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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.


I also agree.
My sister went to Havard undergrad (Full scholarship), Havard Med & Peds. Now, She is struggling with her payment on a 4 y/o minivan. She has been out of the residency since 2001.

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. 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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.

misterspaghetti said:   BenH said:   
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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Actually it doesn't make it irrelevant. All it does is make my assumption that larger urban areas pay more incorrect. As I have not done extensive research into this I won't argue if your statement is correct or not, but if so, it only strengthens my point.

misterspaghetti said:   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. 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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Simply not true

mikef07 said:   misterspaghetti said:   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. 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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Simply not true


I'm not sure what makes you say this. Large cities offer lower salaries simply because they can - they have a ton of competition for open positions. Not to mention the increased competition for patients in large cities as a result of the higher physician to population ratio. The smaller communities attract healthcare workers by offering larger salaries, and even then, they often have trouble finding them.

BenH said:   misterspaghetti said:   BenH said:   
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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Actually it doesn't make it irrelevant. All it does is make my assumption that larger urban areas pay more incorrect. As I have not done extensive research into this I won't argue if your statement is correct or not, but if so, it only strengthens my point.


It's true that any medical field are generally paid more in smaller communities (LV, AZ, Midwest, etc) but it does support BenH's statement.
People move to NYC with a pay cut simply because they want to experience nyc. They should not b1tch about their cost of living because they can earn more with 1/2 of living expenses in most other states.

misterspaghetti said:   mikef07 said:   misterspaghetti said:   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. 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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Simply not true


I'm not sure what makes you say this. Large cities offer lower salaries simply because they can - they have a ton of competition for open positions. Not to mention the increased competition for patients in large cities as a result of the higher physician to population ratio. The smaller communities attract healthcare workers by offering larger salaries, and even then, they often have trouble finding them.


Because most are paid by reimbursement, not necessarily salary. Second, it depends on how many patients they support. For example in a previous post I talked about 1 physician in Dallas who makes almost $1M from Male BPH patients alone. Very few (if any) small town Urologists are making this. There is a Urologist in a border town of CA (not San Diego) making around $800K a year (total) so he is highly paid and in a small community. There simply is no correlation to size of community and how well certain doctors are paid. Some in big cities make big $, some make average or below. Some in small towns makes big $, some in small towns don't. It is completely YMMV.

BenH said:   misterspaghetti said:   BenH said:   
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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Actually it doesn't make it irrelevant. All it does is make my assumption that larger urban areas pay more incorrect. As I have not done extensive research into this I won't argue if your statement is correct or not, but if so, it only strengthens my point.


I agree with you. Just pointing out another irony. Didn't mean to come across as suggesting you were wrong.

Pun said:   BenH said:   misterspaghetti said:   BenH said:   
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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Actually it doesn't make it irrelevant. All it does is make my assumption that larger urban areas pay more incorrect. As I have not done extensive research into this I won't argue if your statement is correct or not, but if so, it only strengthens my point.


It's true that any medical field are generally paid more in smaller communities (LV, AZ, Midwest, etc) but it does support BenH's statement.
People move to NYC with a pay cut simply because they want to experience nyc. They simply should not b1tch about their cost of living because they can earn more with 1/2 of living expenses in most other states.


Wrong again. One of the biggest money making Urology practices in America is right near NYC. You are simply making stuff up. Top 10 highest paid practices in Urology are in 1 in San Diego area, 2 in Dallas, 1 in San Antonio, 1 in Houston, 1 in Florida, 1 near NYC, 1 in Maryland/Virginia, 1 in Chicago, and 1 in Las Vegas.

There isn't 1 small time community practice that even approaches what these make.

Everyone thinks that once you're in medical school, you're going to be a doctor. They don't realize that 10% of class will not graduate, 5% won't get into a residency, 5% will not finish their residency. So, not only are you paying that much money for medical school, there a significant risk you might not even end up practicing and end up having hundreds of thousands of loans on the line.

mikef07 said:   misterspaghetti said:   mikef07 said:   misterspaghetti said:   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. 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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Simply not true


I'm not sure what makes you say this. Large cities offer lower salaries simply because they can - they have a ton of competition for open positions. Not to mention the increased competition for patients in large cities as a result of the higher physician to population ratio. The smaller communities attract healthcare workers by offering larger salaries, and even then, they often have trouble finding them.


