5 ms·

Not true, some do (stereotypically the surgeon with 4 ex wives and children that don’t know them) but it really depends on your country/practice pattern. On on

Not true, some do (stereotypically the surgeon with 4 ex wives and children that don’t know them) but it really depends on your country/practice pattern. On one extreme Canadian physicians are (generally) ineligible for pension/retirement benefits. Many US private practice jobs are the same. Academic US jobs usually have some form of retirement support. Add in the opportunity cost of not earning income until you’re 30+ as well as loans and I don’t think it’s a fair characterization to say “most physicians in the 50-70 age range want to work”, especially full time and considering burnout rates of ~50-60%. Can’t speak about Europe which has very different compensation structure and debt burden.

sarchertech 3y ago
> Many US private practice jobs are the same. Where are you getting this from? The vast majority of doctors have access to the same kinds of fixed benefit retirement plans as people in other industries have.
- sokoloff 3y ago
  Very few people in private industry have access to fixed benefit plans (other than social security). Most everyone has fixed contribution plans: 401(k) [or 403(b) for education/non-profit].
  - sarchertech 3y ago
    Sorry I invented the term fixed benefit to be in opposition to defined benefit. What I meant was defined contribution. Which was my point physicians generally have access to the same plans as other industries.
    - sokoloff 3y ago
      "Fixed" and "defined" would be roughly synonyms in this usage, which is why no one understood you. Defined contribution everyone would have understood to be in opposition of defined benefit.
- haldujai 3y ago
  From my job search as a physician. Literally no private practice job I’ve interviewed at or heard of provides defined-benefit retirement, if you know one let me know. Similarly I don’t know of many non-medicine jobs that still offer this either, but they do offer defined-contribution plans and GlassDoor suggests Google matches 7%. The super high income (radiology) jobs people are alluding to here (500k-1m) are structured as partnerships that don’t offer employer contributions (depending if you own your own facilities you can potentially exit for a lump-sum at retirement, if you are just part of a hospital based group you don’t have any assets other than the contract so it’s like a 1-200k exit similar to the buy-in). My surgeon friends in that income bracket are also all fee-for-service/eat what you kill rats that also don’t get employer retirement contributions/benefits or equity. A lot of us don’t even get paid sick days. The jobs that offer you defined-benefit or employer contributions for retirement are academia or HMOs which is like 250-350k in radiology. In Canada we’re technically corporations (for tax deferral) and consequently don’t even have RRSP (401k/IRA equivalent) contribution room (unless you pay yourself in salary). But there’s no employer matching/contribution in either case.
  - vibrio 3y ago
    “ The super high income (radiology) jobs people are alluding to here (500k-1m) are structured as partnerships that don’t offer employer contributions” Am I reading correctly that having no 401k match would be a concern for someone making $500k-$1m annually?
    - haldujai 3y ago
      You’re reading incorrectly and I also wasn’t very clear. It’s not a concern and I’m not saying we’re not well-compensated but 7% is something to consider when comparing total compensation across industries (and is one of the easiest line-items to objectively discuss). A larger part of that physician’s income has to go towards planning retirement and inflation (and self managing that) than is being posited here. In addition to health benefits, sick leave and vacation. Someone making 400k at a place matching 7% with a good benefits package isn’t making less than a radiologist at 500k in private practice. As an example a colleague of mine recently changed jobs and went to ~350k in an academic environment from ~520k PP and after calculating all of the benefits and reduced hours (less evenings/weekends, so assumed he would sign up for extra shifts) came out financially ahead. I haven’t worked an engineering job in over a decade but my gut/recollection is that similar base comp numbers would probably pan out the same especially as there is a significant opportunity cost. It’s the difference between any independent contractor vs employee, regardless of if that’s medicine, construction or freelance SWE so when comparing the “high income physician” job it should be compared like you would a freelancer to FAANG employee @ 10 years of experience. FWIW the median in private practice radiology is ~500k. As our compensation is literally per work-unit the only way to go higher is to work more hours, so the equivalent of FAANG engineer doing freelance work on the side.

sarchertech 3y ago

> Many US private practice jobs are the same. Where are you getting this from? The vast majority of doctors have access to the same kinds of fixed benefit retirement plans as people in other industries have.

sokoloff 3y ago
Very few people in private industry have access to fixed benefit plans (other than social security). Most everyone has fixed contribution plans: 401(k) [or 403(b) for education/non-profit].
- sarchertech 3y ago
  Sorry I invented the term fixed benefit to be in opposition to defined benefit. What I meant was defined contribution. Which was my point physicians generally have access to the same plans as other industries.
  - sokoloff 3y ago
    "Fixed" and "defined" would be roughly synonyms in this usage, which is why no one understood you. Defined contribution everyone would have understood to be in opposition of defined benefit.
haldujai 3y ago
From my job search as a physician. Literally no private practice job I’ve interviewed at or heard of provides defined-benefit retirement, if you know one let me know. Similarly I don’t know of many non-medicine jobs that still offer this either, but they do offer defined-contribution plans and GlassDoor suggests Google matches 7%. The super high income (radiology) jobs people are alluding to here (500k-1m) are structured as partnerships that don’t offer employer contributions (depending if you own your own facilities you can potentially exit for a lump-sum at retirement, if you are just part of a hospital based group you don’t have any assets other than the contract so it’s like a 1-200k exit similar to the buy-in). My surgeon friends in that income bracket are also all fee-for-service/eat what you kill rats that also don’t get employer retirement contributions/benefits or equity. A lot of us don’t even get paid sick days. The jobs that offer you defined-benefit or employer contributions for retirement are academia or HMOs which is like 250-350k in radiology. In Canada we’re technically corporations (for tax deferral) and consequently don’t even have RRSP (401k/IRA equivalent) contribution room (unless you pay yourself in salary). But there’s no employer matching/contribution in either case.
- vibrio 3y ago
  “ The super high income (radiology) jobs people are alluding to here (500k-1m) are structured as partnerships that don’t offer employer contributions” Am I reading correctly that having no 401k match would be a concern for someone making $500k-$1m annually?
  - haldujai 3y ago
    You’re reading incorrectly and I also wasn’t very clear. It’s not a concern and I’m not saying we’re not well-compensated but 7% is something to consider when comparing total compensation across industries (and is one of the easiest line-items to objectively discuss). A larger part of that physician’s income has to go towards planning retirement and inflation (and self managing that) than is being posited here. In addition to health benefits, sick leave and vacation. Someone making 400k at a place matching 7% with a good benefits package isn’t making less than a radiologist at 500k in private practice. As an example a colleague of mine recently changed jobs and went to ~350k in an academic environment from ~520k PP and after calculating all of the benefits and reduced hours (less evenings/weekends, so assumed he would sign up for extra shifts) came out financially ahead. I haven’t worked an engineering job in over a decade but my gut/recollection is that similar base comp numbers would probably pan out the same especially as there is a significant opportunity cost. It’s the difference between any independent contractor vs employee, regardless of if that’s medicine, construction or freelance SWE so when comparing the “high income physician” job it should be compared like you would a freelancer to FAANG employee @ 10 years of experience. FWIW the median in private practice radiology is ~500k. As our compensation is literally per work-unit the only way to go higher is to work more hours, so the equivalent of FAANG engineer doing freelance work on the side.