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misterspaghetti said:   SUCKISSTAPLES said:   linkin06 said:   sigh can any doctors out there give me advice? i'm a third year med student. school itself is not a pleasant experience. i got a 232 on step 1, but 3rd year grades are not going well... just passing. i was thinking of going into peds, but person above said he wouldn't recommend primary care in retrospect? i feel like i may like peds because 1.) helping cute kids who are sick without illnesses they control 2.) being able to be an advocate for kids who often may not have one
OT but just wondering - how can you see sick kids all day without catching their illness too? Are dr superhuman a d immune to all these sick kids , or do they miss half the year working because the dr themselves are ill?

I'd rather work on people with injuries than contagious disease. Then again , I'd rather just work with a book, pen and computer and not deal with anyone in person


There are several reasons. Precautions such as handwashing are very important, but by the time that a disease becomes symptomatic, it is often no longer contagious. And in the end, it's typically the same bugs over a nd over again. So you may come down with it the first time, but then you're immune for the next 25 that you see with the same issue. Keeping visits short also helps.

Sounds like you'd like pathology or radiology.


I got sick a couple times on inpatient peds. Sometimes you just get too tired to avoid a kiddo sneezing into your mouth. Foam in, foam out works alright, though.

Kanosh said:   Anesthesia. Interesting. You don't see many TV doctor shows about anesthesiologists - there's not the excitement of an ER doctor or a surgeon. Dare I say that for most people this speciality might be a bit boring? Important, yes, and vitally so for those going under. I imagine it takes a very specific personality type to do well as an anesthesiologist. What attracted you to the field?

They are among the highest paid of doctors (excluding some surgeons). While it might be boring (as in slightly more repetitive) - I think it is one of the more stressful specialties because there is risk of death for every anesthetized patient.

Curious if the anesthesiologists come back and read this - my wife and I just learned how much anesthesiologists make (many surveys I read stated $300-400K was not uncommon). What we were wondering is who pays for the insurance for a doctor (themselves or the hospital) - and how much does this cost annually? We thought that anesthesiologists might make so much because they had such high risk?

for all physicians it depends on the contract. as a simplification, if your are an employee of a hospital then they typically cover the cost. If you are a contractor or own the business then you as a physician pay it. Pay does not directly relate to costs of malpractice coverage. This is one of the reasons why some OBGYN folks change their practice. The malpractice costs arent really reimbursed.

bigtimesaver3652 said:   Hey bud. Here is my advice as I am a physician. DON'T GO INTO PEDIATRICS!!!! They make like 80k per year, and you have to deal with psycotic parents who are worried about little Johnie's behavioral problems preventing him from going to harvard in the future. If you really like pediattrics, I would recommend doing anesthesia and then doing a fellowship in pediatric anesthesia. I work days now, no weekends or overnights at a pediatric hospital and make about 350k. If you want to work weekends and overnight call you can make 500k/year pretty easily. It is fun and the kids are fun.

232 is a great step 1 score. Don't worry about the passes in the 3rd year clerkships. It is all subjective anyway, if you are a hot female you will get better grades. Just make sure to not piss anyone off.

Ditto. I was going to reply to this OP also that not all kids are cute! You have to *really* want to do it for any kid...the screamy, whiny, brat who will literally wail & flail the entire time in your office - at least one every week. IANAD but have been in the Peds exam rooms enough to know that there's no way I could deal with not just the kids but their over zealous parents too.

linkin06:

Coming from an attending surgical subspecialist, in what is one of (if not) the most difficult fields to get into:

GO INTO ANESTHESIA.

Do a subI at a benign program in a city where you want to live, and you'll match well.

My best friend in med school did horribly on Step I, failed step II the first time he took it, and matched at the top program in NYC. He now likely makes more than I do.

Yes, it is "99% boredom, <1% terror", but all specialties are stressful, and this is a generally "benign" one.

If you had asked me 10 years ago, I would've also offered up Rad Onc, but I believe their time in the sun is quickly coming to an end, as Medicare is wisening up to the ridiculous reimbursement for radiation.

