Physicians: Should I leave my job?

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phantom0308
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Re: Physicians: Should I leave my job?

Post by phantom0308 »

It seems strange that anyone would argue that hard work is the reason why anyone deserves to be paid more. The labor market values skills that are in demand and have low supply. Back breaking professions welding heavy machinery or assembling iPhones are abundant throughout the world and in many of those places the people work incredibly hard. The key to high pay is to get into a field with lots of barriers to entry. Medicine seems to fit that (entrance exams, medical schools with limited capacity, high upfront cost requiring lots of debt financing, high cognitive load)
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familythriftmd
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Re: Physicians: Should I leave my job?

Post by familythriftmd »

Complaining about patients is sometimes a symptom of burnout more than it is about actually not liking people aka patients.

Being in a good financial state in a well-fitting job can go along ways, which is probably why physicians may air their grievances perhaps too freely on Bogleheads, I suppose.
He/him/his
Priam
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Re: Physicians: Should I leave my job?

Post by Priam »

From everything I’ve read you seem lost. Perhaps you took the rural position without really thinking about the surrounding environment you’d be in but I say you need to do what will make you happy. The last thing you want to be doing is looking back 5 years from now and have nothing but regrets... and that means taking a risk to get where you want to be.

You are right about not having a crystal ball.. you may or may not succeed but at least you won’t be looking back and saying you wish you had took a chance. The good thing is at least you tried this rural position and realized what you don’t want but heck we also change as we age and as you get older you may decide you want that quieter life and go back. The future can be a funny thing.

As for the looming graduates that will be entering your field 3-5 years from now I’d be more concern about that. An abundance of workers in any sector means lower salaries and could mean people questioning yours if you are working for someone else.
Last edited by Priam on Tue Sep 22, 2020 7:14 pm, edited 1 time in total.
slyfox1357
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Re: Physicians: Should I leave my job?

Post by slyfox1357 »

'Regardless, my job is pretty chill. I show up around 8:30 and can leave by 4 most days. No call and no weekends. No travelling to outreach clinics.'

'And my job isn't always cushy. I'm here till about 8-9 PM tonight because that's the way it goes sometimes trying to do the right thing for the patient.'

Taken from your original post and then a later post. These are highly contradictory (along with the working on Friday thing).
The responses you received from others would have been vastly different if the second quote was in your original post.

In any respect, you need to leave the 'rural area' position ASAP.....both explicitly and and implicitly in your comments that this is the major rub. Put happiness first. Put aside the 'start your own practice' venture and take the 'coastal resort area' position and see where you are and how you feel in 5 years.
mega317
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Re: Physicians: Should I leave my job?

Post by mega317 »

slyfox1357 wrote: Tue Sep 22, 2020 7:13 pm These are highly contradictory
Nah I don’t think so. It is possible to leave by 4 most days but also stay much later sometimes. I don’t think that changes the conversation. I do agree about Fridays which I addressed earlier.
https://www.bogleheads.org/forum/viewtopic.php?t=6212
BH+
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Re: Physicians: Should I leave my job?

Post by BH+ »

If you are intent on retiring in 15 years and being an employee will get you there, I would take option 1. You can potentially move to and work in 3 or 4 different locations and practice settings until you either find the best fit or you hit your retirement goal. There is a lot of optionality there.

You will probably get fed up with option 2 in a few years and feel trapped again. Option 3 sounds great, but you have to be cautious if you are trying to build a practice in a market that may be on the decline. Plus it will take at least a few years to get the practice to a level that you would reap the benefits of the risk you are taking. Option 4 may be worth a try if you have something else lined up or easily available.
sambb
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Re: Physicians: Should I leave my job?

Post by sambb »

First of all, thanks to ALL of the doctors. You deserve far more than what is given here. You are doing something so important for society and for life.

TO the OP - complaining about administration, rules, etc. is never going to go anywhere. You are an employee and they run your practice. Why? It is their business. Dont worry about it. Space out your time, dont worry about bonuses, and enjoy the care you deliver. I work with many docs and the happiest ones are the ones who dont worry about all of that stuff. The miserable ones are the ones who fight it.

Or maybe it is a bad job. But they make it up with decent pay. So, that is always a compromise. Golden Handcuffs.

Best thing to do in any job is keep your expenses low and savings high, so you can walk away at any time. And who cares how much money you make for the hospital. That is totally irrelevant.
pasadena
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Re: Physicians: Should I leave my job?

Post by pasadena »

I'm not a physician and I don't know anything about this field. But generally speaking, I would say that $120k at your level of income isn't a good reason to stay in a job that makes you miserable. I hope that the new hospital makes you a good offer. However you need to be aware that the grass isn't always greener, and administrative BS will always be a part of an employee's life, at least in bigger companies - hospitals or not.

In the meantime, and I might be wrong here (again, I don't know anything about how hospitals, specifically), you sound like you have some leverage to improve your current situation. Admin has reached out to you for a meeting, and they seem to know that you're dissatisfied? Good.

- You say you bring in a lot of money. Get those numbers, all the facts.
- Bring your written contract.

Listen to what they have to say before saying anything. Then tell them that since you're a valuable employee (numbers!) and you probably won't get the bonus you were expecting due to accounting workarounds, and your PTO arrangement isn't working for you or for them, you will enforce that contract. No more phantom PTO comp, you won't work on Fridays anymore, just like your contract says. The only thing you might be willing to negotiate (give a little!) is to choose another day of the week for that. Sounds like something that you can (and should!) push back on, not the bonus thing. Choose your battles.

You're complaining of them taking advantage of you, but you didn't just let them, you actually helped them.

Then try to focus on the good instead of the bad. I know how it sounds, but it seems like there is a lot of good, so try not to let the bad overshadow that.
Helo80
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Re: Physicians: Should I leave my job?

Post by Helo80 »

The problems you describe OP is nothing that copious amounts of alcohol cannot solve. The Army manages to do it and their annual salary is one week's pay to you.
bltn
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Re: Physicians: Should I leave my job?

Post by bltn »

toocold wrote: Tue Sep 22, 2020 7:49 am Are you sure the hospital bills you out at $12M? Most treatments are a combination of professional fees and facility fees, and just looking at a recent bill, it's almost 1:10. Most health systems actually lose money on the professional side but make it up on the facility side. Before you pursue your own practice, you should understand the economics better.

If you are unhappy, I would find another position. It's a fact that rural settings pay more. I personally would take a paycut to live in an area that I like.
The first paragraph may be a pretty accurate assessment of the hospital s economics with your practice.

I think hospital billing may often be much higher than realized income. After a trip overseas with my family years ago, I had to take my then teenage son to the ER one night with what turned out to be an intestinal infection. We were able to take him home after a few hours..IV fluids, medicines, cat scans and lab work, with doctors charges, came to a total charge of around 19,000 dollars. My Blue Cross insurance allowed about 3500 dollars! This was accepted by the hospital. I often wondered why the hospital would charge so much more than they agreed to receive from our insurance company. Tax write offs?

Anyway, billing may greatly overstate income, depending on the agreements with the insurance companies. If you re making the 75 th percentile in your specialty working 4 days a week with no weekends and night call, consider letting the resentment go, and banking some money for a couple of years. With a new house, a great income and good working hours, you may have a very bright future with this job and hospital.

Working for someone else will never allow one to control his job. The employer will always make money off the employees. However, working as the owner of a business , while allowing you more control and perhaps the chance, but certainly not a sure thing, for more money, will require quite a bit more effort on your part. As a small business owner for 35 years, I worked 70 hour work weeks including most weekends for the first 20-25 years. The success of the business was my responsibility. Some people don t like that pressure.

In your position, I would sit tight for a couple of years, learn more about the economics of the practice, and see how you like the job. If you decide to leave then, you ll have some money saved which will make the change easier. Again, it sounds like your present job has a lot going for it.

Best of luck.
MedSaver
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Re: Physicians: Should I leave my job?

Post by MedSaver »

It's pretty easy to figure out net collections as long as you know your wRVU. All you need is a ballpark $/wRVU to multiply. I'm sure the OP is using net collections rather than total billing. In my practice we collect about 30% of total billed. Even then, with my last group I was producing net collections 2-3x my salary. The real money is on the technical fee side, not the pro fee. Tech fee is where the hospital makes their money and they almost never share that part of the pie.

My advice to OP is to find a good gig in a good location and get out. Sometimes the grass really is greener on the other side.
Last edited by MedSaver on Tue Sep 22, 2020 9:09 pm, edited 1 time in total.
Keenobserver
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Re: Physicians: Should I leave my job?

