Physician Compensation and Subspecialties

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Topic Author
NYGiants235
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Physician Compensation and Subspecialties

Post by NYGiants235 »

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mhalley
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Re: Physician Compensation and Subspecialties

Post by mhalley »

I agree that 190 k is a little low for a hospitalist, esp in NYC . It is not uncommon for new attending to be under compensated until they learn what they are worth. Medscape says northeast avg is 232k. http://www.medscape.com/features/slides ... ist#page=6 (looks like you need to be Medscape member to see the link)
So I would say the answer may be looking for a new job instead of a fellowship before you go that route. I am sure my small hospital in wv would pay you more than that with a huge decrease in col. :D
There are other jobs besides hospitalist for IM without having to specialize. Urgent care, Locums, ER (blasphemy, I know, don't tell wci) private practice, insurance, etc etc.
There is no question you will make more money as a sub. Do you have a feeling for what you would like to do? Burnout is a real problem these days, so it is more important to have a job you like than just going for the :moneybag
mhalley
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Re: Physician Compensation and Subspecialties

Post by mhalley »

Ps you might post on the wci site also.
whitecoatinvestor.com/forums/
new2bogle
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Re: Physician Compensation and Subspecialties

Post by new2bogle »

I am not a physician but have 4 family members who are. $190k is not worth it. One of my siblings is an allergy specialist making closer to $300k (12 years in) in a much lower CoL area.

Have you looked into going to Wall St? (not joking: I know of 2 MDs from my hometown who did that and are now worth double digit millions. But no one likes them because they are super arrogant (however, they were arrogant SoB's when they were younger too - maybe it goes hand in hand)).
jbmitt
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Re: Physician Compensation and Subspecialties

Post by jbmitt »

Look at practicelink under your speciality and many of the postings give a base salary applicable to a 2yr guarantee prior to production, partnership, etc.

You also selected to practice in a desirable area that tends to attract more candidates. There are smaller towns and rural communities that will compensate aggressively for in demand specialties.

I wouldn't suggest going back to fellowship strictly for increased income. Do it because it's something you want to do.
WL2034
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Re: Physician Compensation and Subspecialties

Post by WL2034 »

For hospitalists and other hospital employed MD specialties, the pay tends to be much lower in HCOL "desirable locations" because doctors will move there and are willing to work for less. In my experience, these places also tend to have higher average census and are more stressful, overall.

I know people who have lived in NYC but travel to work hospitalist locums to make around twice that amount.

I can give you specific details if you are interested feel free to PM. Moving (or at least working) outside of NYC is probably the real decision. Personally, I would not work 26 weeks/year, 84 hr/week, for $190k. There are much, much better opportunities out there--but I'm not sure about in NYC.
new2bogle
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Re: Physician Compensation and Subspecialties

Post by new2bogle »

What kind of apartment are you getting in NYC for $600/month?
beezquimby
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Re: Physician Compensation and Subspecialties

Post by beezquimby »

i'm a hospitalist.
If you don't enjoy the work or that particular job, find a new job or sub specialize. Not rocket science here.
PFInterest
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Re: Physician Compensation and Subspecialties

Post by PFInterest »

new2bogle wrote:What kind of apartment are you getting in NYC for $600/month?
I agree. This is the most amazing part of this post.
rjbraun
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Re: Physician Compensation and Subspecialties

Post by rjbraun »

NYGiants235 wrote: My age: 30 y/o
Marital status: Married
Location: NYC
Debt/Obligations: Student loan $165k @ 6.8%
My car is paid in full and valued at ~18k
We are currently renting an apt @ $600/month

Compensation:
$190k/year flat rate
That rent seems incredibly low for NYC, especially for two people. Just wondering if rent is subsidized by the employer and is intended as part of the overall compensation package. If so, and if the job offers other "perks", perhaps those should be factored in.

