> but most make way more than $300k after only a handful of years of experience.
'Eh, not really [1]. Most will wind up in the upper $100k region (most being in some form of primary care). Not after a handful of years, but 4+ yrs college, 4+ yrs medical school, then bare minimum 3 year residency (with most 4+), with each step an order of magnitude more difficult.
> most doctors are sons and daughters of rich folks
Many are, but since we're in the anecdata game, none of my friends were.
Not going to lose sleep over it, upper $100's is plenty to compensate for high debt in the long run. But to pretend its not extremely stressful for most is to be misinformed.
Lastly:
> 5 years of service in a shortage area
After spending the last 2 years in a qualifying region (though not for that purpose); topping off 12 yrs of post-high school with another 5 living somewhere you'd rather not be (to be polite) is no small feat. Thats 35 yrs old before you get a shot at living and working somewhere reasonable.
> The fact of the matter is that no other career path even comes close to the risk-adjusted lifetime financial remuneration of becoming a doctor
Does that stat include doctors who didn't place into residency. This year, 1 in 5 med school grads didn't get a residency. Some of them will match next year, but it's typically considered a one and done process. That something many older doctors tend to forget.
You basically go $1 million in debt (between tuition and lost wages) for a 1 in 5 chance of being a complete financial wreck with a mostly useless degree since you can't become licensed.
Once you've made it being a doctor can be great. However, the process of getting there is absolutely brutal.
> Probably close to half of doctors make less money than the average person working at FAANG.
I feel like comparing doctors as a whole to the subset of software engineers who are at FAANG is not really apt.
> delay any wages until 34
What?
Out of HS at 18, BS at 22, MD at 26.... then what? At least 2 years of residency (PGY1, 2) and you're 28. And then what are you doing for the next SIX years before you're earning wages? Uhhh.
> lower middle class life until 50 while paying of medical school debts
I work as a paramedic, and have multiple provider friends, from family practice, to EM to anesthesiology. While the anesthesiologist is 40 and already owns a book store, and multiple homes, none of the others are wallowing in the "lower middle class". You can pay a lot of student loans at the $300-350K EM residents make in this area.
> barely be in the top 10% after that
I think you're exaggerating on top of exaggeration.
The top 10% line would be at $86K/year.
Let's be more real. Public Health pays the lowest physician salary, averaging at $249K/year. That already puts you in the 2%.
Cruise on up the ladder and Gastro, Cardio, Ortho and Plastics all are north of $500K.
Yes, there is malpractice insurance, and it's not negligible (and some networks will provide allowances to providers for this). But it's also fairly linear to specialty and income, and often not as much as assumed. Obstetrics, as expected, is the highest, at ~$42K (with average salaries of $390K), family practice averages around $10K, and even my anesthesiologist friend is only paying around $13-15K/year.
>have to earn very high pay to cover the (insane) cost of medical school and insurance.
Also opportunity cost for people capable to become physicians in the US have other options with competitive pay to quality of life at work ratio. Lots of ways to not spend one’s 20s memorizing stuff for step exams and then spend 26 to 30 being a slave during residency, and then maybe a fellowship or getting board certified, and at the end, you still have to deal with patients.
Alternatively, they could go for a job where they sit behind a computer and not deal with the general public and get to work from home when shit hits the fan.
>They also have to go to school for 10 years before they’re even allowed in the job market.
Not to mention that during that time they are accruing loans in insane amounts (we are talking about $200-300k) and get worked in insane shifts (24-36 hour shifts are not unheard of during residency rotations).
Oh, and they don't get paid at all until they start residency rotations which is AFTER 4 years of med school, and their pay during residency is on the order of $30k-50k for what effectively amounts to 80-100 hours a week. Mind you, that's on top of the fact that in the US, you only enter a med school after you already got a college degree. So you enter a med school at the age of 23.
I have respect for the doctors, but I definitely do not envy their position. Their real work doesn't even start until their 30s, at which point they are already really deep in student loan debt. Of course it is manageable, since they get paid handsomely. But their work-life balance and the entire process where you start your "real work" after the age of 30 with $200-300k in loans, at that point, isn't something that a lot of people consider when they think "those doctors are having it nice."
It isn't even a second thought to me that I would much much rather study for interviews every single time i switch a job as a software engineer than deal with what doctors deal. And that's not even mentioning that studying for a typical software dev interview is absolutely nothing compared to the studying that med school students have to do in order to pass their board exams.
I can't remember where I saw the statistic, but the number of years it takes for a physician to have a positive net worth after leaving medical school has been increasing dramatically. (This is because debt from medical school and undergraduate have increased nominally, while the expected income of a physician has dropped dramatically[0])
[0] Again, the magnitude of this effect varies by state, but it's a nationwide trend.
> Doctors are well paid in the US but they are typically not rich.
What doctors do you know? My friends who are just getting out of residency and such are making a few hundred thousand a year. My college roommate’s father was an anesthesiologist making $800k/year.
Just because they don’t draw attention to themselves with ostentatious vehicles doesn’t mean they couldn’t afford to (the anesthesiologist only had a Porsche for each of his kids).
