6 ms·

The problem of doctors’ salaries

7 points by ALee 9y ago

maxharris 9y ago
I was a premed in undergrad, and I graduated with a molecular biology degree. I got a job in a research lab, which I stayed in for almost two years. I still have a stack of MCAT books sitting in my storage unit. Want to know a huge reason why I left that whole world and decided to write software for a living instead? It's pretty simple - all of the younger doctors that I talked to told me that it was my last chance to avoid making a huge mistake. That medicine has become a gilded cage for them. Doctors have far less autonomy than they used to, that they have to work for twenty or more years to pay back their enormous student loans, and that they'd quit on the spot if they could afford to do so. I was also told that my future pay prospects would dwindle further. So given the prospect of being trapped in a job that I'd hate, which will at some point start to pay less and less each year, is it any wonder that I decided to do something else with my life? What comes next isn't pretty. In the words of my doctor friend, "Don't get sick."
- wahern 9y ago
  Every adult ends up living in a cage of his own creation. No matter what you do, it's _really_ difficult to change careers later in life, or even to just stop working. And the wealthier you are, the more difficult this feels because you have more to lose. Still, a gilded cage is far better than the cages most people live in. If you've ever been both poor and relatively wealthy at different stages of your life, you'll appreciate the "problem" of having something to lose. Regarding tuition, the median debt upon graduation from medical school in 2016 was $190,000. (https://news.aamc.org/medical-education/article/taking-sting-out-medical-school-debt/ https://news.aamc.org/medical-education/article/taking-sting...) That includes both public and private schools; the median for public schools would be lower. But to makes things easier, let's just round that up to $200,000. At 4.5% over 20 years that's about $1,250/month. $1,250 sounds like a lot, but your take home (net of state and federal taxes, including FICA) for a $200,000 salary is $10,000/month. (I used California for state taxes. See http://goodcalculators.com/us-salary-tax-calculator/ http://goodcalculators.com/us-salary-tax-calculator/) Basically, people who make a lot of money seem like they have bigger problems, but they really don't. At least, it's not the kind of problem that is going to shorten their lifespan, like the problems poor people have to deal with. I went to law school mid career and immediately returned to software programming afterward. Going to law school was the best decision of my life, and I never regretted the $130,000 in loan debt one bit. 6 years after graduation and I've already paid-off over half of it.[1] Doctors aren't forced to pay down their loan over 20 years; they chose to because they _can_; because as highly paid professionals they can access long-term, unsecured bank loans that the vast majority of people cannot. I recently refinanced the remaining balance of my debt with a 15 year unsecured loan at a rate < 4.5%. Because I can. Because it's the smart thing to do. [1] Though as a programmer I do better than most lawyers. Newly minted doctors have far better job prospects than newly minted lawyers, or even lawyers generally.
  - maxharris 9y ago
    What about the years of low income that go into medical training, including residency? That's a huge opportunity cost, and I don't think the above analysis covered it (unless I missed something.) I live a very simple life. I have no debts of any kind! I don't have a physical office to go to, so I am generally in total control of my environment. I live in the city, so my commute is a two-minute walk across the street to the coffee shop. And underneath all of that, I actually enjoy what I do! I'd have to be paid many times more than 190k to put up with the BS that doctors have to deal with on a daily basis. The point of all of this is that if you play these trends out another few decades, software will continue to rocket forward, while medical care will become much worse. Like I quoted above, don't get sick.

7 points by ALee 9y ago

I was a premed in undergrad, and I graduated with a molecular biology degree. I got a job in a research lab, which I stayed in for almost two years. I still have a stack of MCAT books sitting in my storage unit. Want to know a huge reason why I left that whole world and decided to write software for a living instead? It's pretty simple - all of the younger doctors that I talked to told me that it was my last chance to avoid making a huge mistake. That medicine has become a gilded cage for them. Doctors have far less autonomy than they used to, that they have to work for twenty or more years to pay back their enormous student loans, and that they'd quit on the spot if they could afford to do so. I was also told that my future pay prospects would dwindle further. So given the prospect of being trapped in a job that I'd hate, which will at some point start to pay less and less each year, is it any wonder that I decided to do something else with my life? What comes next isn't pretty. In the words of my doctor friend, "Don't get sick."

wahern 9y ago
Every adult ends up living in a cage of his own creation. No matter what you do, it's _really_ difficult to change careers later in life, or even to just stop working. And the wealthier you are, the more difficult this feels because you have more to lose. Still, a gilded cage is far better than the cages most people live in. If you've ever been both poor and relatively wealthy at different stages of your life, you'll appreciate the "problem" of having something to lose. Regarding tuition, the median debt upon graduation from medical school in 2016 was $190,000. (https://news.aamc.org/medical-education/article/taking-sting-out-medical-school-debt/ https://news.aamc.org/medical-education/article/taking-sting...) That includes both public and private schools; the median for public schools would be lower. But to makes things easier, let's just round that up to $200,000. At 4.5% over 20 years that's about $1,250/month. $1,250 sounds like a lot, but your take home (net of state and federal taxes, including FICA) for a $200,000 salary is $10,000/month. (I used California for state taxes. See http://goodcalculators.com/us-salary-tax-calculator/ http://goodcalculators.com/us-salary-tax-calculator/) Basically, people who make a lot of money seem like they have bigger problems, but they really don't. At least, it's not the kind of problem that is going to shorten their lifespan, like the problems poor people have to deal with. I went to law school mid career and immediately returned to software programming afterward. Going to law school was the best decision of my life, and I never regretted the $130,000 in loan debt one bit. 6 years after graduation and I've already paid-off over half of it.[1] Doctors aren't forced to pay down their loan over 20 years; they chose to because they _can_; because as highly paid professionals they can access long-term, unsecured bank loans that the vast majority of people cannot. I recently refinanced the remaining balance of my debt with a 15 year unsecured loan at a rate < 4.5%. Because I can. Because it's the smart thing to do. [1] Though as a programmer I do better than most lawyers. Newly minted doctors have far better job prospects than newly minted lawyers, or even lawyers generally.
- maxharris 9y ago
  What about the years of low income that go into medical training, including residency? That's a huge opportunity cost, and I don't think the above analysis covered it (unless I missed something.) I live a very simple life. I have no debts of any kind! I don't have a physical office to go to, so I am generally in total control of my environment. I live in the city, so my commute is a two-minute walk across the street to the coffee shop. And underneath all of that, I actually enjoy what I do! I'd have to be paid many times more than 190k to put up with the BS that doctors have to deal with on a daily basis. The point of all of this is that if you play these trends out another few decades, software will continue to rocket forward, while medical care will become much worse. Like I quoted above, don't get sick.