Derm is good, but kind of gross (IMHO) and is also waning due to the economy (as is plastic surgery.)

Peds is also very stressful; tons of phone calls, and it's horrible when kids get really sick.

If you must take care of kids, subspecialize in pediatric anesthesia; you'll still have fewer years in than most surgeons, and if some kid REALLY has a problem, the peds surgeon will be there to help.

rpi1967 said:   
In California, some teacher's contract is for 181 days of work per year. School day started after 8:30 and finished before 3PM. Although teaching is a noble profession it is a good deal for some if they receive an early pension after 25 years as in the past. No guarantees for present or future teachers.


Meh. I'm not in CA, but I know very few schools that start after 8:30 and end before 3. Moreover, it is ludicrous to think that those are the only hours that teachers work. I'm sure that there are slackers who do just that, but most of the teachers I know spend long hours grading homework, setting up lesson plans, buying their own supplies for the classroom, answering parent emails, writing recommendation letters (for HS teachers), etc., far beyond their paid hours.

(Also, for a typical middle class job, with 2 wks vacation, 2 wks sick leave, and 10 days of government holidays, that comes out to 233-234 "days of work" per year, so still a discrepancy, but not as big a one as it might seem.)

JacksonX said:   If you had asked me 10 years ago, I would've also offered up Rad Onc, but I believe their time in the sun is quickly coming to an end, as Medicare is wisening up to the ridiculous reimbursement for radiation.One of our very good friends is in Rad Onc. She enjoys it and, although they no longer enjoy the insane compensation that they used to have, it is still one of the higher paid specialties.

There are plenty of issues with Rad Onc's though: there's an enormous amount of physics, which a lot of people don't like; it's a very narrow specialty, which can make it quite difficult to live in your preferred area or even your preferred city. Rad Onc residency programs are also very small, which makes it difficult for medical students to really plan to end up at one.

At one point, Rad Onc's used to enjoy virtually call-free lifestyles but that's no longer the case and virtually all rad onc's now have to deal with a fair amount of call.

It also goes without saying that all oncology specialties, including radiation oncology, are not the most cheerful ones, as most of their patients end up dying.

This is not new thing, if you watched 'american horror story' you see that it was a problem for doctors then too.

The article makes a false assumption by increasing debt for the first 3 years of residency. Nearly any resident will qualify for income based repayment which calculates a reasonable monthly payment based on your income. With this, your first 6 months you pay nothing ( since your last years income was likely poverty level) and any interest earned which your payment doesn't cover is covered by the government.

The best option is public service loan forgiveness which you pay <15% of your income per month and work in a not for profit organization for 10 years (time in residency counts) and the rest of your loans are forgiven.

Source: My girlfriend is in her first year of residency and I have been helping her manage her student loans.

jjbesque said:   The article makes a false assumption by increasing debt for the first 3 years of residency. Nearly any resident will qualify for income based repayment which calculates a reasonable monthly payment based on your income. With this, your first 6 months you pay nothing ( since your last years income was likely poverty level) and any interest earned which your payment doesn't cover is covered by the government.This wouldn't apply to private loans, correct?

I don't know anything about it, so please correct me if my assumption is wrong.

BenH said:   
While a doctor certainly goes through more schooling (probably 3x as much) as most H.S. teachers, they also get paid 3x as much. Please review one such survey:

http://www.profilesdatabase.com/resources/2011-2012-physician-sa...

That's an average starting salary of over $220K and a 6 year practicing average of well over $300K.
.


As you mention later, it's not so much the education 3:1 that's a killer. If you compared hours to become a teacher to hours to become a physician, I'd wager 20:1 or maybe worse.
Residency? It should be illegal. You get a salary, sure, but you can be required to work 24-36 shifts, 60-80 weeks... And you're providing healthcare. Trust me, if you ever see a resident in a doctors office, ask how long they've been awake and consider another doctor.