Post by Keenobserver »

oldfort wrote: Tue Sep 22, 2020 3:30 pm
Keenobserver wrote: Tue Sep 22, 2020 2:23 pm
oldfort wrote: Tue Sep 22, 2020 10:34 am
eagleeyes wrote: Tue Sep 22, 2020 10:22 am
dodecahedron wrote: Tue Sep 22, 2020 9:34 am

If you are aware of the payor mix and billing to collection ratio, then I am sure the third-party payors are also very much aware. And they are likely to drive harder bargains in these exceptionally troubled times when they negotiate reimbursement rates. With GDP declining and financial uncertainty looming, the extreme amounts (by international standards) that Americans have paid for health care in recent years may very well be unsustainable.

As the grand-daughter of a physician who did his residency in the late 1920s, then practiced during the Great Depression (and then volunteered for the Navy to serve on a ship in the Pacific for several years during WWII, though he was beyond draft age by that time), endured all kinds of hardship, had an office in the family home and saw patients there on nights and weekends, made house calls, gave a lot of free care to those who could not afford it, practiced until his 70s, etc., I find the OP's complaining more than a bit troubling.

I think comparing a physician from the 1920s to 2020s is more than a bit ridiculous. The practice of medicine, the governing rules and regulations of medicine, medical malpractice, insurance industry, hospital industrial complex, would be unrecognizable to a physician from the 1920s.

More than likely, OP can see more patients in a few days than grandad in a month, just accounting for geographical constraints of how hard it was to get around back in the 1920s.

We don’t begrudge computer IT folks, lawyers, or business folk etc from getting paid what they are worth relative to how much money they are bringing in, why are people finding his behavior troubling?
Very few lawyers, business, or IT folk make $650k. Of those who do, almost none are working 40 hour weeks. In the big picture, the OP has a unicorn job: top 1% income, sub-40 hour work weeks, and enough vacation time to travel internationally a lot(pre-COVID).
How many IT folks or lawyers have to go through the rigirous, competitive, stressfull and might I mention extended years training as Physcians, especially OP with his speciality? I would say almost none. The amount of stress and years of training just to begin practicing, especially in high speciality is not comparable to IT or Law. So please stop making such comaprisons. $650K grt is not extra ordianry if you are certain specialties. Yes he has a good gig, but he did not get it slacking. He earned it.
Quit the whining and self pity. I think there's a lot of lawyers who would think their career paths are a lot harder than some physicians. Law school is shorter at 3 years, but then there's 7-10 years as an associate before you make equity partner if ever. Only about 5% make it. It's not like 95% of people fail their residency. The long hours never really end as a lawyer, especially in big law. No one is getting their Fridays off, even at the partner level. There was a thread earlier about some programmer who was stressing out because he had 100 hour weeks. Doctors seem to be under a delusion they are the only profession which has stress or requires long hours at some point in their career.
I dont think lawyers find themselves making life and death decisions and therfore cannot fathom the stresses of an ER doctor for9 example. The decisions that need to be made whilst a 9 year is bleeding to death from an accident with their mother screaming her lungs out is not something any lawyer can fathom from a corner downtown office. Neither can an Engineer come close to the stresses of a heart surgeon. The human emotion, psyche, and the stakes involving life and death are unique and duplicated. A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths. I think docs are undercompensated compared to.many.other professions..eg Real estate agentd in Beverly Hills making more just showing people houses. Find yourself or family member with a real sickness and then tell me how much you think your doc is worth
Keenobserver
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Re: Physicians: Should I leave my job?

Post by Keenobserver »

oldfort wrote: Tue Sep 22, 2020 3:30 pm
Keenobserver wrote: Tue Sep 22, 2020 2:23 pm
oldfort wrote: Tue Sep 22, 2020 10:34 am
eagleeyes wrote: Tue Sep 22, 2020 10:22 am
dodecahedron wrote: Tue Sep 22, 2020 9:34 am

If you are aware of the payor mix and billing to collection ratio, then I am sure the third-party payors are also very much aware. And they are likely to drive harder bargains in these exceptionally troubled times when they negotiate reimbursement rates. With GDP declining and financial uncertainty looming, the extreme amounts (by international standards) that Americans have paid for health care in recent years may very well be unsustainable.

As the grand-daughter of a physician who did his residency in the late 1920s, then practiced during the Great Depression (and then volunteered for the Navy to serve on a ship in the Pacific for several years during WWII, though he was beyond draft age by that time), endured all kinds of hardship, had an office in the family home and saw patients there on nights and weekends, made house calls, gave a lot of free care to those who could not afford it, practiced until his 70s, etc., I find the OP's complaining more than a bit troubling.

I think comparing a physician from the 1920s to 2020s is more than a bit ridiculous. The practice of medicine, the governing rules and regulations of medicine, medical malpractice, insurance industry, hospital industrial complex, would be unrecognizable to a physician from the 1920s.

More than likely, OP can see more patients in a few days than grandad in a month, just accounting for geographical constraints of how hard it was to get around back in the 1920s.

We don’t begrudge computer IT folks, lawyers, or business folk etc from getting paid what they are worth relative to how much money they are bringing in, why are people finding his behavior troubling?
Very few lawyers, business, or IT folk make $650k. Of those who do, almost none are working 40 hour weeks. In the big picture, the OP has a unicorn job: top 1% income, sub-40 hour work weeks, and enough vacation time to travel internationally a lot(pre-COVID).
How many IT folks or lawyers have to go through the rigirous, competitive, stressfull and might I mention extended years training as Physcians, especially OP with his speciality? I would say almost none. The amount of stress and years of training just to begin practicing, especially in high speciality is not comparable to IT or Law. So please stop making such comaprisons. $650K grt is not extra ordianry if you are certain specialties. Yes he has a good gig, but he did not get it slacking. He earned it.
Quit the whining and self pity. I think there's a lot of lawyers who would think their career paths are a lot harder than some physicians. Law school is shorter at 3 years, but then there's 7-10 years as an associate before you make equity partner if ever. Only about 5% make it. It's not like 95% of people fail their residency. The long hours never really end as a lawyer, especially in big law. No one is getting their Fridays off, even at the partner level. There was a thread earlier about some programmer who was stressing out because he had 100 hour weeks. Doctors seem to be under a delusion they are the only profession which has stress or requires long hours at some point in their career.
I dont think lawyers find themselves making life and death decisions and therfore cannot fathom the stresses of an ER doctor for9 example. The decisions that need to be made whilst a 9 year is bleeding to death from an accident with their mother screaming her lungs out is not something any lawyer can fathom from a corner downtown office. Neither can an Engineer come close to the stresses of a heart surgeon. The human emotion, psyche, and the stakes involving life and death are unique and duplicated. A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths. I think docs are undercompensated compared to.many.other professions..eg Real estate agentd in Beverly Hills making more just showing people houses. Find yourself or family member with a real sickness and then tell me how much you think your doc is worth.
potatopancake
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Re: Physicians: Should I leave my job?

Post by potatopancake »

Reviewing your posts, I would relocate as soon as possible. You don't like your geography. The market is saturated and will become worse in the next few years (3 - 5). Now is the best time to find your long-term position.
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Watty
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Re: Physicians: Should I leave my job?

Post by Watty »

All the talk about trying to justify incomes on things like stress and critical skills is mainly off base. It is really much simpler in that because for the most part supply and demand determines what a job will pay. For example some jobs like being a firefighter or EMT would tick a lot of the same boxes as an ER doctor but they only get a fraction of the pay, mainly because it is a lot easier to train and hire more of them if you need them.

Keenobserver wrote: Tue Sep 22, 2020 9:09 pm A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths.
Retired software developer here: It is different but sometimes they are.

Early in my career I worked on hospital systems were a software problem could have killed someone. For example I worked on laboratory and pharmacy systems where there is no margin for error. That was my first job out of college so it really good experience since it honed my programming skills to at least try to write rock solid code as my default programming style.

Later on in my career I also had to worked on systems that would do things like track food and be able to quickly recall food when there was a problem with something like e coli or listeria. That is a lot harder than it sounds when you consider that one food item may have been repackaged or used as an ingredient in making something different that would also need to be recalled. For example you will often hear of a recall of ground beef but that may have been used as an ingredient in many other prepared foods.

I never worked on them but things like the software for flight systems are also a matter of life and death. Bad software was the core of the problem with the Boeing 737 Max problems which caused several planes to crash. That is a bit of an extreme case but there are lots and lots of things that you use on a daily basis have embedded software like your car that you depend on the software working right.
ThatGuy
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Re: Physicians: Should I leave my job?