Because most are paid by reimbursement, not necessarily salary. Second, it depends on how many patients they support. For example in a previous post I talked about 1 physician in Dallas who makes almost $1M from Male BPH patients alone. Very few (if any) small town Urologists are making this. There is a Urologist in a border town of CA (not San Diego) making around $800K a year (total) so he is highly paid and in a small community. There simply is no correlation to size of community and how well certain doctors are paid. Some in big cities make big $, some make average or below. Some in small towns makes big $, some in small towns don't. It is completely YMMV.


You seem very focused on a few anecdotal outlier cases. We are speaking generally. Of course, it is YMMV, but there is a very large correlation to the size of the community. I've already explained the trend and the reason behind it. Any of us can name outlier cases in either category.

For the portion that own their own practice, it will depend on market share and would, theoretically, be the same in a small versus a large city assuming the same number of patients/procedures. For the rest, they are drawn to the "less desirable" locale by the higher offers. These include hospital-employed physicians, partnership track physicians, and other non-owners.

A lot of the time, insurance contracts will give higher reimbursement per CPT code in underserved areas.

Whereas insurance companies in NYC will often pay Medicare rates or lower because of the high number of physicians (competition), they will often pay much better rates in relatively underserved areas to encourage doctors to accept insurance

Thus, it is true that docs in smaller communities often make more than those in large cities.
There are certainly exceptions (ie the "big docs" who don't accept insurance in NYC)

misterspaghetti said:   mikef07 said:   misterspaghetti said:   mikef07 said:   misterspaghetti said:   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. 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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Simply not true



I'm not sure what makes you say this. Large cities offer lower salaries simply because they can - they have a ton of competition for open positions. Not to mention the increased competition for patients in large cities as a result of the higher physician to population ratio. The smaller communities attract healthcare workers by offering larger salaries, and even then, they often have trouble finding them.


Because most are paid by reimbursement, not necessarily salary. Second, it depends on how many patients they support. For example in a previous post I talked about 1 physician in Dallas who makes almost $1M from Male BPH patients alone. Very few (if any) small town Urologists are making this. There is a Urologist in a border town of CA (not San Diego) making around $800K a year (total) so he is highly paid and in a small community. There simply is no correlation to size of community and how well certain doctors are paid. Some in big cities make big $, some make average or below. Some in small towns makes big $, some in small towns don't. It is completely YMMV.


You seem very focused on a few anecdotal outlier cases. We are speaking generally. Of course, it is YMMV, but there is a very large correlation to the size of the community. I've already explained the trend and the reason behind it. Any of us can name outlier cases in either category.

For the portion that own their own practice, it will depend on market share and would, theoretically, be the same in a small versus a large city assuming the same number of patients/procedures. For the rest, they are drawn to the "less desirable" locale by the higher offers. These include hospital-employed physicians, partnership track physicians, and other non-owners.


Except I have the books on over 500 practices in both small communities and large communities and in almost every case big city doctors (and their suburbs) make more than small community doctors. In fact the few outlier cases are those in small communities that happens to do as well as their big city counterparts. But please continue to talk nonsense. i only do this for a living and have been for 10+ years. Our company is paid a % of revenue so there isn't any lying from these guys.

So your explanation of a trend simply isn't true.

Give me specifics of where Urologists are paid more instead of making crap up. I can give you specifics of small town Urologists and where they are who make as much but they are few and far between. You just said any of us can name outlier cases. Lets here your cases of where specifically these towns are that pay more than their big city counterparts.

There are no hospital owned employees even touching close to what the top guys make. So while a big city hospital may offer a Urologist $300,000 and a small community hospital may offer a Urologist $400,000 it doesn't come close to what your top 25% of Urologists make in the big cities. What you can and shouldl say is that sometimes a small community may pay a higher salary than what a big city hospital pay as a salary if you happen to be in the small minority of a specialist that is a salary only employee.

My brother is a doc, many friends are, and I worked in the ortho industry for many years.

I can tell you, without a doubt, the biggest threat to a doctor's financial well being is the fact that many of them think they know how to run an efficient business without any business training whatsoever, and have too much hubris to admit they need to hire someone to do that aspect for them.

That, and fooling around with their nurses/assistants and having to pay significant alimony/child support when they get busted.

digduggler said:   My brother is a doc, many friends are, and I worked in the ortho industry for many years.

I can tell you, without a doubt, the biggest threat to a doctor's financial well being is the fact that many of them think they know how to run an efficient business without any business training whatsoever, and have too much hubris to admit they need to hire someone to do that aspect for them.

That, and fooling around with their nurses/assistants and having to pay significant alimony/child support when they get busted.


Regular people get caught, too, but they have the decency to lie about it so as not to hurt their wives.

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'd rather be operated on by a doctor making $250k/year and had 6 hours of sleep than someone making $500k and only got to lay down for 2 hours.