Edit: Just noticed two others also flagged the rent thing
Last edited by rjbraun on Wed Jul 19, 2017 2:58 pm, edited 1 time in total.
cpants
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Re: Physician Compensation and Subspecialties

Post by cpants »

It might be easier said than done to do a GI or cards fellowship. Aren't those pretty competitive?
sawhorse
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Re: Physician Compensation and Subspecialties

Post by sawhorse »

PFInterest wrote:
new2bogle wrote:What kind of apartment are you getting in NYC for $600/month?
I agree. This is the most amazing part of this post.
Parking spots in New York City go for more than $600 a month. Is this a typo?
kjvmartin
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Re: Physician Compensation and Subspecialties

Post by kjvmartin »

NYGiants235 wrote: the more work, the more I feel like it's just a job and I am being under-compensated
"Oh, you hate your job? Why didn't you say so? There's a support group for that. It's called everybody, and they meet at the bar." Drew Carey

Beware that the grass may not be greener.
sawhorse
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Re: Physician Compensation and Subspecialties

Post by sawhorse »

NYGiants235 wrote: Secondly, I found that the job was much harder and more unpleasant than I expected it to be. The hours are pretty long/brutal, and the off-weeks are not as nice as I expected. I thought all of the off-time would be really nice, but I find that I'd prefer to be off on weekends/holidays like most of my friends (and normal working people). Because I'm off when others are working, there really isn't much to do but sit at home and watch TV or read books; when my friends are actually planning things, I am unavailable every other weekend.
Do you plan to have kids? The off weeks become a lot more valuable if you have young children because it allows you to save on daycare and take the kids to appointments and things like that.
jbmitt wrote:I wouldn't suggest going back to fellowship strictly for increased income. Do it because it's something you want to do.
:thumbsup :thumbsup
Topic Author
NYGiants235
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Re: Physician Compensation and Subspecialties

Post by NYGiants235 »

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nanosour
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Re: Physician Compensation and Subspecialties

Post by nanosour »

Your biggest problem is you're a Giants fan. The heartache that goes with that is excruciating. Find another team to root for and life will seem a lot better :beer
WL2034
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Re: Physician Compensation and Subspecialties

Post by WL2034 »

NYGiants235 wrote:Ha, I am having a really good chuckle at all the comments about my rent.

The rent is subsidized by my wife's residency program and we are located slightly outside the city.
What specialty is your wife in? If it's another shift-work specialty, EM, etc. then there are some added scheduling perks to being a hospitalist. If she's going to be in clinic 9-5 M-F it isn't as nice.
camden
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Re: Physician Compensation and Subspecialties

Post by camden »

Leaving the monetary considerations aside, ask yourself whether there is a medical subspecialty you like and are interested in enough to want to do it pretty much exclusively for the rest of your career. Unless the answer is an unequivocal "yes", I'd look for a new job and perhaps eventually a new practice location.
Calli114
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Re: Physician Compensation and Subspecialties

Post by Calli114 »

I agree with the other posters who have said your desirable NYC location probably keeps the salary offers down - if you were willing to do geographic arbitrage, there are almost certainly better offers combined with LCOL in the Midwest, for example.
And another option would be to get a few years of good experience then decide if you might want to be an intensivist, which seems like a natural progression for some hospitalists.
Topic Author
NYGiants235
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Re: Physician Compensation and Subspecialties

Post by NYGiants235 »

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NYGiants235
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Re: Physician Compensation and Subspecialties

Post by NYGiants235 »

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staythecourse
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Re: Physician Compensation and Subspecialties

Post by staythecourse »

Doc here. Subspecialist myself worked in group private practice now am in solo practice. My wife is specialist as well who worked in corporate medicine. Are dad's are docs and so are are siblings. MANY of our friends are docs of ALL specialties. Basically, have seen or heard of almost everything. So take the insight for what it is worth.

1. Is there a NEED to stay in the area? Can you find a job elsewhere, i.e. LCOL. If you look in a LCOL it is a double bonus. Your income goes up AND your expenses are down. OR how about doing locums in small towns. Money would be great and a bit of constant change of scenery may be good for you.
2. Is there any subspecialty you actually like outside of monetary reasons?
3. In IM you already know what makes money: GI, cards, and oncology. The problem is ALL of them either work EXTREMELY hard to make that money and/ or are seeing reimbursement cuts. So, after 3 years you will make more money BUT in exchange for working harder and more hours and more weekend call, i.e. scope at 2AM for GI bleed/ FB stuck in esophagus on a July 4th or cardiac cath call where you have to be 30 min. to hospital FOREVER.
4. A LOT of docs are not happy in ANY field so that may not change by changing fields. Not sure if it is more then other white collar jobs (pretty sure lawyers hate their jobs more though).
5. A lot of the unhappiness does not come from their field of medicine or the patients, but the ever increasing admin. annoyances that you have been shielded form thus far as a hospitalist. This is only increasing as more docs are being employed not even by private practices but by corporate medicine and the fact academics are starting to feel the production pressures as well.