Post by ThatGuy »

Keenobserver wrote: Tue Sep 22, 2020 9:08 pmI dont think lawyers find themselves making life and death decisions and therfore cannot fathom the stresses of an ER doctor for9 example. The decisions that need to be made whilst a 9 year is bleeding to death from an accident with their mother screaming her lungs out is not something any lawyer can fathom from a corner downtown office. Neither can an Engineer come close to the stresses of a heart surgeon. The human emotion, psyche, and the stakes involving life and death are unique and duplicated. A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths. I think docs are undercompensated compared to.many.other professions..eg Real estate agentd in Beverly Hills making more just showing people houses. Find yourself or family member with a real sickness and then tell me how much you think your doc is worth
Argumentum ad passione.

As noted by many others, doctors aren't the only ones who deal with stress, or conflict, or even life and death situations. They're definitely not the only ones that go through difficult training. Yet it is obnoxiously common for a doctor feel entitled to ever greater riches. The riches already given are driven by artificial supply constraints, not god like qualities conferred by attaining an MD.
Washington Times wrote:Almost 10% of medical school students each year do not get a hospital residency, leaving thousands without the required training to work as physicians and contributing to a growing shortage of doctors in the U.S., medical education professionals say.

...

What’s more, first-year enrollment at U.S. medical schools has increased, the Association of American Medical Colleges said, but the number of residencies has not kept up with the steady growth.
Work is the curse of the drinking class - Oscar Wilde
Keenobserver
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Re: Physicians: Should I leave my job?

Post by Keenobserver »

Watty wrote: Tue Sep 22, 2020 10:04 pm All the talk about trying to justify incomes on things like stress and critical skills is mainly off base. It is really much simpler in that because for the most part supply and demand determines what a job will pay. For example some jobs like being a firefighter or EMT would tick a lot of the same boxes as an ER doctor but they only get a fraction of the pay, mainly because it is a lot easier to train and hire more of them if you need them.

Keenobserver wrote: Tue Sep 22, 2020 9:09 pm A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths.
Retired software developer here: It is different but sometimes they are.

Early in my career I worked on hospital systems were a software problem could have killed someone. For example I worked on laboratory and pharmacy systems where there is no margin for error. That was my first job out of college so it really good experience since it honed my programming skills to at least try to write rock solid code as my default programming style.

Later on in my career I also had to worked on systems that would do things like track food and be able to quickly recall food when there was a problem with something like e coli or listeria. That is a lot harder than it sounds when you consider that one food item may have been repackaged or used as an ingredient in making something different that would also need to be recalled. For example you will often hear of a recall of ground beef but that may have been used as an ingredient in many other prepared foods.

I never worked on them but things like the software for flight systems are also a matter of life and death. Bad software was the core of the problem with the Boeing 737 Max problems which caused several planes to crash. That is a bit of an extreme case but there are lots and lots of things that you use on a daily basis have embedded software like your car that you depend on the software working right.
So you were making time sensitive life and death decisions daily as a computer programmer, where what you decided on the spot in a dynmic situation single handedly determined whether someone lived or died, with each situation being unique and sometimes unprecedented?
Keenobserver
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Re: Physicians: Should I leave my job?

Post by Keenobserver »

ThatGuy wrote: Tue Sep 22, 2020 10:29 pm
Keenobserver wrote: Tue Sep 22, 2020 9:08 pmI dont think lawyers find themselves making life and death decisions and therfore cannot fathom the stresses of an ER doctor for9 example. The decisions that need to be made whilst a 9 year is bleeding to death from an accident with their mother screaming her lungs out is not something any lawyer can fathom from a corner downtown office. Neither can an Engineer come close to the stresses of a heart surgeon. The human emotion, psyche, and the stakes involving life and death are unique and duplicated. A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths. I think docs are undercompensated compared to.many.other professions..eg Real estate agentd in Beverly Hills making more just showing people houses. Find yourself or family member with a real sickness and then tell me how much you think your doc is worth
Argumentum ad passione.

As noted by many others, doctors aren't the only ones who deal with stress, or conflict, or even life and death situations. They're definitely not the only ones that go through difficult training. Yet it is obnoxiously common for a doctor feel entitled to ever greater riches. The riches already given are driven by artificial supply constraints, not god like qualities conferred by attaining an MD.
Washington Times wrote:Almost 10% of medical school students each year do not get a hospital residency, leaving thousands without the required training to work as physicians and contributing to a growing shortage of doctors in the U.S., medical education professionals say.

...

What’s more, first-year enrollment at U.S. medical schools has increased, the Association of American Medical Colleges said, but the number of residencies has not kept up with the steady growth.
Ok. Please identify other professions with same rigirous entry level training requirements that are poorly compensated.
eagleeyes
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Re: Physicians: Should I leave my job?

Post by eagleeyes »

Keenobserver wrote: Tue Sep 22, 2020 10:40 pm
Watty wrote: Tue Sep 22, 2020 10:04 pm All the talk about trying to justify incomes on things like stress and critical skills is mainly off base. It is really much simpler in that because for the most part supply and demand determines what a job will pay. For example some jobs like being a firefighter or EMT would tick a lot of the same boxes as an ER doctor but they only get a fraction of the pay, mainly because it is a lot easier to train and hire more of them if you need them.

Keenobserver wrote: Tue Sep 22, 2020 9:09 pm A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths.
Retired software developer here: It is different but sometimes they are.

Early in my career I worked on hospital systems were a software problem could have killed someone. For example I worked on laboratory and pharmacy systems where there is no margin for error. That was my first job out of college so it really good experience since it honed my programming skills to at least try to write rock solid code as my default programming style.

Later on in my career I also had to worked on systems that would do things like track food and be able to quickly recall food when there was a problem with something like e coli or listeria. That is a lot harder than it sounds when you consider that one food item may have been repackaged or used as an ingredient in making something different that would also need to be recalled. For example you will often hear of a recall of ground beef but that may have been used as an ingredient in many other prepared foods.

I never worked on them but things like the software for flight systems are also a matter of life and death. Bad software was the core of the problem with the Boeing 737 Max problems which caused several planes to crash. That is a bit of an extreme case but there are lots and lots of things that you use on a daily basis have embedded software like your car that you depend on the software working right.
So you were making time sensitive life and death decisions daily as a computer programmer, where what you decided on the spot in a dynmic situation single handedly determined whether someone lived or died, with each situation being unique and sometimes unprecedented?
Watty,

I hear what you are saying.

In addition to some mentioned above, there is also the difference in repercussions. Did the person who poorly designed the Boeing max air have any professional consequences? Any civil or legal consequences? When doctors make mistakes, the consequences are serious of course, but the repercussions are also serious.

As an example. The Burger King cook didn’t wash his hands after using the RR gave customers terrible E. coli. Terrible but nothing really happens.

The surgeon who doesn’t wash his hands, gives his patients surgical infection, and is now possibly on the hook for complications via a lawsuit.

most malpractice lawsuits last several years unless settled and it is major source of angst among docs. It is why many doctors order as many tests as they do, consult as many specialists as they can, and are as conservative as they can be, because mistakes lead to lawsuits. Even innocent mistakes. Inconsequential mistakes.

Perhaps the Boeing engineer was fired. He probably wasn’t sued. He probably moved on to the next job.
adave
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Re: Physicians: Should I leave my job?

Post by adave »

Many doctors undertake "geographic arbitrage" strategies early in their career going to a rural location for high income. I believe a lot of this is due to deferred gratification over the years and wanting to get out and make real coin. Personally, I think this is a bad idea as where you live your day to day life will greatly impact your happiness, even more so if you are married / have kids. For most, they end up miserable, and often spend their days counting down to when they feel they can leave said rural location. Most physicians make enough anywhere to not have to subject themselves to this. I say get out ASAP.
kiwi123
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Re: Physicians: Should I leave my job?

Post by kiwi123 »

If you can be bothered with the hassle over $100k+ in compensation, it would be worth consulting with a good employment lawyer. If their dealings with you are as shady as you say they are then it "could" be somewhat straightforward to negotiate a payout from them to make you whole. I say "could" because this could send things in many different directions and it may not be worth the time/hassle/risk/damage to your reputation if they decide to make it nasty.

Often just the subtle implication that you might lawyer up is enough to come to a reasonable compromise without anyone's feelings being hurt. If you decide to move on, then "...as part of ensuring a smooth transition I would also expect to be made whole per my contract and your prior acknowledgement of x, y, z missing comp...". They can easily read between the lines.