> I just want to point out that - you landed (probably more random than intentional) into arguably the best career in the history of labor.
I don't disagree. However, I certainly am not a top earner in the industry. Much of my career has been remote. My income is not out of line with most STEM fields. The main benefit for me was the ability to work remotely, moving with my wife to various small towns/cities.
Keep in mind, my wife had almost 10 years of med school and residency to start her career. I was making income the whole time. That's essentially a $1M difference 10 years into careers. It takes a while to overcome that gap.
-----
> I think the particular problem with the medical industry is... it's particular detrimental to society to be overworking doctors to the bone and it not really paying off for them until they're in their 50s.
Yep. There's also a huge personal burden of carrying that non-dischargable debt. If residency doesn't work out for some reason, you're in a huge hole.
We know many physicians who say they wouldn't do it again if they had know how shitty the journey would be.
> I know cardiologists pulling down 500k+ and that is ridiculous. I can see highly skilled surgeons making that much, but pill pushers?
I don't know about you but I'm not willing to be a student until I'm in my mid 30s, working crazy hours, likely accumulating a significant amount of debt along the way, without some kind of a substantial payout on the other side.
> Every time the topic comes up, you bring up the Medicare funding issue. Every time I explain why that doesn't seem to make sense: you can balance demand and supply by passing some of the costs on to the resident[1]; many will still gladly accept this because of the extreme returns to becoming a doctor.
And every time, I've explained that there aren't "extreme returns" to becoming a doctor. After accounting for all the expenses that physicians are required to pay out-of-pocket (which are not tax-deductible, due to AMT), the expected take-home pay is lower than what a mid-career engineer at Google or Microsoft makes, And the debt load is already high enough that it's discouraging people from entering the field[0][1][2], due to both the size and the risk..
Making medicine an even riskier bet (by taking on an even larger debt load with a longer time horizon) isn't going to solve any of that; it'll just lower the overall quality. At that point, it's more efficient to talk about NPs and PAs than piling on more debt to physicians.
> so unless you think that medical professionals are useless or that medicine should only be practiced by the rich, you should reconsider your views.
Doctors and medical professionals are among the highest paid in this country[1]. Paying off their student loans makes the least sense.
> The fact that you have to take enormous debts to be allowed to study (which is your only hope for social mobility)
This is so absurdly false. It's a false narrative that's been pushed by higher-learning institutions for decades, and now regular people believe it. You do not need a piece of paper to earn a tremendous amount in this country. So very many blue-collar jobs earn six figures annually.
What's required to have social and economic mobility is a work ethic and skill. It's that simple.
> My sister is currently a second-year medical resident, and "incredibly brutal compared..." feels like a understatement to me. She works 80hr weeks, often nights, helping people with deeply personal and painful issues that are hard to leave behind when you go home. This is after four years in medical school, with still at least a year to go before starting to earn doctor-level money.
I wonder which medical residency is she at? My wife is a resident at a pretty busy hospital in NY metro area. She is in her first year as well and doesn't do more than two night floats a week and no more than 60-65 hours a week. I also know so many other doctors (friends/acquaintances of my wife and via my ex-landlord who owns multiple family houses which he rents out these up-and-coming/current medical residents in NY metro area) and NO ONE works even close to 80 hours a week.
This is not to mention that it gets much better after the first year, and by the third year, you're only supervising most of the first years and simply studying for Step 3 (board) exam (if you haven't taken it by then).
I wonder if people tend to exaggerate when it comes tho how much time they spend for work because it makes them feel good/justifiable to the amount of income that they (eventually) receive. Having quit medical school after second year in my home country (SE Asia) and having seen my wife (then fiance) studying for Step 2 and 3 exams, I personally believe that medical studies mostly requires memorization (a LOT of it) and we would be surprised how little critical thinking skills and scientific knowledge (not recent ones they've memorized off the books, but I'm talking about things like physics, math and even chemistry) your average doctor has. They forget it all in a year or two after med school for sure (I can't possibly recall more than 206 bones that I learned in Anatomy in 2nd year!)
> To be a doctor, you need a 4 year college degree, then acceptance into a medical school, then pass the medical school courses and do N years of residency. The average medical school graduate has $200K of debt at that point.
It's not even that simple anymore. There's also the PGY1 year. There aren't nearly enough residencies to satisfy demand anymore. You might have to change specialties a few times before you land a residency. We're at the point where if you didn't go to medical school in the US, you're SOL. Even if you did, it's a struggle -- hope you went to a great medical school.
This at a time when we have higher demand for doctors than ever. Nobody wants to change the residency situation because the economics of it don't work out.
> But where is the money going? I don't know many poor doctors, but most of the ones I do know are not exactly rolling in cash.
The average debt is reportedly $190k for medical school graduates.
> The country should follow N.Y.U.’s lead in recognizing the damage wrought by crushing student debt. Making higher education free for all should not just be a pipe dream.
I don't know how I feel about this. I for one expect people who make over five times our target minimum wage[1] to contribute more through income taxes than they do now. While I agree people at higher levels should progressively pay dramatically more in taxes, if I were to run for political office today, I'd run on the platform of increased (federal) individual income tax for all and an eventual end to all tax credits, deductions, and any such incentives.