In the end I think you will be increasing your pay to work after 3 more years of training and good chance being even MORE unhappy unless you actually have a passion for field (which you don't as you would have applied if you did).

My advice... Stick with hospitalist which the time off during week comes in handy when your personal life gets MUCH more hectic, i.e. kids, less admin. annoyances, and more opportunities for nonclinical work. My STRONG advice is move to a LCOL area. More money, admin can't afford to lose you so treat you better, and less expensive to live. A triple WIN!!

Biggest thing I have noticed from unhappy docs is they DON'T just vote with their feet. If they did they admins. would have to improve their treatment of employed physicians since it is them and NOT admin that bring revenue to a hospital (despite them thinking it is the opposite).

Good luck.
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staythecourse
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Re: Physician Compensation and Subspecialties

Post by staythecourse »

NYGiants235 wrote:Also, Eli Manning is the greatest QB alive.
Umm... NO.

With that thought process I am not sure I mentally stable you really are to be making your own decisions. :D

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle
WL2034
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Re: Physician Compensation and Subspecialties

Post by WL2034 »

NYGiants235 wrote:
Moving outside of NY will be very difficult for me since I grew up here and all of my family/friends are located here. I took the job that I have now after weighing all of my options in the area, which you all have rightly have guessed were also not so enticing. The monetary differences range +/- (mostly +) ~$50k, but many other jobs had worse terms such as night-float only (ew), no mid-levels (residents/PAs/NPs/etc), and other such intangibles.
staythecourse wrote: 1. Is there a NEED to stay in the area? Can you find a job elsewhere, i.e. LCOL. If you look in a LCOL it is a double bonus. Your income goes up AND your expenses are down. OR how about doing locums in small towns. Money would be great and a bit of constant change of scenery may be good for you.
I think staythecourse has some great advice in this post, but I'll just expand on this a little bit.

Here's a thought experiment:

You work around 84 hr/week for the 7 day stretches you are working in NYC. So I'm going to assume you don't spend a lot of time socializing during those weeks anyway. You could work in a LCOL area for 7 days at a time, every other week, and make 1.6x-2.0x income. You could do that as locums or permanent, still keep your home in NYC and still come out far ahead. Depends on if the travel is worth it to you.

Another thing, and let's just say your wife is also a hospitalist (compensation may be similar depending on specialty, anyway). So you are looking at making a combined gross of $380k while living in maybe the most HCOL area in US (maybe #2?), or you could make $600k+ combined gross in a lower COL area and travel to visit NYC for 7-10 days a month. You could stay at the Waldorf Astoria 100 nights/year and still come out ahead. And I'm not just talking about some small town in the midwest. You could be in east coast or southeastern cities within 30-45 minutes of major cities with international airports. You can probably be financially independent 10-15 years sooner living outside of NYC.

The quality of the jobs is very different, too. Not sure your current set up, but some of these hospitalist positions in desirable locations will have 20+ patient encounters daily when considering rounding census + admissions / consults. In the LCOL areas, you can find jobs with 13-15 encounters and much better pay -- often in the hospital 9-10 hours/day, rather than 12 hours /day. I think long-term, the latter is much more sustainable with lower risk of burn out.

No doubt that living in NYC has a lot of benefits and there isn't anywhere else that is going to provide the exact same environment. Obviously, there are a lot of hospitalists who choose to work there despite the low pay (which is why the pay is low!). Personally, I wouldn't choose to, unless my spouse had a job that required staying in NYC. I think if you are really set on staying in NYC, I would consider a subspecialty, maybe something that allows you to get into a private practice / partnership. But as others have said, you might not be any happier.
kiddoc
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Re: Physician Compensation and Subspecialties

Post by kiddoc »

1- How much does the 7 days on/ 7 days off schedule for full time pay matter to you? Very few subspecialists have that kind of a schedule. Subspecialists' schedules are typically more stressed and can involve driving to multiple locations/ shuttling between clinic and hospital.

2- Especially if you plan to stay in NYC, subspecialization will not make life easier. You will become 2-3 times busier but will still be paid less than your own specialty in... say Upstate New York.

3- Really consider moving to a LCOL area close to NYC: Northeast PA, Upstate New York, maybe southern Connecticut. You will still be close to friends/ family, earn more, spend less and have a better quality of life.