Anyway, you have a lot of good options and a healthy income/potential income to go in several good directions so all things considered you're not in a bad position.
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Watty
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Re: Physicians: Should I leave my job?

Post by Watty »

Keenobserver wrote: Tue Sep 22, 2020 10:40 pm So you were making time sensitive life and death decisions daily as a computer programmer, where what you decided on the spot in a dynmic situation single handedly determined whether someone lived or died, with each situation being unique and sometimes unprecedented?
Just the opposite so it it sort of an apples and oranges comparison. It varies but usually a software developer will not be able to sign on to a production system so the possible situations need to anticipated long ahead of time. It is pretty unusual but I know that some software I wrote over 30 years ago is still running in a large production system.
eagleeyes wrote: Tue Sep 22, 2020 11:00 pm Did the person who poorly designed the Boeing max air have any professional consequences? Any civil or legal consequences?
That seems to have been more of a management problem than the person who wrote the code and there are lots of lawsuits going on against Boeing now and they will likely go bankrupt but the pandemic crippling air travel is a factor in that. There are also ongoing criminal investigations.

That is an extreme example though. Before I retired I always worked for large corporations so there was virtually no chance that I would be sued if there was a problem with the code I wrote. The reason is that I was part of a team that also included analysts and QA people so that it would have been hard to say that I was legally responsible for a problem with the code that I wrote. Years ago when I worked for the company that wrote hospital software the QA department was actually larger than the software development department.
Keenobserver wrote: Tue Sep 22, 2020 10:43 pm Ok. Please identify other professions with same rigirous entry level training requirements that are poorly compensated.
How about a doctor in pretty much any country other than the US?

A quick google search found this.

Image

https://www.medscape.com/slideshow/2019 ... -6011814#2
deserat
Posts: 49
Joined: Fri Dec 27, 2019 5:08 am

Re: Physicians: Should I leave my job?

Post by deserat »

flyfishers83 wrote: Tue Sep 22, 2020 9:19 am
S4C5 wrote: Tue Sep 22, 2020 9:01 am
flyfishers83 wrote: Tue Sep 22, 2020 8:46 am Assuming you're saving more than 300k per year
That's a pretty hefty assumption when the after-tax income is $360k/year. I think I live frugally, but dang. I'm probably close.
Sometimes I wonder what I'm doing wrong when I see these other posts from physicians only a few years older than me who have multimillion dollar portfolios, lower incomes, AND have paid off student loans that I didn't have! I thought I was doing well until I started browsing these forums!
OK. So maybe you spend 160k/yr. That's still saving 200k/yr which puts you at 2 million NW at 40 with no investment gains. You're doing phenomenally well. There are so many of your colleagues that will never catch you financially. They'll pay be paying student loans for 20 years and spending like crazy.
To the OP - I would also read what other physicians post on the internet here or on any blogs with a grain of salt. Remember the old internet joke:
"on the internet you don't know if you are communicating with a dog." You are doing well - much better than most people in the world. You are very fortunate you don't have the onerous medical student loan monkey on your back - I work in healthcare and had a long discussion with a clinician and he showed me the path that MDs have to take with regard to education and then earnings potential. They put a lot of their life on hold at a young age to get to where you are. I had thought about the MD path, but chose engineering because I was impatient. I salivate at your current financial position at your age. Perhaps playing with FIRECALC, i-ORP or the RPM spreadsheet here will alleviate your concerns regarding your situation.

You are young, too. Five years a age 36 can seem like a long time, yet when you are 50 and beyond, five years flies by fast. I suspect the COVID lockdowns and inability to participate in your preferred stress relief activity (traveling) has contributed to the angst. I understand fully. I would caution letting perhaps an emotional response to your current and the world situation push you to make a hasty decision.

I echo many here who also caution on the grass is greener thinking. Hospitals are horribly inefficient places to work, however, for the most part they can be more free of the nepotistic and familial dramas one would see in a private setting.

In any case, you are obviously intelligent and driven. I think it is good you posted here to ground your thoughts with regard to your decision. My last bit of advice, you only control your actions, attitude and aspirations, i.e. your response to your situation. Many times an attitude adjustment and/or re-direction of your energy and attention can alleviate a stressful situation - that was a very hard lesson for me to learn, however, I use it daily now and am much happier. :-)
coalcracker
Posts: 643
Joined: Sat Feb 04, 2012 12:25 pm

Re: Physicians: Should I leave my job?

Post by coalcracker »

Watty wrote: Wed Sep 23, 2020 3:40 am
Keenobserver wrote: Tue Sep 22, 2020 10:40 pm So you were making time sensitive life and death decisions daily as a computer programmer, where what you decided on the spot in a dynmic situation single handedly determined whether someone lived or died, with each situation being unique and sometimes unprecedented?
Just the opposite so it it sort of an apples and oranges comparison. It varies but usually a software developer will not be able to sign on to a production system so the possible situations need to anticipated long ahead of time. It is pretty unusual but I know that some software I wrote over 30 years ago is still running in a large production system.
eagleeyes wrote: Tue Sep 22, 2020 11:00 pm Did the person who poorly designed the Boeing max air have any professional consequences? Any civil or legal consequences?
That seems to have been more of a management problem than the person who wrote the code and there are lots of lawsuits going on against Boeing now and they will likely go bankrupt but the pandemic crippling air travel is a factor in that. There are also ongoing criminal investigations.

That is an extreme example though. Before I retired I always worked for large corporations so there was virtually no chance that I would be sued if there was a problem with the code I wrote. The reason is that I was part of a team that also included analysts and QA people so that it would have been hard to say that I was legally responsible for a problem with the code that I wrote. Years ago when I worked for the company that wrote hospital software the QA department was actually larger than the software development department.
Keenobserver wrote: Tue Sep 22, 2020 10:43 pm Ok. Please identify other professions with same rigirous entry level training requirements that are poorly compensated.
How about a doctor in pretty much any country other than the US?

A quick google search found this.

Image

https://www.medscape.com/slideshow/2019 ... -6011814#2
Comparing foreign doctors to US doctors is an apples to oranges comparison in that 1) most medical schools outside the US cost nothing or pennies on the dollar compared to US schools and 2) malpractice lawsuits are almost unheard of outside the US.

I recently read of a Canadian obstetrician who unnecessarily induced labor to occur on the weekends in hundreds of women so he could collect higher fees. He was given a formal reprimand, still allowed to practice, and not fined for his malpractice.
ponyboy
Posts: 1021
Joined: Fri Feb 06, 2015 10:39 am

Re: Physicians: Should I leave my job?

Post by ponyboy »

I know a lawyer who became a partner in a huge firm in DC a couple years ago. Makes north of $600k and works non stop. He's gained a ton of weight. His wife has told her friends how lonely she is. Their social life has changed. But hey...he makes a boat load of $$. Sounds like a hoot.
oldfort
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Re: Physicians: Should I leave my job?

Post by oldfort »

Keenobserver wrote: Tue Sep 22, 2020 9:09 pm I dont think lawyers find themselves making life and death decisions and therfore cannot fathom the stresses of an ER doctor for9 example. The decisions that need to be made whilst a 9 year is bleeding to death from an accident with their mother screaming her lungs out is not something any lawyer can fathom from a corner downtown office. Neither can an Engineer come close to the stresses of a heart surgeon. The human emotion, psyche, and the stakes involving life and death are unique and duplicated. A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths. I think docs are undercompensated compared to.many.other professions..eg Real estate agentd in Beverly Hills making more just showing people houses. Find yourself or family member with a real sickness and then tell me how much you think your doc is worth.
OP, don't be this guy. If you go through life, seeing yourself as a victim or a martyr, you're never going to be happy. Any doctor who truly believes being a real estate agent is a better job than a doctor should get out of patient care ASAP.
Keenobserver
Posts: 630
Joined: Thu Aug 13, 2015 1:05 pm

Re: Physicians: Should I leave my job?

Post by Keenobserver »

Watty wrote: Wed Sep 23, 2020 3:40 am
Keenobserver wrote: Tue Sep 22, 2020 10:40 pm So you were making time sensitive life and death decisions daily as a computer programmer, where what you decided on the spot in a dynmic situation single handedly determined whether someone lived or died, with each situation being unique and sometimes unprecedented?
Just the opposite so it it sort of an apples and oranges comparison. It varies but usually a software developer will not be able to sign on to a production system so the possible situations need to anticipated long ahead of time. It is pretty unusual but I know that some software I wrote over 30 years ago is still running in a large production system.
eagleeyes wrote: Tue Sep 22, 2020 11:00 pm Did the person who poorly designed the Boeing max air have any professional consequences? Any civil or legal consequences?
That seems to have been more of a management problem than the person who wrote the code and there are lots of lawsuits going on against Boeing now and they will likely go bankrupt but the pandemic crippling air travel is a factor in that. There are also ongoing criminal investigations.