I'd be interested in a study of 30-year total earnings potential of a teacher, an engineer, a computer scientist, and a doctor.... My wager is on engineer or comp-sci for total best earnings potential after factoring in debt and earnings.

dcg9381 said:   BenH said:   
While a doctor certainly goes through more schooling (probably 3x as much) as most H.S. teachers, they also get paid 3x as much. Please review one such survey:

http://www.profilesdatabase.com/resources/2011-2012-physician-sa...

That's an average starting salary of over $220K and a 6 year practicing average of well over $300K.
.


As you mention later, it's not so much the education 3:1 that's a killer. If you compared hours to become a teacher to hours to become a physician, I'd wager 20:1 or maybe worse.
Residency? It should be illegal. You get a salary, sure, but you can be required to work 24-36 shifts, 60-80 weeks... And you're providing healthcare. Trust me, if you ever see a resident in a doctors office, ask how long they've been awake and consider another doctor.

I'd be interested in a study of 30-year total earnings potential of a teacher, an engineer, a computer scientist, and a doctor.... My wager is on engineer or comp-sci for total best earnings potential after factoring in debt and earnings.



I agree with you that the residency system that allows for such long hours is crazy. Can't imagine why we let someone work such long hours then trust them with peoples lives.

However lifetime earnings of doctors is higher than engineers or comp-sci on average including average student loan debts.

JacksonX said:   I have not had a chance to read the whole thread.
However, it is ironic that I am driving home now after spending the night dealing with emergencies and emergent procedures.
Going home to lay down for 2 hrs before I have to go in again.
The 1230 am phone call awoke my family as usual; my two year old isn't used to it yet.
(And I'm in a fairly benign specialty!)

So, yeah, medicine kind of sucks. It still reimburses reasonably well, but it's something you really, really need to want to do or it's not for you.
Guess what most of us highly paid professionals work around the clock. But keep to your bubble and continue to believe you are special.

JacksonX said:   I have not had a chance to read the whole thread.
However, it is ironic that I am driving home now after spending the night dealing with emergencies and emergent procedures.
Going home to lay down for 2 hrs before I have to go in again.
The 1230 am phone call awoke my family as usual; my two year old isn't used to it yet.
(And I'm in a fairly benign specialty!)

So, yeah, medicine kind of sucks. It still reimburses reasonably well, but it's something you really, really need to want to do or it's not for you.


Someone in your specialty that is running a semi decent practice should be making $600K+ per year. Hell a Dallas Urologist was reimbursed $998,400 (at a profit of over $600K) on his BPH patients alone last year. And yes I have access to over 500 Urologists books (so to speak) since we get a cut of everything we advise on. I think most here would gladly wake their family for that kind of coin.

geo123 said:   It also goes without saying that all oncology specialties, including radiation oncology, are not the most cheerful ones, as most of their patients end up dying.

True, but look at it this way: expected outcomes are low going in, so it's a lot easier to accept when people do poorly. You could always console yourself with the knowledge of having provided a "better" death.

In my experience, the most gut-wrenching deaths are the sudden, unexpected ones. I don't think I could do pediatrics; even though most patients do well, the shocking tragedies would haunt me.

ETA: Also, the pay would suck.

jjbesque said:   The article makes a false assumption by increasing debt for the first 3 years of residency. Nearly any resident will qualify for income based repayment which calculates a reasonable monthly payment based on your income. With this, your first 6 months you pay nothing ( since your last years income was likely poverty level) and any interest earned which your payment doesn't cover is covered by the government.

The best option is public service loan forgiveness which you pay <15% of your income per month and work in a not for profit organization for 10 years (time in residency counts) and the rest of your loans are forgiven.

Source: My girlfriend is in her first year of residency and I have been helping her manage her student loans.


The bolded part is only true on the subsidized portion, which are no longer being offered for incoming med students

BenH said:   Kanosh said:   Anesthesia. Interesting. You don't see many TV doctor shows about anesthesiologists - there's not the excitement of an ER doctor or a surgeon. Dare I say that for most people this speciality might be a bit boring? Important, yes, and vitally so for those going under. I imagine it takes a very specific personality type to do well as an anesthesiologist. What attracted you to the field?