I got tired of reading all the statistics in that article. If being a physician is so terrible and a questionable investment, the author failed to explain what we are supposed to do if there are no more doctors. Are we supposed to drop dead from an ailment that could have easily been treated by a doctor?

joebos said:   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.

..or will improve access to care, which will cost more.

mikef07 said:   Pun said:   BenH said:   misterspaghetti said:   BenH said:   
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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Actually it doesn't make it irrelevant. All it does is make my assumption that larger urban areas pay more incorrect. As I have not done extensive research into this I won't argue if your statement is correct or not, but if so, it only strengthens my point.


It's true that any medical field are generally paid more in smaller communities (LV, AZ, Midwest, etc) but it does support BenH's statement.
People move to NYC with a pay cut simply because they want to experience nyc. They simply should not b1tch about their cost of living because they can earn more with 1/2 of living expenses in most other states.


Wrong again. One of the biggest money making Urology practices in America is right near NYC. You are simply making stuff up. Top 10 highest paid practices in Urology are in 1 in San Diego area, 2 in Dallas, 1 in San Antonio, 1 in Houston, 1 in Florida, 1 near NYC, 1 in Maryland/Virginia, 1 in Chicago, and 1 in Las Vegas.

There isn't 1 small time community practice that even approaches what these make.


Top earners are from the big cities(that's where all the big money is) but generally, higher salary/pvt office incomes are from smaller communities.
Are you a physician? I am. I get my monthly journals, and occasionally it gives statistical income based on states. NYC, CA, MA are the lowest.

mikef07 said:   misterspaghetti said:   mikef07 said:   misterspaghetti said:   mikef07 said:   misterspaghetti said:   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. 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.


Which is really irrelevant since those in the medical field are generally paid more in smaller communities than they are in the large urban areas.


Simply not true



I'm not sure what makes you say this. Large cities offer lower salaries simply because they can - they have a ton of competition for open positions. Not to mention the increased competition for patients in large cities as a result of the higher physician to population ratio. The smaller communities attract healthcare workers by offering larger salaries, and even then, they often have trouble finding them.


Because most are paid by reimbursement, not necessarily salary. Second, it depends on how many patients they support. For example in a previous post I talked about 1 physician in Dallas who makes almost $1M from Male BPH patients alone. Very few (if any) small town Urologists are making this. There is a Urologist in a border town of CA (not San Diego) making around $800K a year (total) so he is highly paid and in a small community. There simply is no correlation to size of community and how well certain doctors are paid. Some in big cities make big $, some make average or below. Some in small towns makes big $, some in small towns don't. It is completely YMMV.


You seem very focused on a few anecdotal outlier cases. We are speaking generally. Of course, it is YMMV, but there is a very large correlation to the size of the community. I've already explained the trend and the reason behind it. Any of us can name outlier cases in either category.

For the portion that own their own practice, it will depend on market share and would, theoretically, be the same in a small versus a large city assuming the same number of patients/procedures. For the rest, they are drawn to the "less desirable" locale by the higher offers. These include hospital-employed physicians, partnership track physicians, and other non-owners.


Except I have the books on over 500 practices in both small communities and large communities and in almost every case big city doctors (and their suburbs) make more than small community doctors. In fact the few outlier cases are those in small communities that happens to do as well as their big city counterparts. But please continue to talk nonsense. i only do this for a living and have been for 10+ years. Our company is paid a % of revenue so there isn't any lying from these guys.

So your explanation of a trend simply isn't true.

Give me specifics of where Urologists are paid more instead of making crap up. I can give you specifics of small town Urologists and where they are who make as much but they are few and far between. You just said any of us can name outlier cases. Lets here your cases of where specifically these towns are that pay more than their big city counterparts.

There are no hospital owned employees even touching close to what the top guys make. So while a big city hospital may offer a Urologist $300,000 and a small community hospital may offer a Urologist $400,000 it doesn't come close to what your top 25% of Urologists make in the big cities. What you can and shouldl say is that sometimes a small community may pay a higher salary than what a big city hospital pay as a salary if you happen to be in the small minority of a specialist that is a salary only employee.


Do you represent a bunch of Urologists/practices, etc? I only ask because all your examples use them.

I am, of course, asking for selfish reasons.

As a 4th year Urology resident (at a very good program) I am starting to look into what I will be doing next.

Just wanting you see if you are someone I should get to know, ha.

ER doc here.

You seem to focus quite a bit on urology practices, and I cannot comment on that. What I can say is that as an EP, I can make nearly double in the middle of nowhere as I can in the city.