That is an extreme example though. Before I retired I always worked for large corporations so there was virtually no chance that I would be sued if there was a problem with the code I wrote. The reason is that I was part of a team that also included analysts and QA people so that it would have been hard to say that I was legally responsible for a problem with the code that I wrote. Years ago when I worked for the company that wrote hospital software the QA department was actually larger than the software development department.
Keenobserver wrote: Tue Sep 22, 2020 10:43 pm Ok. Please identify other professions with same rigirous entry level training requirements that are poorly compensated.
How about a doctor in pretty much any country other than the US?

A quick google search found this.

Image

https://www.medscape.com/slideshow/2019 ... -6011814#2
Oh boy where do I start. I asked for a list of professions that are poorly compensated with the same rigirious entry level training ( I am.not even talking about specialities- the years and work.it.may tske to.become a cardiologist or a neuro surgeon) as a physcian. You did.not mention any but instead listed physcians in other countries, which I will excuse due ignorance of the different healtchare systems and challanges unique to US physcias. Firstly, most other countries do.not have the same length of entry level practice requirments as USA. In UK for example, you become a physcian earlier/ younger, and start earning earlier as you start med school after A levels. Same is the case for its former colonies. 2. Are physcians in those nations graduating with a quarter million or more in $ tuition debt? 3. Are physcians in those countries paying ridiculous liability insurances due to litigious nature of US? Those 3 points off the top.of my head that make any comparions to.most other nations futile. Not to mention, I was not even comparing physcian to physcian.
Keenobserver
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Re: Physicians: Should I leave my job?

Post by Keenobserver »

oldfort wrote: Wed Sep 23, 2020 7:02 am
Keenobserver wrote: Tue Sep 22, 2020 9:09 pm I dont think lawyers find themselves making life and death decisions and therfore cannot fathom the stresses of an ER doctor for9 example. The decisions that need to be made whilst a 9 year is bleeding to death from an accident with their mother screaming her lungs out is not something any lawyer can fathom from a corner downtown office. Neither can an Engineer come close to the stresses of a heart surgeon. The human emotion, psyche, and the stakes involving life and death are unique and duplicated. A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths. I think docs are undercompensated compared to.many.other professions..eg Real estate agentd in Beverly Hills making more just showing people houses. Find yourself or family member with a real sickness and then tell me how much you think your doc is worth.
OP, don't be this guy. If you go through life, seeing yourself as a victim or a martyr, you're never going to be happy. Any doctor who truly believes being a real estate agent is a better job than a doctor should get out of patient care ASAP.
Here is the kicker. I am Not a doctor. There lay waste your judgements.
oldfort
Posts: 2403
Joined: Mon Mar 02, 2020 8:45 pm

Re: Physicians: Should I leave my job?

Post by oldfort »

Keenobserver wrote: Wed Sep 23, 2020 7:16 am
oldfort wrote: Wed Sep 23, 2020 7:02 am
Keenobserver wrote: Tue Sep 22, 2020 9:09 pm I dont think lawyers find themselves making life and death decisions and therfore cannot fathom the stresses of an ER doctor for9 example. The decisions that need to be made whilst a 9 year is bleeding to death from an accident with their mother screaming her lungs out is not something any lawyer can fathom from a corner downtown office. Neither can an Engineer come close to the stresses of a heart surgeon. The human emotion, psyche, and the stakes involving life and death are unique and duplicated. A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths. I think docs are undercompensated compared to.many.other professions..eg Real estate agentd in Beverly Hills making more just showing people houses. Find yourself or family member with a real sickness and then tell me how much you think your doc is worth.
OP, don't be this guy. If you go through life, seeing yourself as a victim or a martyr, you're never going to be happy. Any doctor who truly believes being a real estate agent is a better job than a doctor should get out of patient care ASAP.
Here is the kicker. I am Not a doctor. There lay waste your judgements.
You do work in health care though, which must be how you internalized all these weird assumptions about doctors?
chisey
Posts: 277
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Re: Physicians: Should I leave my job?

Post by chisey »

A lot of threads have risen to the top lately about physicians, their practice, their compensation, their billing. I think there's a fundamental problem in how we view physicians and you can see it in this thread as readily as you can in the threads started by unhappy patients.

I think the problem is we, the public, think that because of the personal and life-impacting nature of their work, that they should/do "rise above" the profit motive. This creates an expectation that ends up with people shocked when they run into the business side of their health care providers.

If we stopped putting physicians on that pedestal we would be disappointed far less often, because-- let's be honest-- profit is no less a motive for medical practices and providers than it is for any other service provider. All of the things about medical work that make us put them up there-- the trust we give them, the life-and-death nature of their work, the years they put into training-- they're paid for all of that. That's part of the business. They don't do it because they love us, like a parent or a friend. And the sooner we dispense with the warm fuzzies, the sooner we understand the decisions they face and how they make them, both business and personal.They're not special; they just provide a highly specialized and very expensive essential service. And like any other type of service, there are good ones, bad ones, those who truly care, and those who don't. They should be held accountable when they stink, and it should also be understood that they have to make many decisions based entirely on money.

I don't envy physicians. It's a major investment of time and money to become one and not an easy career. But I also don't have a lot of sympathy for their complaints about compensation and dealing with insurance companies, because it's not at all out of line with what they signed up for.
stoptothink
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Re: Physicians: Should I leave my job?

Post by stoptothink »

chisey wrote: Wed Sep 23, 2020 8:08 am A lot of threads have risen to the top lately about physicians, their practice, their compensation, their billing. I think there's a fundamental problem in how we view physicians and you can see it in this thread as readily as you can in the threads started by unhappy patients.

I think the problem is we, the public, think that because of the personal and life-impacting nature of their work, that they should/do "rise above" the profit motive. This creates an expectation that ends up with people shocked when they run into the business side of their health care providers.

If we stopped putting physicians on that pedestal we would be disappointed far less often, because-- let's be honest-- profit is no less a motive for medical practices and providers than it is for any other service provider. All of the things about medical work that make us put them up there-- the trust we give them, the life-and-death nature of their work, the years they put into training-- they're paid for all of that. That's part of the business. They don't do it because they love us, like a parent or a friend. And the sooner we dispense with the warm fuzzies, the sooner we understand the decisions they face and how they make them, both business and personal.They're not special; they just provide a highly specialized and very expensive essential service. And like any other type of service, there are good ones, bad ones, those who truly care, and those who don't. They should be held accountable when they stink, and it should also be understood that they have to make many decisions based entirely on money.

I don't envy physicians. It's a major investment of time and money to become one and not an easy career. But I also don't have a lot of sympathy for their complaints about compensation and dealing with insurance companies, because it's not at all out of line with what they signed up for.
Great post
User avatar
8foot7
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Re: Physicians: Should I leave my job?

Post by 8foot7 »

OP needs therapy, not financial advice. If you're unhappy at 650k, and feel taken advantage of, then money is not your problem and the Bogleheads forum can't solve it.
Tingting1013
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Re: Physicians: Should I leave my job?

Post by Tingting1013 »

coalcracker wrote: Wed Sep 23, 2020 5:53 am
Comparing foreign doctors to US doctors is an apples to oranges comparison in that 1) most medical schools outside the US cost nothing or pennies on the dollar compared to US schools and 2) malpractice lawsuits are almost unheard of outside the US.
By this logic, should doctors have their salaries cut as soon as they pay off their loans?

US doctors make an order of magnitude more than their foreign counterparts, and it’s not due to better patient outcomes.
mega317
Posts: 4582
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Re: Physicians: Should I leave my job?

Post by mega317 »

"US doctors make an order of magnitude more than their foreign counterparts"
"I asked for a list of professions that are poorly compensated with the same rigirious entry level training"
"So you were making time sensitive life and death decisions daily as a computer programmer"
"9 year is bleeding to death"
"Complaining about patients"

It's too bad for the OP that a really good conversation has been completely derailed and will get locked soon. I hope you got what you needed in the earlier posts.
https://www.bogleheads.org/forum/viewtopic.php?t=6212
Keenobserver
Posts: 630
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Re: Physicians: Should I leave my job?

