
- Joined
- Aug 3, 2015
- Messages
- 66
- Reaction score
- 201
That price-tag implies to me that this individual is within <30 mins of downtown DC. As someone who'd also like to live within a major metro area that post-partnership salary seems like more than enough!
- Joined
- Aug 3, 2015
- Messages
- 66
- Reaction score
- 201
Another surgical subspecialty quote from previously mentioned thread:
"I generally don't like the humblebrag about salary/specialty etc but in a semi-professional setting it hopefully helps people earlier in training get a sense for what is out there.
ENT private practice, non-fellowship trained. Midwest. Wife also physician, part time. Did 3 years with practice at 400k (includes what I got for productivity bonus). New contract at 550-600k with room to go up depending on productivity. Option to buy-in although everything is currently on hold with COVID-19. I take call 1 in 4 weeks, operate 2 days a week and see clinic the other 3 to 3 1/2 days, average 100+ clinic patients a week. Last year my personal collections (not what gets billed but what is collected) were around 1.2m hence the higher contract coming. Looking to expand into allergy which may open up another revenue stream.
5500sq ft house with another 2500sq ft unfinished basement, 4 young kids (6, 4, 3, 1). Outside of the house and kids, I'm pretty cheap. All student debt paid off, two minivans (necessary) and a paid off subaru outback. 1-2 family vacations a year where we drive to see family or do something fairly low key like rent a cottage on the coast for a week. Maxing out 401k, IRA's, funding 529's adequately and saving a large chunk of post-tax money in index funds for retirement. My biggest hobby is PC gaming so I have a good computer and spend very little outside of that. We did splurge for a Peloton 2 years ago which has been great for my health. We eat out once a month (date night), do a lot of home cooking and simple kid meals because when you have 4 little ones all they really want is kraft macaroni, pasta, hot dogs and chicken nuggets! My kids are my luxury splurge, we are thinking of having a 5th because they are so awesome, and I'm fine spending all my money to support them. I still wear the clothes I had in medical school, until I find out my wife has thrown something away because it looks too old and buys me something else to wear."
"I generally don't like the humblebrag about salary/specialty etc but in a semi-professional setting it hopefully helps people earlier in training get a sense for what is out there.
ENT private practice, non-fellowship trained. Midwest. Wife also physician, part time. Did 3 years with practice at 400k (includes what I got for productivity bonus). New contract at 550-600k with room to go up depending on productivity. Option to buy-in although everything is currently on hold with COVID-19. I take call 1 in 4 weeks, operate 2 days a week and see clinic the other 3 to 3 1/2 days, average 100+ clinic patients a week. Last year my personal collections (not what gets billed but what is collected) were around 1.2m hence the higher contract coming. Looking to expand into allergy which may open up another revenue stream.
5500sq ft house with another 2500sq ft unfinished basement, 4 young kids (6, 4, 3, 1). Outside of the house and kids, I'm pretty cheap. All student debt paid off, two minivans (necessary) and a paid off subaru outback. 1-2 family vacations a year where we drive to see family or do something fairly low key like rent a cottage on the coast for a week. Maxing out 401k, IRA's, funding 529's adequately and saving a large chunk of post-tax money in index funds for retirement. My biggest hobby is PC gaming so I have a good computer and spend very little outside of that. We did splurge for a Peloton 2 years ago which has been great for my health. We eat out once a month (date night), do a lot of home cooking and simple kid meals because when you have 4 little ones all they really want is kraft macaroni, pasta, hot dogs and chicken nuggets! My kids are my luxury splurge, we are thinking of having a 5th because they are so awesome, and I'm fine spending all my money to support them. I still wear the clothes I had in medical school, until I find out my wife has thrown something away because it looks too old and buys me something else to wear."
In your opinion, right....
Impossible to answer this in broad strokes. But that doesn't mean we can't try. In general, healthcare still responds to market forces. When you work in an area that's saturated, you're going to have lower demand for your specific services and therefore you will be paid less. This is true within each specialty. The ranking between specialties for salaries still holds. A neurosurgeon is going to make more than a hospitalist in a given market. These are, of course, broad strokes. You can be an internist practicing concierge medicine and bring in a whole lot of money even in those cities. But that's a very specific case. Academic versus private practice is also different. So if you're truly interested in salary, then you should look at some of the MGMA reports on specialty which also provides a regional breakdown.
- Joined
- Dec 21, 2007
- Messages
- 2,077
- Reaction score
- 2,930
I more meant the part about making 250K working 55 hours a week and not taking more than 4 days off in a row in 3 years. That is idiocy.
The townhouse is stupid too but I at least get that even if it's completely overpriced.
- Joined
- Jun 8, 2018
- Messages
- 381
- Reaction score
- 556
Obviously the implication is that bottom barrel rates/study = low pay, but we can't really compare the efficiency of a telerad in reading studies to one who is actually working at a practice right? If 100% of your time is spent on interpreting studies and 0 on protocoling, talking with techs, other rads, etc, and there's an unlimited amount of studies to read, it seems like depending on the person you could do well for yourself, even if you're $/rvu is far less than what you'd capture at a PP. Also, obviously corporate tele is going to give you the worst rates, but couldn't you try and act as a relief for various PPs?