How will these high earners pay my demands for a higher income tax if they have trouble paying their loans? I understand that take home pay per month with $180k salary is about $9k per month[2]. Let us say your student loan payment is about $2k[3]. Let us say that your medical insurance and other career related expenses are about $1k. This still leaves you with about $6k per month. Assuming you save half your income (which I hope you do at this income level), you have about $3k a month to spend on rent, groceries, and transit. Assuming you don't have any children and don't have any plans to have any children, this is not a bad spot to be in. Sure, one is not wealthy or financially independent until you are like 65 if you started working at 30, but if one wanted to make money, why is one in the medical field? In my opinion, it is kind of absurd to get into medicine and expect to become wealthy.
[1] Target minimum wage of $15 an hour at two thousand hours a year is $30,000. Five times $30,000 is $150,000.
> I'm sure American doctors would pay down their debt quite quickly if they lived like a Cuban doctor and nearly their entire paycheck went to school loans.
After medical school, doctors still aren't qualified or licensed to practice - they need to go through residency first, which pays really poorly (in some cases, less than the equivalent of minimum wage). During that time, doctors aren't going to be paying down their loans, because they're just making enough to get by. (Some doctors even end up having to take on additional debt just to get through residency. That debt comes from the private market and has a higher interest rate than the unsubsidized Stafford loans).
This period lasts anywhere from 4-10 years, depending on your specialty. In the end, it's not unusual for a doctor who enters medical school in their mid-20s[0] and is not independently wealthy to expect to turn 40 before paying off their final medical school loan.
Medicine isn't the unbelievably, guaranteed lucrative field people think it is. It may have been in the past, but those days are long gone, and the expected lifetime earnings for physicians continues to drop each year, which means it takes even longer to pay off your debt.
[0] This is actually typical; most physicians, especially at top schools, don't enter medical school straight out of their undergraduate program
> Your first link does not show numbers much different from the previous article linked.
Correct. I cited that link because it more clearly shows that those numbers refer to the debt upon graduation from medical school, not the date at which the income numbers in the previous article become relevant (which comes several years after the completion of residency).
I'm not sure why you selectively quote that one phrase from the second link (which in context is not saying that $100K isn't a lot; it's really just a warning about how much worse it is to triple the principal on a debt with compound interest), and yet ignore the clear evidence that it does, in fact, take decades to pay off the debt (and even then, that's just to break even). Even if you don't like those particular links, it's pretty easy to corroborate that elsewhere.
Earning a "comfortable income" on paper is not very meaningful when you could be well into your fifties and still be behind where you would have been at 25 had you dropped out of college at 20 and gone to work for Wall Street or a startup, or pretty much any other high paying job that someone of that caliber would also be capable of. On top of that, as I already said, the income statistics for private practice physicians don't factor in many of the costs associated with maintaining a practice, so it's more like talking about the revenue of a small business than the income of an individual.
Medicine isn't really that secure a job anymore, either, contrary to popular belief. That's why so many practices have had to close in the last ten years, and why physician salaries, for those not in private practice, have been on a sharp decline.
It's really popular to hate on physicians for supposedly making a lot of money for a supposedly cushy job. That may have been true once, but it's not really true anymore, and it's becoming even less and less true very quickly.
>Because who in their right mind wants to sacrifice 16 years of earning potential, take on 500K of debt only to become an MD with long work days and now prices that are fixed with no other form of negotiation leverage in sight.
Asians/Indians make most MDs in the US because being a doctor is valued a lot in their communities even if you've infinite debt, you still get respect.
Second, most doctors come from doctor families. They've already transversed the path once, and their kids can reuse the knowledge and connections.
So yea, my father is MD and he can easily support 16 years of MD education for me. If you don't have a family with similar resources, obviously either you can take debt which comes with enourmose stress/worries which decrease your chance to complete or not compete at all!
Individualistic people aren't going to find it easier to compete with community backed people.
> people going into 200k debt to become doctor's are mostly over paying
That's probably average combining undergrad and medical school. I go to one of the cheapest medical schools in the country, and it's > $240k in loans alone, let alone interest (plus the $130k from undergrad for me)
'Eh, not really [1]. Most will wind up in the upper $100k region (most being in some form of primary care). Not after a handful of years, but 4+ yrs college, 4+ yrs medical school, then bare minimum 3 year residency (with most 4+), with each step an order of magnitude more difficult.
> most doctors are sons and daughters of rich folks
Many are, but since we're in the anecdata game, none of my friends were.
Not going to lose sleep over it, upper $100's is plenty to compensate for high debt in the long run. But to pretend its not extremely stressful for most is to be misinformed.
Lastly: > 5 years of service in a shortage area
After spending the last 2 years in a qualifying region (though not for that purpose); topping off 12 yrs of post-high school with another 5 living somewhere you'd rather not be (to be polite) is no small feat. Thats 35 yrs old before you get a shot at living and working somewhere reasonable.
[1] http://www.medscape.com/features/slideshow/compensation/2013...
reply