Post by Keenobserver »

oldfort wrote: Wed Sep 23, 2020 7:40 am
Keenobserver wrote: Wed Sep 23, 2020 7:16 am
oldfort wrote: Wed Sep 23, 2020 7:02 am
Keenobserver wrote: Tue Sep 22, 2020 9:09 pm I dont think lawyers find themselves making life and death decisions and therfore cannot fathom the stresses of an ER doctor for9 example. The decisions that need to be made whilst a 9 year is bleeding to death from an accident with their mother screaming her lungs out is not something any lawyer can fathom from a corner downtown office. Neither can an Engineer come close to the stresses of a heart surgeon. The human emotion, psyche, and the stakes involving life and death are unique and duplicated. A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths. I think docs are undercompensated compared to.many.other professions..eg Real estate agentd in Beverly Hills making more just showing people houses. Find yourself or family member with a real sickness and then tell me how much you think your doc is worth.
OP, don't be this guy. If you go through life, seeing yourself as a victim or a martyr, you're never going to be happy. Any doctor who truly believes being a real estate agent is a better job than a doctor should get out of patient care ASAP.
Here is the kicker. I am Not a doctor. There lay waste your judgements.
You do work in health care though, which must be how you internalized all these weird assumptions about doctors?
Yes I do work in healthcare but not a physcian. But when i see computer programmers / lawyers claiming similarity to physcians; they too regularly make life and death decisions and that their entry level training is also similiar, I cant help myself but chime in. I dont have a horse in this race as Im not a physcian, but am tired of people making snarky comments like they are overpaid without comprehending the dynamics of US healthcare systems and the liabilities.
Big Worm
Posts: 204
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Re: Physicians: Should I leave my job?

Post by Big Worm »

dodecahedron wrote: Tue Sep 22, 2020 9:06 amI agree that you need to understand the economics better.

The hospital might be "billing you out" at $12M but the amount they actually *receive* from third party insurers is typically a small fraction of what they bill. Typical bills have unrealistically high and inflated "sticker prices" that essentially nobody pays. Then you have the uninsured patients with little or no assets. It does not matter what you bill them because you can't get blood from a stone.
I am interested to know how the OP got to the 12M number. This would require seeing the "books" and/or the raw billing numbers. I don't think this info would be readily available in the situation described.
Keenobserver
Posts: 630
Joined: Thu Aug 13, 2015 1:05 pm

Re: Physicians: Should I leave my job?

Post by Keenobserver »

chisey wrote: Wed Sep 23, 2020 8:08 am A lot of threads have risen to the top lately about physicians, their practice, their compensation, their billing. I think there's a fundamental problem in how we view physicians and you can see it in this thread as readily as you can in the threads started by unhappy patients.

I think the problem is we, the public, think that because of the personal and life-impacting nature of their work, that they should/do "rise above" the profit motive. This creates an expectation that ends up with people shocked when they run into the business side of their health care providers.

If we stopped putting physicians on that pedestal we would be disappointed far less often, because-- let's be honest-- profit is no less a motive for medical practices and providers than it is for any other service provider. All of the things about medical work that make us put them up there-- the trust we give them, the life-and-death nature of their work, the years they put into training-- they're paid for all of that. That's part of the business. They don't do it because they love us, like a parent or a friend. And the sooner we dispense with the warm fuzzies, the sooner we understand the decisions they face and how they make them, both business and personal.They're not special; they just provide a highly specialized and very expensive essential service. And like any other type of service, there are good ones, bad ones, those who truly care, and those who don't. They should be held accountable when they stink, and it should also be understood that they have to make many decisions based entirely on money.

I don't envy physicians. It's a major investment of time and money to become one and not an easy career. But I also don't have a lot of sympathy for their complaints about compensation and dealing with insurance companies, because it's not at all out of line with what they signed up for.
I would say this is one of the most balanced posts about this hot topic.
Big Worm
Posts: 204
Joined: Thu Apr 18, 2013 10:20 am

Re: Physicians: Should I leave my job?

Post by Big Worm »

8foot7 wrote: Wed Sep 23, 2020 9:21 amOP needs therapy, not financial advice. If you're unhappy at 650k, and feel taken advantage of, then money is not your problem and the Bogleheads forum can't solve it.
Kind of rough. OP is in BFE, single and unhappy. It's tough to go through all the school and training and then see someone else reap the rewards from your hard work.
potatopancake
Posts: 38
Joined: Fri Jul 13, 2018 4:38 pm

Re: Physicians: Should I leave my job?

Post by potatopancake »

Tingting1013 wrote: Wed Sep 23, 2020 9:26 am
coalcracker wrote: Wed Sep 23, 2020 5:53 am
Comparing foreign doctors to US doctors is an apples to oranges comparison in that 1) most medical schools outside the US cost nothing or pennies on the dollar compared to US schools and 2) malpractice lawsuits are almost unheard of outside the US.
By this logic, should doctors have their salaries cut as soon as they pay off their loans?

US doctors make an order of magnitude more than their foreign counterparts, and it’s not due to better patient outcomes.
Salaries in the United States are higher than other countries regardless of profession. Lawyers, computer engineers, doctors, sales all command higher median salary in the USA vs ‘x’ country.
Big Worm
Posts: 204
Joined: Thu Apr 18, 2013 10:20 am

Re: Physicians: Should I leave my job?

Post by Big Worm »

chisey wrote: Wed Sep 23, 2020 8:08 amBut I also don't have a lot of sympathy for their complaints about compensation and dealing with insurance companies, because it's not at all out of line with what they signed up for.
Not true for a lot of us. Many of us had no idea what specialty we would go into at the start of med school and compensation varies wildly amongst specialties. Nobody thinks about hassling with the insurance companies until you are done with training.
toocold
Posts: 167
Joined: Sun Jul 23, 2017 9:17 am

Re: Physicians: Should I leave my job?

Post by toocold »

Keenobserver wrote: Wed Sep 23, 2020 9:58 am I would say this is one of the most balanced posts about this hot topic.
I would say all these discussions are colored by what's happening in US healthcare. Healthcare continues to be one of the top 3 issues as a society (due to its uncontrollable costs that is blatantly visible to everybody), so when anybody comes on and says they don't make enough money or how to make more money from healthcare, there a significant backlash -- whether that be doctors, nurses, hospitals, insurers, pharma companies.

I think if the OP posted without actually posting his comp, the discussion would have been more around his life's situation rather than the expansive discussion it has become around doctor and entitlement as a whole.

Expecting a lock soon -- since this has become like a reddit post. :happy
ponyboy
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Joined: Fri Feb 06, 2015 10:39 am

Re: Physicians: Should I leave my job?

Post by ponyboy »

Im not a doctor, but I did stay at a Holiday Inn Express.
is50xenough
Posts: 167
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Re: Physicians: Should I leave my job?

Post by is50xenough »

S4C5 wrote: Tue Sep 22, 2020 5:07 am I'm 36 years old and finished residency a little over a year ago and took the highest paying job I could find. I graduated with no debt as I had a side business that earned me around 100k/year throughout medical school and residency. I've done well in terms of making money from work, but not in terms of from investments. I have about $500k in a brokerage account (taxable), $200k in savings, and probably $250k in various retirement plans. I'd like to be out of the game by age 50 and at least partially retired in the Caribbean or Europe or somewhere similar.

For the purposes of anonymity, I won't disclose my specialty here, but I'm in a small subspecialty with a tight job market. Like most subspecialties, the main worries for the future are oversupply driving down revenues and job opportunities and geographic flexibility if I want to make a lateral move.

The job I took was hospital employed in a rural area. I was given a $125k signing bonus (which has been wasting away in a CD at 2.8%), but it's tied to a 5 year forgiveness clause (if I leave before 5 years I have to pay a prorated portion back). My salary is $650k/year with a $70/wRVU conversion factor. In other words, I need around 9300 wRVU per year to make up my salary guarantee and anything beyond that is bonus. I SHOULD be making around 11,000 wRVU per year, which would be around $770k/year income (but I'm not, see below).