4- Consider moving to a rural location for a few years, especially if the position qualifies for student loan forgiveness and you have loans outstanding. These jobs also pay much better. For example, I used to work in Northwest Arkansas: hardly a rural area. Hospitalists there had a census of 10-18 on overage, no nights, and got paid around 260K + benefits + qualified for loan forgiveness.
"The four most dangerous words in investing are: 'this time it's different.'" - Sir John Templeton
twbd
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Re: Physician Compensation and Subspecialties

Post by twbd »

NYGiants235 wrote:Also, Eli Manning is the greatest QB alive.
:oops: Eli is only the 4th best fb player in his own family, lol :sharebeer
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White Coat Investor
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Re: Physician Compensation and Subspecialties

Post by White Coat Investor »

$190K is a little on the low side for hospitalist medicine, but only a little.

That said, there are plenty of ways to make more money, both inside and outside of medicine.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course
arsenalfan
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Re: Physician Compensation and Subspecialties

Post by arsenalfan »

Throwing this out there...retrain in another field altogether? Ophtho/Derm/IR?

Granted it is the rare, talented MD who does so, but know some great young OBs/GenSurgeons who decided to go back and retrain in a field more lifestyle conducive for them, after 1-3 years in practice.

Other than that, I echo sentiment to find your passion and not do anything only for the $$$. The most miserable docs I know are the ones who seem to have been money motivated. Reimbursements cut, I work too long, I hate the EMR, patients are not appreciative, wah wah wah. It's a service industry, buddy. (ok rant stopped).

Hospitalist and ICU seem difficult gigs. The ones I know in Boston and NYC grapple with the whole On/Off ,feast/famine thing. Though to me it doesn't seem horribly different from the academic MDs I know, who get slaughtered on service for 2 weeks out of the 3 month period (but they have 2.5 months to recharge/research/etc). I will say after 10 years in private practice anesthesia, staying up most of the night ~1 night every 2 weeks, the post-call days are only getting more zombie-like, with gym/run/errands the only thing I can do, and nothing requiring executive function!

Consider making a 5/10/15 year plan with your partner, and then an investment policy statement (i.e. X retires at Y age with Z $$$, and A goes to part time at B age with $C saved) etc. Sounds crazy but brainstorm, during a relaxing time you're both well rested and up for it. It may be illuminating and force you to think about LCOL/HCOL/real goals. Maybe move to LCOL for now, and return to HCOL if/when you have kids? $600 housing is awesome - how long is it sustainable (if indefinitely, awesome!).

Good luck, perhaps your gig isn't terribly bad and the perils of comparing are getting to you. The grass is always greener. There's always someone lower in your residency/med school who is now partner/has ASC income/moved to VC, etc, etc...
Last edited by arsenalfan on Wed Jul 19, 2017 7:51 pm, edited 1 time in total.
mega317
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Re: Physician Compensation and Subspecialties

Post by mega317 »

Ped hospitalist here. Really great thread. Here are my thoughts:

- I occasionally also considered specializing. Ultimately I decided that I would either end up with a job that involved a lot of outpatient time or something that's equally or more intense than hospitalist. If could stand outpatient work I could just go make more money as a private primary care. And honestly that's probably always on the table. In my 5 years as a hospitalist I've had 4 or 5 partners do that.

- Are you on a hospitalist email listserv? It's mostly medical talk but something that comes up all the time on ours is that more than one weekend a month is unsustainable and produces a lot of unhappiness. From your post it sounds like that's a big one for you too. Maybe there is a way for you to improve that. Does your division have any flexibility to hire moonlighters for weekends, for example?

- You are in a great position to talk to a ton of subspecialists. Ask your consultants if you can take them to lunch and pick their brains about their jobs. They'll probably end up buying. And do your consultants seem particularly happy at work? Mine mostly haven't at 4 different institutions. I noticed it in med school and it scared me.

- Your time off will ultimately feel more refreshing if you do things. Travel, exercise, hobbies, etc. rather than what I used to call "aggressively relax" i.e. sleep, books, TV, bogleheads.org.

- I really like the post suggesting a move and spending significant time visiting NY. Problem is if/when there are kids. Travel is a huge pain with toddlers and then you can't do that most of the year when they're in school.

- I don't think the 7 on 7 off helps with child care costs because you can't pay every other week for daycare.
staythecourse wrote:A lot of the unhappiness does not come from their field of medicine or the patients, but the ever increasing admin. annoyances that you have been shielded form thus far as a hospitalist.