They are among the highest paid of doctors (excluding some surgeons). While it might be boring (as in slightly more repetitive) - I think it is one of the more stressful specialties because there is risk of death for every anesthetized patient.

Curious if the anesthesiologists come back and read this - my wife and I just learned how much anesthesiologists make (many surveys I read stated $300-400K was not uncommon). What we were wondering is who pays for the insurance for a doctor (themselves or the hospital) - and how much does this cost annually? We thought that anesthesiologists might make so much because they had such high risk?


Maybe I can answer your questions, I've been doing Anesthesia for about 5 years now. Honestly, I don't need the excitement. You can go from doing nothing at night all the way to doing a liver transplant for 8 hours in the middle of the night. Very uncertain. You need to be able to deal with stressful episodes quickly. I view anesthesia like the relief pitcher in baseball. You mop up the problems and make it look easy.

What attracted me was using a knowledge of physiology and pharmacology to tackle human disease. It is actually quite interesting. For me, it doesn't get boring as I do extremely high risk cases. You also get to do a lot of procedures like nerve blocks and lines.

We pay our own insurance, about 20,000 per year. Our specialty is very safe for patients and we continue to improve.

Usually starting salaries are about $300,000, but you get more the more you work. Honestly if you live in a high cost of living like Manhattan your money may not go that far.

mikef07 said:   JacksonX said:   I have not had a chance to read the whole thread.
However, it is ironic that I am driving home now after spending the night dealing with emergencies and emergent procedures.
Going home to lay down for 2 hrs before I have to go in again.
The 1230 am phone call awoke my family as usual; my two year old isn't used to it yet.
(And I'm in a fairly benign specialty!)

So, yeah, medicine kind of sucks. It still reimburses reasonably well, but it's something you really, really need to want to do or it's not for you.


Someone in your specialty that is running a semi decent practice should be making $600K+ per year. Hell a Dallas Urologist was reimbursed $998,400 (at a profit of over $600K) on his BPH patients alone last year. And yes I have access to over 500 Urologists books (so to speak) since we get a cut of everything we advise on. I think most here would gladly wake their family for that kind of coin.


Don't get me wrong, I would never complain about my salary.
I just didn't consider certain factors in med school.
With anesthesia, you can do a cakewalk transitional year followed by 3 years of a reasonable residency where you do NOT work 120 hours a week.
You can then get a "real job" a lot sooner than many other specialties;
Heck, you could just work your tail off as a gas doc for those extra "free" years, make bank, then semi-retire!

I am glad hard work is still rewarded in America. I drove by a housing project on my home earlier today. Saw quite a few people just milling around. If any of those guys had "operated" on me, I am sure I would have a hard time typing right now. On the other hand, I am comfortable letting a hard working highly trained doctor operate on me, because I feel my chance is now at least 50/50.

bigtimesaver3652 said:   
We pay our own insurance, about 20,000 per year. Our specialty is very safe for patients and we continue to improve.

Usually starting salaries are about $300,000, but you get more the more you work. Honestly if you live in a high cost of living like Manhattan your money may not go that far.


Thanks for the info. That insurance is certainly not pocket change, but considering a starting salary in the 300K range it certainly is a small cost of doing business.

And what you state about living in a high cost area like Manhattan is true of any job. There are ~1.5 million people living in Manhattan, and I'm sure many of them make quite a bit under the $100K or so that is currently a comfortable living wage there. Of course, if you are the sole earner in a family of 4 living a more high-maintenance lifestyle 300K in Manhattan it certainly won't go as far as even half that will go in Oklahoma

I don't think anyone who is offered a minimum of 300K is going to complain if they are told they need to move to Manhattan for the work...

this was supposed to be a reply. That obviously didn't work. I shall try again.

geo123 said:   jjbesque said:   The article makes a false assumption by increasing debt for the first 3 years of residency. Nearly any resident will qualify for income based repayment which calculates a reasonable monthly payment based on your income. With this, your first 6 months you pay nothing ( since your last years income was likely poverty level) and any interest earned which your payment doesn't cover is covered by the government.This wouldn't apply to private loans, correct?