I live in Chicago, but it pays so poorly that I actually travel to rural Wisconsin and North Dakota for half the month for work. It is literally 2x the salary. In these middle-of-nowhere hospitals, there are all sorts of specialties (gas, ENT, and yes urology) that are travelling to these rural places from NYC, SF, Chi, etc. I do pick up an occasional shift in Chicago because it's nice to work close to home sometimes, but it pays so badly that it's frankly just not worth the time.

So I'm not sure where you're getting your information from, but it is absolutely the polar opposite to what I have been experiencing for the last five years of my practice.

I will say that if it's too rural, then the pay drops to Chicago levels just because there are so few patients. The sweet spot seems to be a rural location that is currently experiencing unprecedented volumes of patients (i.e. ND with the oil boom).

As someone said earlier, Chicago pays badly just because they can. There is no end to the number of docs who want a job in the city. Try convincing someone to come out to ND (hint: $$ helps).

Another point I wanted to make is that if you're the only game in town (i.e. you are the only neurosurgeon for 250 miles), you can basically name your salary. I knew a neurosurgeon out of Montana who basically threw an offer on the table of $1.7 mil, and the hospital took it because they had to keep their level 2 trauma status. This happens all the time in small communities. There is about a 0% chance of having that kind of leverage in an urban environment.

MiaFLSurf said:   
Do you represent a bunch of Urologists/practices, etc? I only ask because all your examples use them.

I am, of course, asking for selfish reasons.

As a 4th year Urology resident (at a very good program) I am starting to look into what I will be doing next.

Just wanting you see if you are someone I should get to know, ha.


Word of advice to you.
STAY AS FAR AWAY AS YOU CAN from these groups. Learn from your mentor and get a good sense of running a business instead.
Many are linked with the Scientology groups.

jkimcpa said:   I'd rather be operated on by a doctor making $250k/year and had 6 hours of sleep than someone making $500k and only got to lay down for 2 hours.

I'd take either. It's the surgery resident making 35k that's been up for 24 hours that worries me. And yea, it's legal.

While I have no problem with highly paid doctors, I'd rather be cared for by a doctor who didn't choose his profession because of the money.

MiaFLSurf-

I'm an attending urologist, and know plenty of guys in many areas of the country.
I am well versed in the business of urology

PM me if you'd like to discuss

Pun said:   MiaFLSurf said:   
Do you represent a bunch of Urologists/practices, etc? I only ask because all your examples use them.

I am, of course, asking for selfish reasons.

As a 4th year Urology resident (at a very good program) I am starting to look into what I will be doing next.

Just wanting you see if you are someone I should get to know, ha.


Word of advice to you.
STAY AS FAR AWAY AS YOU CAN from these groups. Learn from your mentor and get a good sense of running a business instead.
Many are linked with the Scientology groups.


Always take anything you read on the Internet with a grain of salt.
Mentors and highly regarded people you meet at meetings are generally the best sources.

Pun said:   Many are linked with the Scientology groups.

Not that I'm doubting you, but I've never heard this and would like to learn more.

Got a link or reference?

Pun said:   [

Top earners are from the big cities(that's where all the big money is) but generally, higher salary/pvt office incomes are from smaller communities.
Are you a physician? I am. I get my monthly journals, and occasionally it gives statistical income based on states. NYC, CA, MA are the lowest.


Not what I have seen both in reality and in statistical publications. Let me know how many practices' actual books you get to see?

expired said:   While I have no problem with highly paid doctors, I'd rather be cared for by a doctor who didn't choose his profession because of the money.

Good luck with that. I could post numerous quotes that I hear on a daily basis from doctors that would make your stomach curdle.

MiaFLSurf said:   
Do you represent a bunch of Urologists/practices, etc? I only ask because all your examples use them.

I am, of course, asking for selfish reasons.

As a 4th year Urology resident (at a very good program) I am starting to look into what I will be doing next.

Just wanting you see if you are someone I should get to know, ha.


I work with more offices than any of these physicians here know. Am I worth knowing for you? I have no clue. What I will tell you is that if you are worth knowing we will find you. If it makes sense to work with us (and you) you will. If not then you won't.

rxfudd said:   ER doc here.

You seem to focus quite a bit on urology practices, and I cannot comment on that. What I can say is that as an EP, I can make nearly double in the middle of nowhere as I can in the city.

I live in Chicago, but it pays so poorly that I actually travel to rural Wisconsin and North Dakota for half the month for work. It is literally 2x the salary. In these middle-of-nowhere hospitals, there are all sorts of specialties (gas, ENT, and yes urology) that are travelling to these rural places from NYC, SF, Chi, etc. I do pick up an occasional shift in Chicago because it's nice to work close to home sometimes, but it pays so badly that it's frankly just not worth the time.