Do not underestimate this.
https://www.bogleheads.org/forum/viewtopic.php?t=6212
hmw
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Re: Physician Compensation and Subspecialties

Post by hmw »

If you must stay in NYC, don't count on making 600k a year as a GI or card. The monetary reward may not be as large as you think. One data point. One graduating interventional card fellow I know was offered a starting salary of $180k in S Cal in 2013.
sambb
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Re: Physician Compensation and Subspecialties

Post by sambb »

You shoudlnt look at compensation. Instead, it is compensation by hours worked. I know two MDs. One works 12-14 hour days, 6 days a week, 365 days a year, and rarely takes vacation. he makes 2x as much as another MD in the same field, who works half as hard. So ultimately, they make the same.
joe135
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Re: Physician Compensation and Subspecialties

Post by joe135 »

I'm going to go against the grain here (I'm in a surgical specialty). If you must remain in NYC, and you don't mind 3+ years of training, go into cards/gi/oncology. The difference in lifetime earnings will be larger than you think. Talk to these specialists in the hospital you work in. If they don't reveal how much they're making, it's likely 3-5 times what you are (assuming you're at a private hospital). True, they are working 12 hour days, but so is everyone else in NYC (which is why I moved out of the region after training there).
Finance-MD
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Re: Physician Compensation and Subspecialties

Post by Finance-MD »

sambb wrote:You shoudlnt look at compensation. Instead, it is compensation by hours worked. I know two MDs. One works 12-14 hour days, 6 days a week, 365 days a year, and rarely takes vacation. he makes 2x as much as another MD in the same field, who works half as hard. So ultimately, they make the same.
Doubling hours and doubling salary actually means making less (hourly). #Taxes
Beehave
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Re: Physician Compensation and Subspecialties

Post by Beehave »

Get certified in dermatology.
Move to a retirement community area in Arizona or Florida.
Every retired baby boomer is getting skin checks at least once a year and each visit there is some reason to remove something or other.
You will retire young and wealthy at least if current insurance conditions hold up.
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Re: Physician Compensation and Subspecialties

Post by daveydoo »

NYGiants235 wrote:
I am wholeheartedly willing to pursue a subspecialty strictly for monetary reasons.
Some familiarity with this world. Your financial advisor laughed at you and now you want to enter a different specialty? Trust me -- that one won't be "good enough," either.

Hospitalists entering fellowship are an odd lot, imo; many struggle to embrace the "the buck stops here" mentality that is needed. Respectfully, your love of nothing in medicine -- apart from the promise of wealth -- doesn't inspire confidence.
"I mean, it's one banana, Michael...what could it cost? Ten dollars?"
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NYGiants235
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Re: Physician Compensation and Subspecialties

Post by NYGiants235 »

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oncorhynchus
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Re: Physician Compensation and Subspecialties

Post by oncorhynchus »

IM doc here, recently retired from military service, now in the process of transitioning to my new practice. I won't bore you with my tales of non-competitive compensation and sub-optimal working/living conditions; just wanted to emphasize some of the points already brought up that resonate with me:

- You appear to be paying almost a $60K+/yr premium to practice in NYC. If this bothers you, consider practicing elsewhere. There are lots of other places needing your skills with a better COL/workload combo (see others' prior posts).

- Only pursue a fellowship if that is the kind of medicine you want to practice, ever mindful that the grass/reimbursement is not always greener.

- You and your physician spouse will have to find an arrangement that works for the both of you.

- Just like when buying a car, be prepared to vote with your feet and walk away if the deal isn't good enough. If you're not sure what good enough is, have someone you trust (colleague, mentor, residency director, lawyer/service specializing in physician contracts) look over the proposal.

Good luck,

o
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greybus
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Re: Physician Compensation and Subspecialties

Post by greybus »

NYGiants235 wrote: I find this to be an odd statement, since many people use a hospitalist position as a stopgap before pursuing their passions. The reasons are myriad, but it could be a short break to start a family, make some money, do research, and the list goes on.
What was your reason then for not pursuing a fellowship straight out of IM? You said you were at risk of burnout from your residency. You are currently 30. How many years have you been an attending? This may sound cliche, but unless you really want to be in medicine, you should find something else to do, as you are looking at a multi-decade career. There are other jobs that can pay potentially as much for the hours you're putting in, or pay less for far less stress/work. Burn out (and depression/suicide) in physicians is a real problem.
hightower
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Re: Physician Compensation and Subspecialties

Post by hightower »

NYGiants235 wrote:I recently graduated from medical residency training, and just started a new job as a hospitalist in a major metropolitan area in the northeast. I went to a pretty competitive and well-regarded training program, and had every opportunity to pursue subspecialty training in the area of my choosing, but I decided against it because I was experiencing burnout from training. At the time I accepted by job offer, I had every intention of staying at my new job long term.