Here are the problems with my current position:

1. I am an employee. I heard about the pitfalls of this but had to experience it first-hand to see how badly hospital administrators really treat physicians they employee. I have no control over my clinic. I can't hire and fire insubordinate staff. I can't get the hospital to invest a dime in anything for my patients (even if I can prove it will generate income in the long-term, let alone if it's the right thing for patient care). It's maddening.
2. Income. $650k/year sounds like a lot, but my department bills out probably 1 million a month. I know I am very profitable to the system and make them a lot of money. The wRVU bonus is basically a scam. The hospital is apparently notorious for not paying our this bonus. I tried to audit the records on my own to discover why my wRVU numbers were so low and I discovered that they are not reporting wRVU based on date of service, but to date of billing, which is often months behind. So, for example, if I earned 11,000 wRVU in a calendar year with 2k wRVU in December, but they were a month behind in billing, when the bonus was calculated on January 1, I would only have 9000 wRVU for the year and would not receive a payout. I called them on this scheme and a heated argument ensued. They promised they would tie wRVUs to date of service "for me only," but as this was such an egregious bait-and-switch, I have little faith I will ever receive any wRVU-based production bonus. I have talked to other physicians about how wRVUs are calculated here, and they are appalled. The hospital likes to hire young physicians, and it's obvious why. They want people who are naïve to how the business works.
The benefits are awful. I am maxing out my 403b and 457b (19k/year each), but the company match doesn't start until after 2 years and doesn't fully vest until 5 years later.
3. Location. It's extremely rural. There is nothing here and oddly the cost of living is very high.
4. Lies. The people I work for consistently lie. A great example is that when I signed my contract I was promised a 4 day work week (in writing). When I showed up, they wanted me to work Fridays. As a compromise, I agreed to work Fridays but that I would be allowed to bank 52 Fridays a year as PTO. I now have 82 days a year of PTO total. That's a lot of PTO to try and use (and find locums coverage for), and of course, we aren't compensated for unused PTO. And of course, when I'm gone for weeks at a time, they aren't giving me the wRVUs my clinic is producing. Whereas if I had Fridays off, I wouldn't be doing any work/earning any income on those days anyway since I get it all done in the other 4 days. So basically, I'm losing 52 days a year of wRVU bonus. Those are expensive vacation days. Additionally, being gone that much is bad for continuity of care and I have to spend a lot of time when I get back tidying everything up.

The pros of my current position:
1. Time off/lifestyle. I was enjoying travelling all over the world until COVID hit. Regardless, my job is pretty chill. I show up around 8:30 and can leave by 4 most days. No call and no weekends. No travelling to outreach clinics. However, without being able to travel and having no kids, this is fairly pointless and boring. I'd rather work more and make more money.
2. Income. Even though I feel like I should be making more considering how rural the system is and how much I bill, I still make around the 75th percentile level compared to my peers.

I have realized fairly quickly, the path to success in my field is ownership, which is something very few of us are able to accomplish. Most are employees. However, some are able to buy into private practices and earn incomes around 1-1.5 million. Finding these parternship track positions is difficult, and they typically require 2-3 years of a $300k associate salary.

I have been interviewing and am faced with 4 very different options:
1. Hospital employee in a much better location (a coastal resort area). If I could talk them into letting me invest in the practice as some sort of joint venture, I would be interested. I really want to have some skin in the game and actual potential for higher reward for more work and growing the practice. I'm not sure I want to just keep earning the same salary no matter what I do forever.
2. Private practice in a multispecialty group. All partners regardless of specialty make the same income, which is about what I make now. It's in a city (Minneapolis) instead of a rural area, but the weather is far worse and requires a lot more work, travel, and with less time off. The upside is that I would no longer work directly for the hospital.
3. Starting my own practice. I have been talking to a few other doctors and we see an opportunity in a very rural area near where I am now that is not served. The downsides are much more financial risk and really going off the beaten path, but the upside is that if we had our own practice, we could be collecting the same $1 million/month my current practice is currently turning over to the hospital system.
4. Resign my current position and attempt to negotiate higher pay. At this point, I think it would take a salary guarantee of $800k for me to stay, and I don't see the hospital agreeing to that. And I'm not even sure that's worth all the other B.S.

The two major financial considerations in leaving are the payback of my $125k signing bonus and the fact that I just built a custom $600k house here that is nearing completion and I will have 20% in and may be difficult to sell to re-coup my expenses.

So, should I stick with it here or go with one of the other options above? Word has gotten around that I'm considering leaving and admin has scheduled a meeting with me later this week.
Wow, coming into this late and many good comments already made and I will likely repeat some, so sorry. Few thoughts in no order and this from a physician (retired now) who was in admin position with dozens of docs like OP working for him.

1. Heard an incredible grand rounds from the practice manager/business admin of a large physician practice. He was giving talk on looking for first job to potentially highly compensated department with talk meant for residents. YOU ARE THE EXAMPLE HE USED to a TEE!!!!! He described graduating resident taking first job in rural area because of pay. Only after being there for a year, did the doc realize that it bothered him that fine dining was Red Lobster or some other chain, clothes was Walmart if lucky enough to have one. Took high paying job but ended up unable to stick out and lost all the $ advantage paying back tail and other costs due to breaking contract early. OMG, example was right on! Talk was even better than I thought.

2. I had many docs who talked just like you. They had SOME business sense. I presume you are a very bright person but must consider for a second, and be a bit more humble, because for all your smarts you didn't see the downsides of the job you were accepting when everything you describe is a KNOWN complication. Particularly, the rural part.

3. Admin scheduling meeting later in week. Please be prepared for ALL scenarios: a) you made an impression and they want to renegotiate and make you happy, b) you made an impression and they want you to settle down as you are being a disruptor and bad influence or just settle down cause what you got, is what you got. c) you made an impression, it is bad, staff is unhappy and a guy who got interested in job late is still interested and you are gone. Don't ignore last in your preparation, but don't ignore a and b. This could be time to present calm demand for what will really make you happy. Just the day off per week might be acceptable to them

4. The whole financial conversation about what you make and what you are paid is just so familiar. Long story short, you must bring in about 3.5 times your salary to get your "x" where "X" equals your salary. First, there are the salary so that is 1 "x", there are all the taxes and benefits which generally comes to a total of 20-35% of your salary depending on how good your benefits are. So not just SS tax, paying for your time away, any retirement matching, health, disability, life insurance, etc. Now to actual work: need staff, need an office---and even if already in a paid off hospital needs electricity, cleaning, supplies. Billing people, scheduling and on and on. This figure is accurate and well established whether academic medicine or private practice. Might is vary a bit sure, but very widely accepted and I see it in postings above. Anyway, that is in actual collections. You can likely multiple that number by some factor if just want to consider billings. Don't know what fraction of billings hospital actually gets. If half then you need 7.0 "X", or thereabouts.

5. Yes, you need to pay for areas losing money. But to make it palatable, no matter what highly compensated field you are in, you must be a specialist not primary care to get the salary you are talking. Who do you get patients from? Peds, IM, Family medicine who are employed by hospital? They may lose money but have captured patient base so your total cost includes sharing in their loss.

6. Truly you answer your own question later when you say you would take exact same job (with all hassles above) and less pay if you were in your geographic preference area. Really, you made a mistake and should have looked at job in geographic preference area. Now decision is how much time and money you want to lose to get to where you should have been to begin with.

7. I can read all the posts again but didn't see mention of significant other---gee would dating and having a significant other change how you feel? Might invest some time where you are for a year and see what happens. Nothing like a partner who grew up in the area and knows all the positives to change your mind about location

8. Quitting to get what you want? Never do that unless have job lined up so you are in good position when they say, "resignation accepted, thanks, you can leave right now, this gentleman will escort you out the door when you have all your stuff."

Hope this doesn't sound too harsh. Truly, good luck on your road to self-fulfillment.
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8foot7
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Re: Physicians: Should I leave my job?

Post by 8foot7 »

Big Worm wrote: Wed Sep 23, 2020 10:00 am
8foot7 wrote: Wed Sep 23, 2020 9:21 amOP needs therapy, not financial advice. If you're unhappy at 650k, and feel taken advantage of, then money is not your problem and the Bogleheads forum can't solve it.
Kind of rough. OP is in BFE, single and unhappy. It's tough to go through all the school and training and then see someone else reap the rewards from your hard work.
OP at 650k/year plus bonus plus working 8:30-4 is reaping rewards on a relative and an absolute basis. Quite frankly it is silly to believe otherwise.
Here's a question - at what compensation level would OP not feel like he was being screwed?
This isn't a money problem.
quantAndHold
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Re: Physicians: Should I leave my job?

Post by quantAndHold »

I never wanted to be a physician. Not at all. I never wanted to work that hard or that long in school, I didn't want to start my working life in my mid 30's with a pile of debt, etc. But when I hear people making $500k+ whining and complaining about their jobs and/or the state of their profession, my only thought is "suck it up, buttercup. You're making as much in a year as a lot of us make in 10. You knew what you signed up for long ago."

Back to OP's situation, though... OP seems especially concerned with having to pay back the signing bonus, and the "unfairness" of the medical practice turning them into a profit center.