So I'm not sure where you're getting your information from, but it is absolutely the polar opposite to what I have been experiencing for the last five years of my practice.

I will say that if it's too rural, then the pay drops to Chicago levels just because there are so few patients. The sweet spot seems to be a rural location that is currently experiencing unprecedented volumes of patients (i.e. ND with the oil boom).

As someone said earlier, Chicago pays badly just because they can. There is no end to the number of docs who want a job in the city. Try convincing someone to come out to ND (hint: $$ helps).



I (well our company does) work with physicians in North Dakota so your point is moot. All my information comes from the real books. We get a cut of all procedures performed related to our field. There ain't no lying there. There is no Urologist that services North Dakota that is making what the top 10 guys in Dallas do. Period.

Pun said:   MiaFLSurf said:   
Do you represent a bunch of Urologists/practices, etc? I only ask because all your examples use them.

I am, of course, asking for selfish reasons.

As a 4th year Urology resident (at a very good program) I am starting to look into what I will be doing next.

Just wanting you see if you are someone I should get to know, ha.


Word of advice to you.
STAY AS FAR AWAY AS YOU CAN from these groups. Learn from your mentor and get a good sense of running a business instead.
Many are linked with the Scientology groups.



Really? What do I do? Funny. I would say stay away from advice from people who comment on things about what others jobs are when they have no clue. If physicians were great at medicine and/or business my company would not exist. The only reason we exist is because physicians make poor medical decisions and poor business decisions.


JacksonX said:   MiaFLSurf-

I'm an attending urologist, and know plenty of guys in many areas of the country.
I am well versed in the business of urology

PM me if you'd like to discuss


I would disagree with this based on our last conversation where we talked about different procedures offered for BPH and you didn't even offer some of the best procedures for your patients and are not aware of the newest and most relevant statistics/studies regarding the top 5-6 procedures. I would call that anything but well versed, but that is my opinion. I also know many more physicians than you (I promise that) and can tell you there are a handful I would recommend to mentor anyone. I can tell you who runs the best business and who I would see if I needed a procedure and let me tell you they aren't the same. The guys who run the best businesses are rarely the best doctors. Physicians also have the biggest jealousy factors when it comes to other physicians especially around them. I always laugh when I see the rating in magazines where they take the opinions of other physicians in the area to rank them. 60% of them I wouldn't let touch me or my family yet they are the highest rated by their peers.


JacksonX said:   
Always take anything you read on the Internet with a grain of salt.
Mentors and highly regarded people you meet at meetings are generally the best sources.


Definitely based on our last conversation I would agree with this. Highly regarded people in your specialty are largely ones taking huge $ from manufacturers of drugs and equipment. I know the 5 highest regarded people in your specialty personally (located in Dallas, Mayo, Hopkins, Duke, and Mayo Scottsdale) and they are on the take for big $ from pharma and device companies. Now due to the sunshine act we can see all te payments made to you guys. It is amazing how much more a Urologist getting paid $50,000 by GSK prescribes GSK meds. By the way that is one of the highest regarded docs in Urology and that is just what GSK paid him so I would take highly regarded with a grain of salt. 12 companies paid out 760 million dollars in "consulting" fees and who do you think they go after? Highly regarded physicians.

Mike-

Thanks for your opinion.
I am a young urologist who considers himself up on the latest treatments and well read in my discipline.
I make more than the average urologist and have a good quality of living working a 4 day week, and am proud of the care I provide for my patients
I also speak to a lot if my contemporaries (mainly on the east coast.)
I think a lot of my success is related to my practice's business savvy as well as our striving to provide excellence of care for my patients.

If a urology resident wants advice from a urologist in private practice, I consider myself a good source
(And residency directors from several local programs have had their trainees speak to me in the past because of this.)

DrDubious said:   Pun said:   Many are linked with the Scientology groups.

Not that I'm doubting you, but I've never heard this and would like to learn more.

Got a link or reference?


Mike clearly has no clue. Many physicians have come forward on this thread with their input and he still argues.
Mike, do you get our monthly journals? At least once or twice a year, there are statistical data of state incomes based on over 30,000-40,000 offices. You have what...500? You call that a number that most physicians have ever worked with? I am sorry but, just within my network, I have over 700 practicing physicians all over the country. Although, I have no clue of what their numbers are, I'd take these statistical data based on medical journals over your lousy 500 books.