I recently had a spate of experiences, however, which are really pushing me toward applying for fellowship. Firstly, I met with a family friend who also happens to be a "financial planner" (aka insurance salesman) to get my affairs in order (term life insurance, own-occupation LTD). We discussed my compensation as part of planning the appropriate amount of coverage I would need. When he saw my numbers, he was nearly in disbelief that they were so low, and repeatedly stated that I should include bonuses or other compensation, even though I had none. Eventually, after prodding him about it (in a joking way, as to be friendly), he let me know I had the lowest compensation package of any physician he's worked with by a large margin (he lives in the same area as I do, and works with physicians often), and encouraged me to either find a new job or pursue a subspecialty.

Secondly, I found that the job was much harder and more unpleasant than I expected it to be. The hours are pretty long/brutal, and the off-weeks are not as nice as I expected. I thought all of the off-time would be really nice, but I find that I'd prefer to be off on weekends/holidays like most of my friends (and normal working people). Because I'm off when others are working, there really isn't much to do but sit at home and watch TV or read books; when my friends are actually planning things, I am unavailable every other weekend.

I am wholeheartedly willing to pursue a subspecialty strictly for monetary reasons. There's nothing about my current job that I find compelling me to stay, and the more work, the more I feel like it's just a job and I am being under-compensated. This is compounded by the fact that I see friends/co-residents who I didn't find particularly smart or hard-working who have gone on to pursue more lucrative subspecialties.

My age: 30 y/o
Marital status: Married
Location: NYC
Debt/Obligations: Student loan $165k @ 6.8%
My car is paid in full and valued at ~18k
We are currently renting an apt @ $600/month

Compensation:
$190k/year flat rate
Edit: I realized that I forgot to include one benefit, which is that employer will match 401(k) contribution up to 5%, however employer contributions don't vest until I hit 36 months of employment.

I have spoken to co-workers who have been with my employer for 10+ years, and it looks like there is little room for growth in salary, unless you make a lateral move to an administrative job, of which there are rarely any opportunities to pursue.

I have looked at various salary databases, and it looks like I can triple or quadruple my compensation by pursuing a specialty like cardiology or GI (both of which I would be happy to practice).

So to any fellow MDs out there, what's too high: my standards, or my expectations? Am I being unreasonable about subspecialty compensation?
It's pretty easy to hit 300k as a hospitalist with bonuses. I made around 275k last year. You dont have to do a fellowship to make better money. You just need to look for a better position.
4nwestsaylng
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Re: Physician Compensation and Subspecialties

Post by 4nwestsaylng »

Excellent hospitalists are really "needed", question is whether a health system or society is willing to pay them appropriately,in NYC it appears that is not the case.

But being a hospitalist is sort of like a medicine residency that never ends. Some docs come in to it after tiring of being in a solo or group practice-it may be part of their exit strategy pre-retirement, or they may want to work part time.
Right now your 190K salary is about what a good MBA gets as a new hiring in NYC , if from a good school. And for that business graduate, it is just as possible that he/she will find their career rewarding. Docs don't have a monopoly on needing job satisfaction, and along with that, docs should not feel that theirs is a "calling", meaning they should not expect good compensation for responsibility and hours. The old "calling" response is always to shut you up.

You have taken good care of the patients as a hospitalist, maybe let one of the new residency grads now take over for you; docs often have this delusion that they are indispensible.

Look at the subspecialties. Derm or ophthalmology are great, but highly competitive. My dermatologist was previously an internal medicine residency grad, he is now about 50, and his medicine knowledge is clear, above his derm knowledge, in terms of spotting other conditions and referring. However in the competitive residencies you may need to do a year or so as basically a low pay or volunteer pre-residency research fellow.

I think that would be worth it, if your wife could get working upon finishing her residency, and support you for a while.It gets your name on a few research papers, and gets you a few good letters of reference. You need this to compete with the newbie grads who have been serving the poor and doing volunteer work since ninth grade for their "community service" resumes.