I don't know anything about it, so please correct me if my assumption is wrong.


Yes, they must be federal loans to qualify, which is the vast majority of her loans. She does have some Parent Plus loans which while federal, are not in her name, and therefore are her dads legal responsibility to pay and therefore don't get interest paid or get forgiven. She is paying him back for those while her federal payments are low.

misterspaghetti said:   jjbesque said:   The article makes a false assumption by increasing debt for the first 3 years of residency. Nearly any resident will qualify for income based repayment which calculates a reasonable monthly payment based on your income. With this, your first 6 months you pay nothing ( since your last years income was likely poverty level) and any interest earned which your payment doesn't cover is covered by the government.

The best option is public service loan forgiveness which you pay <15% of your income per month and work in a not for profit organization for 10 years (time in residency counts) and the rest of your loans are forgiven.

Source: My girlfriend is in her first year of residency and I have been helping her manage her student loans.


The bolded part is only true on the subsidized portion, which are no longer being offered for incoming med students


I hadn't heard this. I didn't think that the first 6 months were anything specical, it just works out that the calculated loan payment often ends up being $0. Or are you saying that students can't get loans that qualify for Income Based Repayment? If that is the case, Obama's update to the plan which reduced payments and length before forgiveness is kind of useless.

misterspaghetti said:   JohnGalt69 said:   misterspaghetti said:   
Secondly, physicians have tried for more than a decade to push congress to increase residency funding. Obamacare was their first major success in that arena. I don't buy your "if they wanted to do it, they could figure out a way" attitude. That's like me saying that if you really wanted to be a billionaire, you could figure out a way. It isn't that simple.


Ha, they tried to get government funding for free labor? What about allowing a new medical school to open? What about allowing doctors to immigrate? Those are the things that matter and are within the control of the AMA.


1. Residents are paid.

2. Increasing the number of medical schools or class size of existing medical schools will do ABSOLUTELY NOTHING toward increasing the number of practicing physicians without a commensurate increase in the number of residency spots. That is the bottle-neck. Think about it logically: if we have 100 medical school graduates and only 50 residency spots, why do you think increasing the number of medical school graduates would help?

3. They could potentially allow more docs to immigrate (they do allow many to do so now), but there is currently a requirement for US clinical experience prior to licensure. Keep in mind that docs try to come to the US from all over the world and from every kind of medical system imaginable. Without knowledge of how to function in this system, it's bad for both them and the patient. It's hard enough for a doc to go from practicing in one state to another - imagine going from a socialized system to this one.

Medical school has set rigorous standards for admission and licensure in the U.S. in attempt to keep quality up. Doing this on the one hand and then opening the flood gates to anyone who has trained in any kind of system with the other doesn't make a lot of sense.


My point is the labor is free TO THEM, because Medicare is paying for it. Why can't they pay for it themselves? It doesn't add any value? It's a joke to say "the government won't pay for us to train any new doctors, so there's NOTHING WE CAN DO to avoid a shortage of doctors. Oh well!"

The rest is just as big of a joke. "Quality" is what every monopolist licensing board uses as their justification, every single one. But it's just not true that qualified, skilled doctors are not being turned away every day by medical school and at the borders. Medical schools won't accept even the best qualified 30-year old, just because they are too old! The reason is plain as day, skyrocketing physician salaries. It's no coincidence that physician supply was throttled at the same time salaries took off into the stratosphere. Doctors all over the world (like 50 years ago in the U.S.) make small fractions of the amount doctors make in the U.S. today.

whodini said:   I am glad hard work is still rewarded in America. I drove by a housing project on my home earlier today. Saw quite a few people just milling around. If any of those guys had "operated" on me, I am sure I would have a hard time typing right now. On the other hand, I am comfortable letting a hard working highly trained doctor operate on me, because I feel my chance is now at least 50/50.

I love that you put your odds of survival at 50/50 on your arbitrary and completely made-up surgery that was performed by an equally made-up hard working and highly trained doctor.

I love being a Urologist.

Not many people can actually say they LOVE their job.