These management companies do MORE HARM than goods. There are many doctors who are incapable of running an office, but they are much better off by seeking help from their colleagues and mentors, instead of sinking $$$ on these companies. Personally, I have seen over two dozens of physicians who got burnt bad from these managements and had to close their doors.

I am not sure what Mike does for living within his company, but from my experience, any management companies that leeches off of physicians claiming to be consultant, marketing, billing group tend to be total disaster in the end. Yes, there may be few outliers who thrive with the help of these management, but the offices would have done the same or better with the help from your colleagues and mentors instead.

Drdubious,
Try googling. Just to throw one out there, Ster1ing Healthcare Manangement. I am not saying (nor denying) that they are one of them (some groups will break the law to harass you, and for that reason I have replaced L with 1 on Ster1ing)

Since this is a public info, here is the link
Text

Pun said:   DrDubious said:   Pun said:   Many are linked with the Scientology groups.

Not that I'm doubting you, but I've never heard this and would like to learn more.

Got a link or reference?


Mike clearly has no clue. Many physicians have come forward on this thread with their input and he still argues.
Mike, do you get our monthly journals? At least once or twice a year, there are statistical data of state incomes based on over 30,000-40,000 offices. You have what...500? You call that a number that most physicians have ever worked with? I am sorry but, just within my network, I have over 700 practicing physicians all over the country. Although, I have no clue of what their numbers are, I'd take these statistical data based on medical journals over your lousy 500 books.

These management companies do MORE HARM than goods. There are many doctors who are incapable of running an office, but they are much better off by seeking help from their colleagues and mentors, instead of sinking $$$ on these companies. Personally, I have seen over two dozens of physicians who got burnt bad from these managements and had to close their doors.

Drdubious,
Try googling. Just to throw one out there, Ster1ing Healthcare Manangement. I am not saying (nor denying) that they are one of them (some groups will break the law to harass you, and for that reason I have replaced L with 1 on Ster1ing)


Keep your head in the sand. BTW there are not 30,000 to 40,000 Urology offices in the USA. In 2009 there were approximately 10,000 Urologists in the US. Our company works with over 1500 practices. I personally work with over 500. So I could look up billing amounts for any of the 1500. Second learn about statistics. If NYC has 100 physicians and the top 20 are higher than rural docs and the bottom 40 are way lower than rural docs, then to say that physicians are higher paid in rural areas over big city docs is just plain wrong. On average when taking into account the bottom 40 they may be. Your top paid physicians in America If you ranked them 1-100) are in big cities (and their suburbs) for the most part.

Furthermore a rural community might have two Urologists making $400K whereas a big city might have 40 making only $300K or less thus driving the average pay down, but there are also 10 or so making well over $500K. Third many physicians lie. All those journals do is ask physicians what they make. They also don't take into account physicians who are able to double dip because they own surgery centers, hospitals, various rolling lab facilities, etc. Those can only be supported in larger cities and their suburbs.

But yeah you know what you are talking about. I do this for a living and unlike your journals we actually see what is billed rather than a survey asking doctors what they make. BTW we get every journal related to our field. 700 practicing physicians? Great. Since I have relationships with well over 500 practices (A little hint. One practice has over 50 docs) my number far exceeds yours. Second you have viewed their billables exactly 0 times (other than your own practice) whereas I have seen pretty much everyone's that we work with. Finally I have no dog in this fight. We work with both rural and big city docs. I can tell you unequivocally the top practices are in big cities.

I can;t speak on any other company other than mine. In the end when they open their books up after we work with them they are more profitable and provide higher success rates to their patients at least according to their own books. If not they would leave us in a heartbeat. WE give them the ability to offer substantially more options for their patients. Again this is off topic and what we provide is irrelevant. What is relevant is that I get to see the books.

Specifically tell me where in rural America a Urologist is making more than $700K per year because I personally know of 20+ big city docs that are and since you claim that rural docs make more naming what city they are in should be no problem especially since you know over 700 practicing physicians in the US alone. Ironically I could tell you which rural docs do make that kind of money so we can see if you can name 5 or so. WIll wait for your answer as to what rural cities these guys are in.

Mike,
I really don't have much other comment to you. If you really think you know better than all these physicians, well great!
Also, I am not a urologist and I was not referring to 30-40k Urology office, but GP. Since the argument was about Rural vs urban (or big vs small cities/states), I had chimed in on general income level of a physicians based on location.

Pun said:   Mike,
I really don't have much other comment to you. If you really think you know better than all these physicians, well great!
Also, I am not a urologist and I was not referring to 30-40k Urology office, but GP. Since the argument was about Rural vs urban (or big vs small cities/states), I had chimed in on general income level of a physicians based on location.