Look at NY but also look at the Midwest.
hightower
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Re: Physician Compensation and Subspecialties

Post by hightower »

WL2034 wrote:
NYGiants235 wrote:
Moving outside of NY will be very difficult for me since I grew up here and all of my family/friends are located here. I took the job that I have now after weighing all of my options in the area, which you all have rightly have guessed were also not so enticing. The monetary differences range +/- (mostly +) ~$50k, but many other jobs had worse terms such as night-float only (ew), no mid-levels (residents/PAs/NPs/etc), and other such intangibles.
staythecourse wrote: 1. Is there a NEED to stay in the area? Can you find a job elsewhere, i.e. LCOL. If you look in a LCOL it is a double bonus. Your income goes up AND your expenses are down. OR how about doing locums in small towns. Money would be great and a bit of constant change of scenery may be good for you.
I think staythecourse has some great advice in this post, but I'll just expand on this a little bit.

Here's a thought experiment:

You work around 84 hr/week for the 7 day stretches you are working in NYC. So I'm going to assume you don't spend a lot of time socializing during those weeks anyway. You could work in a LCOL area for 7 days at a time, every other week, and make 1.6x-2.0x income. You could do that as locums or permanent, still keep your home in NYC and still come out far ahead. Depends on if the travel is worth it to you.

Another thing, and let's just say your wife is also a hospitalist (compensation may be similar depending on specialty, anyway). So you are looking at making a combined gross of $380k while living in maybe the most HCOL area in US (maybe #2?), or you could make $600k+ combined gross in a lower COL area and travel to visit NYC for 7-10 days a month. You could stay at the Waldorf Astoria 100 nights/year and still come out ahead. And I'm not just talking about some small town in the midwest. You could be in east coast or southeastern cities within 30-45 minutes of major cities with international airports. You can probably be financially independent 10-15 years sooner living outside of NYC.

The quality of the jobs is very different, too. Not sure your current set up, but some of these hospitalist positions in desirable locations will have 20+ patient encounters daily when considering rounding census + admissions / consults. In the LCOL areas, you can find jobs with 13-15 encounters and much better pay -- often in the hospital 9-10 hours/day, rather than 12 hours /day. I think long-term, the latter is much more sustainable with lower risk of burn out.

No doubt that living in NYC has a lot of benefits and there isn't anywhere else that is going to provide the exact same environment. Obviously, there are a lot of hospitalists who choose to work there despite the low pay (which is why the pay is low!). Personally, I wouldn't choose to, unless my spouse had a job that required staying in NYC. I think if you are really set on staying in NYC, I would consider a subspecialty, maybe something that allows you to get into a private practice / partnership. But as others have said, you might not be any happier.
I totally agree. If you claim to care about making moneg, living in NYC as a physician is not wise. You're missing out on a lot of income potential. It is pretty remarkable you manage to have 600/month rent though. Do you have room mates?
seamonkey
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Re: Physician Compensation and Subspecialties

Post by seamonkey »

I'm a physician. (Stating this up front seems to inspire credence.)

You make nearly $200K a year with ridiculously low housing costs and reasonable student loan debt in one of the greatest places to live on the planet. This really isn't a dire financial question anymore.

You either like what you do or you don't. The tradeoff for 2-3 more years of training may not be worth it. Find what you like in medicine and do it for 25-30 years. You could be financially independent within 10-15 years, helping a whole lot of patients along the way.
Carter3
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Re: Physician Compensation and Subspecialties

Post by Carter3 »

I was a hospitalist and retrained. I don't think you come out ahead in the long run with the bump in salary, especially if you have loans that will be deferred while you train.

In addition, I don't think your salary is all that low, especially for New York.
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GK4321
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Re: Physician Compensation and Subspecialties

Post by GK4321 »

NYGiants235 wrote:I recently graduated from medical residency training, and just started a new job as a hospitalist in a major metropolitan area in the northeast....
Most residents graduate at the end of June and start working in July.

Did you just start your first job as an attending 3 weeks ago?

If so, I'd give it some time.
daveydoo
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Re: Physician Compensation and Subspecialties

Post by daveydoo »

NYGiants235 wrote:
daveydoo wrote:Hospitalists entering fellowship are an odd lot, imo; many struggle to embrace the "the buck stops here" mentality that is needed.
I find this to be an odd statement, since many people use a hospitalist position as a stopgap before pursuing their passions. The reasons are myriad, but it could be a short break to start a family, make some money, do research, and the list goes on.
I never said it was uncommon. Yes, many do. It's devolved into shiftwork and the focus of conversation is how much on vs. how much off, etc. As others have noted, many treat it like permanent residency. Some are superb. Many, many suck -- think of a really efficient bad resident. But it's funny that you never mentioned a "passion" until refuting me -- you said your advisor laughed at you.
NYGiants235 wrote:
daveydoo wrote:Respectfully, your love of nothing in medicine -- apart from the promise of wealth -- doesn't inspire confidence.
You've made a lot of assumptions here. The simplest way I can address this is by saying that we all have a price. I'm sure you're not surprised that the most lucrative specialties in medicine also happen to be the most competitive. Are physicians as a whole just an awful, value-less group of people?