JacksonX said:   I have not had a chance to read the whole thread.
However, it is ironic that I am driving home now after spending the night dealing with emergencies and emergent procedures.
Going home to lay down for 2 hrs before I have to go in again.
The 1230 am phone call awoke my family as usual; my two year old isn't used to it yet.
(And I'm in a fairly benign specialty!)

So, yeah, medicine kind of sucks. It still reimburses reasonably well, but it's something you really, really need to want to do or it's not for you.


Medicine is not the only field that this applies to.

Bought a piece of equipment today and was charged $300 for some obamacare tax. What the heezy? I am not a PCP by the way and I would never feel sorry for a PCP.

I think the only stress equivalent to managing someone else's health is managing someone else's money. It's all good when things are going well. (But then again, some people just don't give a crap - I sort of envy those people sometimes)

MiaFLSurf said:   I love being a Urologist.

Not many people can actually say they LOVE their job.
I love my job... but love can be a bitch.

So what is fatwallet's opinion on going into the field of a CRNA? (Nurse Anesthesia)

By my calculations, it will cost me $15,000 for my bachelors in nursing by going to a concurrent program that is a partnership with the local community college and the state university.

After ICU experience, I can apply to grad school to become an CRNA, costing about $50,000. AVG salary for an CRNA is between $120,000 and $140,000.

ragedogg69 said:   So what is fatwallet's opinion on going into the field of a CRNA? (Nurse Anesthesia)

By my calculations, it will cost me $15,000 for my bachelors in nursing by going to a concurrent program that is a partnership with the local community college and the state university.

After ICU experience, I can apply to grad school to become an CRNA, costing about $50,000. AVG salary for an CRNA is between $120,000 and $140,000.


It's a fantastic idea.
Tried to convince my wife to do it.
Most of the perks of anesthesia but without nearly as much liability.

Best case scenario-

Community college RN for near free.
Start work at local hospital, get 50-60k at age 20
Hospital pays for BSN, which you get age 22-23
Work for another 1-2 years in icu, making around 70k, more if you do overtime
Go to crna school, work a few shifts a month to minimize loans.
Finish at age 26-27 with essentially no debt, a nice stockpile of cash (or even a house) from working ages. 20-25 or so
And get a job making ~200k/year.

Yes, sometimes I daydream.

jjbesque said:   misterspaghetti said:   jjbesque said:   The article makes a false assumption by increasing debt for the first 3 years of residency. Nearly any resident will qualify for income based repayment which calculates a reasonable monthly payment based on your income. With this, your first 6 months you pay nothing ( since your last years income was likely poverty level) and any interest earned which your payment doesn't cover is covered by the government.

The best option is public service loan forgiveness which you pay <15% of your income per month and work in a not for profit organization for 10 years (time in residency counts) and the rest of your loans are forgiven.

Source: My girlfriend is in her first year of residency and I have been helping her manage her student loans.


The bolded part is only true on the subsidized portion, which are no longer being offered for incoming med students


I hadn't heard this. I didn't think that the first 6 months were anything specical, it just works out that the calculated loan payment often ends up being $0. Or are you saying that students can't get loans that qualify for Income Based Repayment? If that is the case, Obama's update to the plan which reduced payments and length before forgiveness is kind of useless.


I bolded too much. See above.

You are correct about the first 6 months being ~$0.

Traditionally, med students were offered both subsidized and unsubsized loans. Only the interest on the subsidized loans are forgiven as a benefit of IBR and the subsidized loans are no longer being offered for incoming students. Also, only Department of Education DIRECT LOANS (not FFELP loans) qualify for IBR. Make sure that's what she has.

BenH said:   bigtimesaver3652 said:   
We pay our own insurance, about 20,000 per year. Our specialty is very safe for patients and we continue to improve.

Usually starting salaries are about $300,000, but you get more the more you work. Honestly if you live in a high cost of living like Manhattan your money may not go that far.


Thanks for the info. That insurance is certainly not pocket change, but considering a starting salary in the 300K range it certainly is a small cost of doing business.
As an fyi, the $20K/year malpractice insurance premium that he mentioned is almost always for a claims-based policy. What this means is that at some point he'll have to purchase tail coverage for that policy, which will cost tens of thousands of dollars more. So, his actual cost is actually higher than $20K/year but what it will average out to be cannot be determined until later.