I know 0 about GP so that may be the case. I do know specialties though and Urology especially and big city Urologists make more than rural docs as in if you ranked them 1-100 based on earnings.

And yes I can speak to what 500 urology practices (with thousands of docs in those practices) bill compared to any one (or ten) physicians on this board claim since they have a 0% chance of seeing other offices books. Not once would I claim to know what they make. Would you show another doctor who does not practice with you your books? Highly highly doubtful. Fortunately for us they have to show us (its in the contract so we get paid).

Based on this if you want to be a GP it may make sense to go rural. If you want to specialize in something it is likely that you will make more in big cites.

Here is an article talking about trends. Nothing to do with pay.

http://www.facs.org/fellows_info/bulletin/2012/neuwahl0112.pdf

Urology or any other sub specialty group will do better in major cities and states, ABSOLUTELY!
People travel few hundred, thousands of miles to see these specialist who are affiliated with many famed hospitals.
But doctors in general is the opposite. Many families won't even go few extra blocks to see their regular physician.

Pun said:   Urology or any other sub specialty group will do better in major cities and states, ABSOLUTELY!
People travel few hundred, thousands of miles to see these specialist who are affiliated with many famed hospitals.
But doctors in general is the opposite. Many families won't even go few extra blocks to see their regular physician.


Please explain this to me.

The average physician generalist makes a median of $173K in the US.

Based on what you have said it would lead us to believe that in the big cities that it would have to be less than the median or close to it (but below) because:

1) Less docs in rural areas so more would have to be below in big cities slightly because the rural docs would be above the median and there are fewer rural docs

However when I looked at the numbers for your larger cities in America this is what came up:

LA -$189K (above)
Chicago - $183K (above)
Dallas - $172K (at)
Houston $173K (At)
NY - $201K (above)
SF - $207K (above)
Boston - $191K (Above)
Miami - $169K (below) Well you got one right
Seattle (186K) above)

SO rural docs would have to make significantly less than big city counterparts for the median of US to be below all of those large cities otherwise all of the big city docs would be below the median. SO for the median in the US to be that much below there has to be a hell of a lot of rural docs that drag that median down. Please let me know if I missed any significant big cities. I also just checked Atlanta, DC, Phoenix and Vegas (all are at median except DC which is above). Approximately 10% of physicians are in the rural setting so pretty much what you are saying is statistically impossible except for a few outliers.

I will wait for an explanation as to where the generalists are located in the US that are making the median at 173K which is well below most big cities.

Well, let me chime in as a primary care physician:

There are some huge differences in primary care salaries based on a couple of qualities:

1. State: Different parts of the country have been dominated by a myriad of insurance philosophies. Some states are dominated by capitated HMOs, others are based on pure production. Some states have outrageous malpractice insurance (New Jersey, Mississippi), others have pretty good malparactice.

2. Type of practice: Are you solo, group (Specialist run), group (Primary care run), Hospital system owned, etc. Usually the bigger the practice, the better your insurance contracts can be, but it depends on who's running the system to direct which way the money falls.

3. Partner vs. Non Partner

4. Medicaid vs. Non-Medicaid: If you're seeing a lot of medicaid patients, you will NOT make a lot of money. I don't care who you are... you can't make money that way.

Adding up these differences can mean making 120,000 in one place vs. $300,000 in another for doing the same amount of work.

mikef07 said:   Pun said:   Urology or any other sub specialty group will do better in major cities and states, ABSOLUTELY!
People travel few hundred, thousands of miles to see these specialist who are affiliated with many famed hospitals.
But doctors in general is the opposite. Many families won't even go few extra blocks to see their regular physician.


Please explain this to me.

The average physician generalist makes a median of $173K in the US.

Based on what you have said it would lead us to believe that in the big cities that it would have to be less than the median or close to it (but below) because:

1) Less docs in rural areas so more would have to be below in big cities slightly because the rural docs would be above the median and there are fewer rural docs

However when I looked at the numbers for your larger cities in America this is what came up:

LA -$189K (above)
Chicago - $183K (above)
Dallas - $172K (at)
Houston $173K (At)
NY - $201K (above)
SF - $207K (above)
Boston - $191K (Above)
Miami - $169K (below) Well you got one right
Seattle (186K) above)

SO rural docs would have to make significantly less than big city counterparts for the median of US to be below all of those large cities otherwise all of the big city docs would be below the median. SO for the median in the US to be that much below there has to be a hell of a lot of rural docs that drag that median down. Please let me know if I missed any significant big cities. I also just checked Atlanta, DC, Phoenix and Vegas (all are at median except DC which is above). Approximately 10% of physicians are in the rural setting so pretty much what you are saying is statistically impossible except for a few outliers.