Also, if you were in a highly desirable locale, it's not like we're comparing the salary you'd get at some midwestern PP
- Joined
- Jan 25, 2007
- Messages
- 1,077
- Reaction score
- 1,962
in general it doesn't come out that way. almost all PP make more than telerad. the rates are so insultingly low that even with more volume you don't get there.
investors gotta get paid
- Joined
- Jun 8, 2018
- Messages
- 381
- Reaction score
- 556
Interesting. Thats pretty cool because the few telerads ive spoke to make above the median rad salary, all from home. Hopefully PP is even higher then which is probably what id want to do, especially considering WFH is becoming more common.
- Joined
- Jul 14, 2018
- Messages
- 225
- Reaction score
- 254
I mean of course. BUT we must be aware that some of the people who condemn rural living or "need to live in a city" have never actually lived in a rural setting for any significant period of time. Anecdotally as myself, I can say that I lived in a suburb of NYC/Philadelphia as an adolescent, where the prevailing messaging is that you live outside of a city therefore you should move into a city if you want to experience something. I'd call that dishonest messaging as I now live in a rural setting and its S-tier better than A1 sauce. I've also lived in a major city, and can attest that its cool, but its got some massive drawbacks. Also, urban living is bad for your lungs.
To each their own but I think the good life in urban centers is easy to glamourize and hard to achieve, while the good life in rural settings is hard to glamourize but easy to achieve.
Just look at this thread-- to have lifestyle and acquire wealth (note I wrote wealth, not money), you have to pick one. And that's with a six-figure salary.
In a rural setting, you can work part time, acquire wealth and still have luxury cash to fly into (enter city name here) for the weekend.
Then there is the factor of community-- knowing the faces of your community has immeasurable benefits. In the city I lived in, I could walk by everyone and not care, day in and day out. In fact, it was expected to not care. Insane
Last edited:
- Joined
- May 5, 2011
- Messages
- 27
- Reaction score
- 67
The previous ENT private practice example seems awful - but is likely the result of COVID rather than an actual representation of what a private practice ENT gets paid.
I would assume most surgical subspecialties in private practice would be able to make 300k post tax after a few years at the practice. I wouldnt expect it right out of residency (lets assume 300-400k starting out pre-tax), but once you build up your practice it is certain possible (if not much, much more). Its hugely variable and dependent on the practice, and you have to be willing to hustle. And once you become a partner those numbers can increase astronomically.
I would assume most surgical subspecialties in private practice would be able to make 300k post tax after a few years at the practice. I wouldnt expect it right out of residency (lets assume 300-400k starting out pre-tax), but once you build up your practice it is certain possible (if not much, much more). Its hugely variable and dependent on the practice, and you have to be willing to hustle. And once you become a partner those numbers can increase astronomically.
- Joined
- Oct 21, 2007
- Messages
- 1,180
- Reaction score
- 1,027
This is pure "coastieism". This coastal mania is as dumb as carrots. This guy isn't just on the devil's treadmill financially. He and his wife probably each spend two hours a day in traffic. When they have kids they won't be spending time at the Kennedy Center or the Smithsonian. They'll be battling more traffic. Utterly stupid.
- Joined
- Dec 21, 2007
- Messages
- 2,077
- Reaction score
- 2,930
I dont see how COVID would make a private practice guy work more not less. Unless you're in charge of all the COVID trachs or something. And even then there's no reason to go years without taking a long vacation.
I haven't cracked 45 hours more than a handful of times in a year and I take call at a pretty large level 1 center. And I make way, way more than that guy. So I think that guy is being abused.
- Joined
- Apr 2, 2021
- Messages
- 896
- Reaction score
- 2,806
What? All specialties can work in private practice…..
D
deleted1081396
Rural living is where it's at. You can reach financial independence a decade faster and just make regular trips to your city of choice. Hospitals and insurance companies can't exploit you as easily because they need you and it could take months or years to replace you. And "rural" doesn't have to mean a small town in South Dakota either, it could be somewhere as little as 30 minutes outside a larger city.
I grew up in a pretty rural place and hated it there, maybe because when I was a teenager I didn't have money and couldn't go anywhere. But now that I'm a little older and have lived in cities for 10 years I yearn so strongly for it again...
I grew up in a pretty rural place and hated it there, maybe because when I was a teenager I didn't have money and couldn't go anywhere. But now that I'm a little older and have lived in cities for 10 years I yearn so strongly for it again...
- Joined
- Jun 10, 2017
- Messages
- 1,169
- Reaction score
- 2,193
This video is a joke (and made by someone who dropped out of plastic surgery residency after their intern year to sell interview prep for $299/hour). He assumes anyone going into a speciality (i.e. not primary care) will need an extra year of research/5 years for medical school and anyone going into primary care will need 4 years of residency. Right there you can tell he is not being genuine in his analysis. This is a theme in all "you make more money as a plumber than as a physician" videos/blog posts. They make as many "small" corrections as possible for the physician numbers without outright saying they want a certain outcome.