As far as physician compensation is concerned, in general there is a very wide disparity between specialist compensation and primary case compensation. Primary care physicians' (family practitioners, internists, pediatricians) compensation is pretty low (depending on the area, pediatricians can start out making under $100K and frequently only go up to about the mid six figures) while specialists make substantially more.

I don't think anyone who is offered a minimum of 300K is going to complain if they are told they need to move to Manhattan for the work...There are plenty of people out there who do complain and turn it down because it's frequently just not worth it. Remember that people are typically not deciding between $300K in a high cost area and $50K in a low cost area. With compensation figures being a lot closer, after you factor in taxes and the disparity in costs, a lot of people end up deciding that they are a lot better off staying away from the highest cost areas... or not, but it is all very fact specific.

JacksonX said:   ragedogg69 said:   So what is fatwallet's opinion on going into the field of a CRNA? (Nurse Anesthesia)

By my calculations, it will cost me $15,000 for my bachelors in nursing by going to a concurrent program that is a partnership with the local community college and the state university.

After ICU experience, I can apply to grad school to become an CRNA, costing about $50,000. AVG salary for an CRNA is between $120,000 and $140,000.


It's a fantastic idea.
Tried to convince my wife to do it.
Most of the perks of anesthesia but without nearly as much liability.

Best case scenario-

Community college RN for near free.
Start work at local hospital, get 50-60k at age 20
Hospital pays for BSN, which you get age 22-23
Work for another 1-2 years in icu, making around 70k, more if you do overtime
Go to crna school, work a few shifts a month to minimize loans.
Finish at age 26-27 with essentially no debt, a nice stockpile of cash (or even a house) from working ages. 20-25 or so
And get a job making ~200k/year.

Yes, sometimes I daydream.


Spouse is an anesthesiologist, actually thinking about becoming a CRNA.
depending on the type of hospital, call at a level one trauma center can make some specialities a burn out job. The problem is that at a surgical center, an anesthesiologist could die of boredom.

JohnGalt69 said:   misterspaghetti said:   JohnGalt69 said:   misterspaghetti said:   
Secondly, physicians have tried for more than a decade to push congress to increase residency funding. Obamacare was their first major success in that arena. I don't buy your "if they wanted to do it, they could figure out a way" attitude. That's like me saying that if you really wanted to be a billionaire, you could figure out a way. It isn't that simple.


Ha, they tried to get government funding for free labor? What about allowing a new medical school to open? What about allowing doctors to immigrate? Those are the things that matter and are within the control of the AMA.


1. Residents are paid.

2. Increasing the number of medical schools or class size of existing medical schools will do ABSOLUTELY NOTHING toward increasing the number of practicing physicians without a commensurate increase in the number of residency spots. That is the bottle-neck. Think about it logically: if we have 100 medical school graduates and only 50 residency spots, why do you think increasing the number of medical school graduates would help?

3. They could potentially allow more docs to immigrate (they do allow many to do so now), but there is currently a requirement for US clinical experience prior to licensure. Keep in mind that docs try to come to the US from all over the world and from every kind of medical system imaginable. Without knowledge of how to function in this system, it's bad for both them and the patient. It's hard enough for a doc to go from practicing in one state to another - imagine going from a socialized system to this one.

Medical school has set rigorous standards for admission and licensure in the U.S. in attempt to keep quality up. Doing this on the one hand and then opening the flood gates to anyone who has trained in any kind of system with the other doesn't make a lot of sense.


My point is the labor is free TO THEM, because Medicare is paying for it. Why can't they pay for it themselves? It doesn't add any value? It's a joke to say "the government won't pay for us to train any new doctors, so there's NOTHING WE CAN DO to avoid a shortage of doctors. Oh well!"