Well, I don't work for free and I wouldn't expect anybody else to, either.
I didn't suggest that you work for free. And your "price" only changed when your financial advisor laughed at you. That's what I was (respectfully) calling you out for. Many people, I'm guessing, factor in income when choosing medicine; very few seem to change horses midstream purely because a third party told them they didn't make enough money. I think you need a different advisor, not a different career. And the second part about your job being hard -- you're probably not gonna like fellowship. Either way, best of luck -- we all need good doctors!
"I mean, it's one banana, Michael...what could it cost? Ten dollars?"
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Artsdoctor
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Re: Physician Compensation and Subspecialties

Post by Artsdoctor »

I'm a doctor in Los Angeles and have lived here for decades. I was educated on the East Coast. That's my preamble.

There's an irony with salaries. The Coasts will often have lower than average salaries compared with the middle of the country. You'd think that it would be different because the cost of living is so much higher. But it's really about supply and demand. The more people really wanting to live in a location, the lower the prices are to get them there. This doesn't always work out, of course.

You're just out of training. Your salary is on the lower side but shouldn't elicit such snide remarks from your financial advisor. I can't comment on how he said it, but if your representation is correct, the guy's a jerk and I'd tell him to take a hike.

Fresh out of training, you have to realize that you don't bring a lot to the table. You may be a very good worker, but your experience is meager. There are intangibles you'd want to consider. Are you in a job that mentors you? Is there really no room for growth? Do they nurture you or work you to death and then spit you out? It's not always about the money, but about the environment. I tell new graduates that the first 3 years are important to really learn how to be an attending; you need to have someone mentor you. If you're not getting that, I'd look elsewhere. Likewise, the opposite is true: if you're being paid a fortune out of training and no one is teaching you anything, you run the risk of squandering all of that education. There will plenty of time to make money in your future; but if you don't learn how to be a decent attending early on, you'll never really get that back.
letsgobobby
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mhalley
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Re: Physician Compensation and Subspecialties

Post by mhalley »

I don't know if any of your reimbursement is at all related to coding, but if so you might check out the happy hospitalist site lectures. He also has a bunch of humorous posts that might ease your pain while you decide what to do. He also has a link to salaries.
http://thehappyhospitalist.blogspot.com ... pital.html
txranger
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Re: Physician Compensation and Subspecialties

Post by txranger »

Out of curiosity, What is avg Hourly rate for subspecialist such as derm or cards or a surgical subspecialist?
staythecourse
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Re: Physician Compensation and Subspecialties

Post by staythecourse »

sambb wrote:You shoudlnt look at compensation. Instead, it is compensation by hours worked. I know two MDs. One works 12-14 hour days, 6 days a week, 365 days a year, and rarely takes vacation. he makes 2x as much as another MD in the same field, who works half as hard. So ultimately, they make the same.
Interesting this in itself should be its own thread. It is AMAZING if you look at the numbers of how much being at the top bracket affects your pay. Basically, what I tell folks the last 3 months or so folks are working for 1/2 the reimbursement as they did from Jan-Jun. Taxes (fed+ state) in many places are 50% or more.

Also, the amazing thing is pull out a calculator for those who sent to daycare and/ or have a nanny how much GROSS income at the top bracket is needed to pay them. For example: If a nanny cost 40k you are basically taking 70+k of your salary just to pay the nanny. If one has multiple kids at different stages (day care, private school, nanny, or any combination) the GROSS salary to pay for all of it easy exceed 100k+. That is insane.

Reading what WCI wrote several years ago really got me thinking that for high income workers it makes more sense to work part time and for more years then trying to go all out and retire early. To save every extra dollar in the last 3-6 months of the year is exceedingly more difficult as you have to overcome the progressive tax system. Had my wife and I thinking and we have started making changes to work schedules to spend more time with kids (which is what we really like anyway).

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle
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