The funniest "error" to me is that he starts his spreadsheet in 2019 with an engineer salary of $100k and then adds 3% wage growth per year, which all seems very reasonable...except. In 2030 when the engineer is making $138k/year (1.03^11), he uses the 2019 average specialist salary for the first year attending salary in 2030. If you correct for wage growth for doctors and engineers, the specialist has higher lifetime earnings by age 39 instead of by 45. If you take away the crazy assumption that all specialists take 5 years to finish medical school, it is age 38. If we use the correct effective interest rate for student loans of 3% instead of his naive 6%, you beat the engineer by age 37.
He uses an engineer salary of $100k at age 22 when the average starting engineer salary is around $60k; $100k is the average engineer salary for all ages/years of experience. Of course he uses the correct salary during residency which is the equivalent "starting salary" for medical school graduates. I will correct for this by setting a starting engineer salary of $60k that grows $10k every year while the physician is in medical school, so when the medical student starts residency, the engineer is making the average engineer salary (for all ages) at age 26. This still clearly is biased towards the engineer, but it won't help them that much in the long run.
Next, he assumes that both the engineer and physician will have their lifetime earnings invested at 7% which is...interesting. Last I checked you cannot invest your entire paycheck if you want to have a place to live and some ramen to eat. This kind of math would (sort of) make sense if he acknowledged that they will both invest/save/401k 10% of their post-tax pay, or some other set percentage. If he did that though, he would have to acknowledge that starting at age 35ish, the physician is living the lifestyle of someone with >3x the take home income of an engineer. We will correct this by having the physician living on an engineers take home pay and investing the remaining money, with the engineer take home pay being 90% of post tax income. Or in other words, the engineer will invest 10% of their take-home pay and the physician will match the lifestyle of the engineer.
For medical school debt, I will add $50k/year @ 6% during medical school, and 3% interest with no payments during residency (REPAYE payments are income based and tiny, but they do cut the interest rate in half).
At this point, we are calculating lifetime savings/investments while living the same lifestyle after the mid 30s. And what are the result? Well quite honestly, hilarious given the premise of that video.
Of course the actual debate and/or introspection is whether or not working more hours and having a much lower income from age 22 to age 35ish is "worth it," in terms of getting to do the job of a physician and the delayed gratification of being rich in your 40s, 50s and 60s versus comfortably middle class your whole adult life.
Lifetime savings/investments at various ages:
| Age | Engineer | Physician |
| 25 | $33k | -$218k |
| 30 | $95k | -$253k |
| 40 | $333k | $2.1MM |
| 50 | $852k | $5.8MM |
| 60 | $1.9MM | $10.3MM |
| 65 | $2.7MM | $13.1MM |
Last edited:
- Joined
- Aug 7, 2019
- Messages
- 591
- Reaction score
- 897
Awesome break down, thanks for taking the time to do this.
Have you watched other videos of his on youtube?
- Joined
- Jun 10, 2017
- Messages
- 1,169
- Reaction score
- 2,193
A few when I was a premed when they were first published (2017, 2018). They are consistently awful in terms of the quality of information. The guy clearly is fairly smart (claims to have gotten 260+ on Step 1) but his motivation is money, not sharing high quality, thoughtfully synthesized information. In the interest of full disclosure, he has Crohn's disease which understandably might have factored into his decision to drop out of his surgery residency. Regardless, anyone offering residency interview prep for $300/hr is a snake and should not be trusted. Residency interviews are nowhere near as adversarial as medical school interviews, and prep for med school interviews is not worth even half that much.
- Joined
- Jun 8, 2018
- Messages
- 381
- Reaction score
- 556
In addition, physicians are forced to live like students/residents until they're in their late-20s to 30s and that's huge. These analyses usually assume the engineer (or plumber) would do that but almost no one does if they can live a normal american lifestyle in their 20s with newer cars, vacations, buying random crap, etc. Non-physicians almost NEVER take advantage of the fact that they could live like a student/resident too and invest the difference.
Like white coat investor says, knowing how to invest is so rare its like a super power. Combine that with a physician income and some cool things start to happen. The way i see it, my SO and i basically had to "sacrifice" some gap years and med school. But as residents we might be pulling in 120-140 as residents starting out, which is absolutely enough to live a good life even in a HCOL. Then after a few years of pulling in 6 figs it's not impossible to make 7 for the rest of our lives. That's a pretty good spot to be even with the delay and student loans.
Like white coat investor says, knowing how to invest is so rare its like a super power. Combine that with a physician income and some cool things start to happen. The way i see it, my SO and i basically had to "sacrifice" some gap years and med school. But as residents we might be pulling in 120-140 as residents starting out, which is absolutely enough to live a good life even in a HCOL. Then after a few years of pulling in 6 figs it's not impossible to make 7 for the rest of our lives. That's a pretty good spot to be even with the delay and student loans.
- Joined
- Jun 10, 2017
- Messages
- 1,169
- Reaction score
- 2,193
This is exactly how the conversations with my SO go lol