I will wait for an explanation as to where the generalists are located in the US that are making the median at 173K which is well below most big cities.


Mike,
I am not sure what data you are looking at but it can be biased based on the type of data pulled.
If it's Salary.com, you are obviously looking at the wrong number.
An Average 30-60yo Primary Care physicians? including salaried? Does it include semi-retiree?

Take a look a few of the links below:
Text
West is comparable to mid/southwest (although still lower) because of cities other than LA (including OC/Irvine, etc), San Diego.

Text
Northeast takes almost every category on Lowest income. Mid/Southwest takes almost every category on Highest income.

Take a look at the median income vs highest paid region income. If you don't know why the median income is higher than highest paid region income, you shouldn't be giving any advice in your urology billing/consulting group.

Rural doctors tend to work less, and earn less, although they have the opportunity to earn more. If one commits to working full time (apple to apple) compare to major city, the salary is significantly more. This relates to what BenH had said before. People earn less in NYC but they choose to earn less while working full hours. On the other hand, people in the rural work less while making similar amount of money due to lower cost of living. IMO, we shouldn't consider them in GENERAL physician's income because they work different number of hours. But every data groups them together.

TO all the Physicians here, if you start your own practice or join group practice, learn the part of managing your Employees first. I have a great Physician in a Group practice, but the front-desk staff rules the place, it's total chaos and the doctors are too-chicken to deal with the personality issues in the workplace.

Pun said:   mikef07 said:   Pun said:   Urology or any other sub specialty group will do better in major cities and states, ABSOLUTELY!
People travel few hundred, thousands of miles to see these specialist who are affiliated with many famed hospitals.
But doctors in general is the opposite. Many families won't even go few extra blocks to see their regular physician.


Please explain this to me.

The average physician generalist makes a median of $173K in the US.

Based on what you have said it would lead us to believe that in the big cities that it would have to be less than the median or close to it (but below) because:

1) Less docs in rural areas so more would have to be below in big cities slightly because the rural docs would be above the median and there are fewer rural docs

However when I looked at the numbers for your larger cities in America this is what came up:

LA -$189K (above)
Chicago - $183K (above)
Dallas - $172K (at)
Houston $173K (At)
NY - $201K (above)
SF - $207K (above)
Boston - $191K (Above)
Miami - $169K (below) Well you got one right
Seattle (186K) above)

SO rural docs would have to make significantly less than big city counterparts for the median of US to be below all of those large cities otherwise all of the big city docs would be below the median. SO for the median in the US to be that much below there has to be a hell of a lot of rural docs that drag that median down. Please let me know if I missed any significant big cities. I also just checked Atlanta, DC, Phoenix and Vegas (all are at median except DC which is above). Approximately 10% of physicians are in the rural setting so pretty much what you are saying is statistically impossible except for a few outliers.

I will wait for an explanation as to where the generalists are located in the US that are making the median at 173K which is well below most big cities.


Mike,
I am not sure what data you are looking at but it can be biased based on the type of data pulled.
If it's Salary.com, you are obviously looking at the wrong number.
An Average 30-60yo Primary Care physicians? including salaried? Does it include semi-retiree?

Take a look a few of the links below:
Text
West is comparable to mid/southwest (although still lower) because of cities other than LA (including OC/Irvine, etc), San Diego.

Text
Northeast takes almost every category on Lowest income. Mid/Southwest takes almost every category on Highest income.

Take a look at the median income vs highest paid region income. If you don't know why the median income is higher than highest paid region income, you shouldn't be giving any advice in your urology billing/consulting group.

Rural doctors tend to work less, and earn less, although they have the opportunity to earn more. If one commits to working full time (apple to apple) compare to major city, the salary is significantly more. This relates to what BenH had said before. People earn less in NYC but they choose to earn less while working full hours. On the other hand, people in the rural work less while making similar amount of money due to lower cost of living. IMO, we shouldn't consider them in GENERAL physician's income because they work different number of hours. But every data groups them together.



AS I pointed out take the top 100 earning physicians and rank them according to pay. If you think the majority are in rural areas you are sadly mistaken. There are no cities listed in those links. Show me median income for SF?LA docs and then show me what rural areas beat them. Little hint too - For rural docs to make more than big city docs they have to make more than every big city doc or the statement is not true. Saying that rural docs earn less because they work less is hilarious. Either they make more or less. Period. Take amount at end of year and compare to other docs amount at end of year. More is more.



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