In the big picture, the signing bonus is a pittance, and if it's a real issue, get whoever you go to next to pay enough of a signing bonus to pay back this one.

As far as being used as a profit center by the hospital. So what? That is how employment works in any industry. If the company can't make a profit off of your labor, they're not going to hire you. Work out the best deal you can, and let the employer take care of themself.

In OP's situation, the one thing that would give me pause is the location of the job. Life's too short to live somewhere where I don't want to live. If I could get a job someplace with good pay and working conditions in a place I'd rather live, I'd do that, even if I took home a little less money at the end of the day.
Yes, I’m really that pedantic.
Helo80
Posts: 1916
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Re: Physicians: Should I leave my job?

Post by Helo80 »

toocold wrote: Wed Sep 23, 2020 10:07 am Expecting a lock soon -- since this has become like a reddit post. :happy

This thread gives the forum a bad rap. I'd delete the thread entirely if I were admin.

I don't see what good is coming from any of this discussion from OP's current gig to the debate over physician compensation/training/stress.
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familythriftmd
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Re: Physicians: Should I leave my job?

Post by familythriftmd »

I hope that it doesn't get locked or removed, because I'm finding it quite informative!
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rjbraun
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Re: Physicians: Should I leave my job?

Post by rjbraun »

Keenobserver wrote: Tue Sep 22, 2020 10:43 pm
ThatGuy wrote: Tue Sep 22, 2020 10:29 pm
Keenobserver wrote: Tue Sep 22, 2020 9:08 pmI dont think lawyers find themselves making life and death decisions and therfore cannot fathom the stresses of an ER doctor for9 example. The decisions that need to be made whilst a 9 year is bleeding to death from an accident with their mother screaming her lungs out is not something any lawyer can fathom from a corner downtown office. Neither can an Engineer come close to the stresses of a heart surgeon. The human emotion, psyche, and the stakes involving life and death are unique and duplicated. A computer programmer is not reslonsible for making decisions that may or may not save somones orgns, limbs, breaths. I think docs are undercompensated compared to.many.other professions..eg Real estate agentd in Beverly Hills making more just showing people houses. Find yourself or family member with a real sickness and then tell me how much you think your doc is worth
Argumentum ad passione.

As noted by many others, doctors aren't the only ones who deal with stress, or conflict, or even life and death situations. They're definitely not the only ones that go through difficult training. Yet it is obnoxiously common for a doctor feel entitled to ever greater riches. The riches already given are driven by artificial supply constraints, not god like qualities conferred by attaining an MD.
Washington Times wrote:Almost 10% of medical school students each year do not get a hospital residency, leaving thousands without the required training to work as physicians and contributing to a growing shortage of doctors in the U.S., medical education professionals say.

...

What’s more, first-year enrollment at U.S. medical schools has increased, the Association of American Medical Colleges said, but the number of residencies has not kept up with the steady growth.
Ok. Please identify other professions with same rigirous entry level training requirements that are poorly compensated.
Veterinarians.

I'm not in the field nor do I have pets or other animals, but I recall reading a news article within the past couple of years about the struggles veterinarians face. It may have been the Washington Post article below, not sure.

Based on my quick search just now, it seems hard to make an apples-to-apples comparison. There are fewer applicants to veterinarian schools than medical schools, but there are also considerably fewer vet schools than med schools (I think I read 28-30 vet schools and 160 med schools, and I don't think that includes DO programs).

The overall internship / residency program may be shorter for vets than for MDs, but I imagine that a vet interested to specialize may need to extend the training process, but I am not intimately familiar with the process to become a DVM; perhaps others on the board are.

In any case, based on the tragically high suicide rate for veterinarians low compensation, particularly in the context of student loan debt, has been reported as a factor.

Of the two veterinarians I know of, and then only really in an indirect fashion, one of them also has a Ph.D. in zoology, so I would say, as an article I read noted, it seems that it may not be so unusual for a DVM to also have a MA or Ph.D. level degree as well.

https://www.avma.org/resources/pet-owne ... y-training

https://www.washingtonpost.com/national ... story.html

https://www.npr.org/2019/09/07/75782200 ... n-and-help
Last edited by rjbraun on Thu Sep 24, 2020 9:57 am, edited 2 times in total.
Normchad
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Re: Physicians: Should I leave my job?

Post by Normchad »

8foot7 wrote: Wed Sep 23, 2020 10:34 am
Big Worm wrote: Wed Sep 23, 2020 10:00 am
8foot7 wrote: Wed Sep 23, 2020 9:21 amOP needs therapy, not financial advice. If you're unhappy at 650k, and feel taken advantage of, then money is not your problem and the Bogleheads forum can't solve it.
Kind of rough. OP is in BFE, single and unhappy. It's tough to go through all the school and training and then see someone else reap the rewards from your hard work.
OP at 650k/year plus bonus plus working 8:30-4 is reaping rewards on a relative and an absolute basis. Quite frankly it is silly to believe otherwise.
Here's a question - at what compensation level would OP not feel like he was being screwed?
This isn't a money problem.
Lot of whiny doctors here.

He took the rural job. He took the $125K signing bonus. He generally works 8-4:30 M-F. He gets $650K per year. With possible big bonuses. Doesn’t sound like he has that “life and death decision making stress” either.

And somehow he feels aggrieved, or taken advantage of. Give me a break.

If you don’t like your life, change it. You have more money and flexibility than 99% of people will ever have.....


Old joke: Do you know the difference between a doctor and God? God doesn’t think he’s a doctor.
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S4C5
Posts: 189
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Re: Physicians: Should I leave my job?

Post by S4C5 »

8foot7 wrote: Wed Sep 23, 2020 10:34 am
Big Worm wrote: Wed Sep 23, 2020 10:00 am
8foot7 wrote: Wed Sep 23, 2020 9:21 amOP needs therapy, not financial advice. If you're unhappy at 650k, and feel taken advantage of, then money is not your problem and the Bogleheads forum can't solve it.
Kind of rough. OP is in BFE, single and unhappy. It's tough to go through all the school and training and then see someone else reap the rewards from your hard work.
OP at 650k/year plus bonus plus working 8:30-4 is reaping rewards on a relative and an absolute basis. Quite frankly it is silly to believe otherwise.
Here's a question - at what compensation level would OP not feel like he was being screwed?
This isn't a money problem.
Yes, there's a number that would probably make me stay. It's what I anticipated I would be making when I took the job.
The issue when I took this job is that I assumed a hefty production bonus to get to that number. That number, if offered to me a in salary form, would be probably be acceptable at this point, but it would be stupid on the administration's part because they aren't motivating me to produce by just paying me a flat salary.
Because of the way the administration fudges the window they use to calculate what bonus is owed, and because of the way my Friday admin day (when I wouldn't be doing much if any work or billing) was replaced with 52 days of PTO a year (which I feel I need to take so I have something), my wRVU numbers end up being much less than anticipated for the work I do (even though I do most of the work anyway but don't get the wRVU credit for it because it's not billed under my name).

The rural hospitals don't like the fact they have to pay more to attract physicians and will try to compare their offer to national averages even though only a small percentage of specialists work in rural settings. They think they are doing you a huge favor by offering you 10-20% more than what you would make in a bigger city in a nicer area, but in reality it's really hard to get people to sign up for that job with only that much extra. Most people would probably require double to come to a place like this, and yeah I'd probably take a 20% paycut to be in a nicer area. Supply and demand forces still prevail, and rural hospitals have to decide whether they just want to lose some of their margin on the practice and pay double for someone who would otherwise take a job in a coastal metro area or pay less but get physicians who can't get jobs anywhere else (due to a variety of factors none good). I've seen a lot of that. And that's unfortunate because the people out here deserve good care too.

Along those lines, the other issue, equal if not bigger, is the hurdles the administration puts in place for me to deliver the care I need to for my patients. It's frankly embarrassing. They make the nurses wear the same facemasks for a week in a row to save a few bucks, as an egregious example for starters, and it gets worse from there. Investing in needed and modern equipment? Forget about it. I'd like some promises they will invest in my practice if I'm going to stay. I don't see this happening.

I agree that this discussion took a pretty nasty turn with heated opinions about how much my peers and I deserve to earn, especially as percentage of what is charged and collected, and other accusations. That's unfortunate. I really appreciate all the other comments though, as it has given me a lot to think about and some needed perspective. Agree that it probably makes sense to just delete this before it spirals out of control further.

Thanks all.
Last edited by S4C5 on Wed Sep 23, 2020 11:35 am, edited 3 times in total.
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