The rest is just as big of a joke. "Quality" is what every monopolist licensing board uses as their justification, every single one. But it's just not true that qualified, skilled doctors are not being turned away every day by medical school and at the borders. Medical schools won't accept even the best qualified 30-year old, just because they are too old! The reason is plain as day, skyrocketing physician salaries. It's no coincidence that physician supply was throttled at the same time salaries took off into the stratosphere. Doctors all over the world (like 50 years ago in the U.S.) make small fractions of the amount doctors make in the U.S. today.


Any attending physician will tell you that they can operate far more efficiently without a resident. ACGME rules governing residencies require that the attending be present during any significant procedure/surgery/etc, obviating the need for a resident. Thus, it isn't free labor - and can actually be a blow to their productivity.

I don't think I've ever heard anyone blantantly disregard the importance of upholding quality in a profession. Really?

You keep suggesting that physician supply is somehow dictated by medical school enrollment. Why is it so hard to understand that increasing the enrollment at medical schools will not increase the number of practicing physicians without a commensurate increase in the number of residency spots? Med schools can open up their doors to every single person of any nationality or ability or disability or ability to pay or level of education, etc etc etc and it will do nothing to increase the number of practicing physicians - the bottleneck will still be present.

Finally, there are many other countries where physicians are well paid. In the UK, Netherlands, Switzerland, Denmark, docs can do quite well. Some Canadian specialties make more than their US counterparts.

The government keeps the number residency slots low because with each fully trained doctor you produce you also produce a new person with the right to bill Medicare.

geo123 said:   
I don't think anyone who is offered a minimum of 300K is going to complain if they are told they need to move to Manhattan for the work...There are plenty of people out there who do complain and turn it down because it's frequently just not worth it. Remember that people are typically not deciding between $300K in a high cost area and $50K in a low cost area. With compensation figures being a lot closer, after you factor in taxes and the disparity in costs, a lot of people end up deciding that they are a lot better off staying away from the highest cost areas... or not, but it is all very fact specific.


This is all really irrelevant as it has nothing to do specifically with the field of medicine. There are many high-paying jobs where your salary range may only differ by 10-20% whereas the cost of living in those areas may differ by 50% or more. Sure - if you have an option to get a job in Manhattan at $300K or Chicago at $300K - you will get more for your money in Chicago. It then simply becomes a question of where do you want to live and work.

I suspect those people who are looking for jobs in Manhattan and other high cost areas is because they *want* to be there. If you have no preference where you live/work it is a 100% stupid decision to take an equivalent job with an equivalent salary in a location where you living expense will be phenomenally higher. Again I stress the *no preference*.

Therefore, my comment was geared towards that *want* to be living in Manhattan. If someone were to complain to me that they are making 300K a year but that it "doesn't get them very far" in Manhattan, I would laugh in their face and tell them a lot of families that aren't in the top 3-5% live in Manhattan, that they are better off than most, and if they want to have an even higher standard of living move to a different are where they may make 25% less salary (if even that) but have living expenses 1/8th of what they are.

Your right about the insurance, I think if I left and paid the tail insurance that would cost me another 20k or so. Unless the new group pays the nose. The occurance policy was a lot more money and I plan to be at the same place for a while so I went with the cheaper claims made policy. I don't pay the tail insurance either when I retire or if I get disabled.

BenH said:   geo123 said:   
I don't think anyone who is offered a minimum of 300K is going to complain if they are told they need to move to Manhattan for the work...There are plenty of people out there who do complain and turn it down because it's frequently just not worth it. Remember that people are typically not deciding between $300K in a high cost area and $50K in a low cost area. With compensation figures being a lot closer, after you factor in taxes and the disparity in costs, a lot of people end up deciding that they are a lot better off staying away from the highest cost areas... or not, but it is all very fact specific.


This is all really irrelevant as it has nothing to do specifically with the field of medicine. There are many high-paying jobs where your salary range may only differ by 10-20% whereas the cost of living in those areas may differ by 50% or more.

One thing that is specific to the medical field is that it is not uncommon to have high paying jobs in almost all places in the US. Even a small midwest city with population 50-100k needs doctors and at least some specialists with competitive pay. In most other fields, that is not common.



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