The Sunday Best is a collection of articles I’ve curated for your reading pleasure.
Expect most of the writing to be from recent weeks and consistent with the themes presented on this website: investing & taxes, financial independence, early retirement, and physician issues.
Presenting, this week’s Sunday Best:
With that admission, I would be remiss if I didn’t also include The White Coat Investor who discussed Real Estate and Alternatives in Our Portfolio (shares of this site is one of those “alternatives”).
Bloggers who practice my specialty might get extra attention. Especially when they cover timely topics, like anesthesiologist Tom of High Income Parents did in Tax Credits for High Income Families / Earners.
When a blogger frequently comments and shares my stuff on Twitter, I notice. Then I find a great post they’ve written, like this one from My Sons Father: 5 Lessons I Learned from My Father’s Death.
I know many of my readers are physicians, and they like to hear from other physicians. This one also worked on Wall Street, hence the name. The Wall Street Physician explains How Wall Street is Like a Game of High-Stakes Poker.
I like how my radiologist friend, The Happy Philosopher, uses post-it note graphing technology to aid us all in Understanding the Relationship Between Utility, Happiness, and Cost.
The Biglaw Investor is another serial retweeter, and happens to be really smart with money. He recently shared How to Know if You’re Saving Enough. My recommendation challenge to physicians is to live on half.
Elva, sister of the late Amanda Liu, MD of Dr. Wise Money, recently shared some news I was happy to hear in a brief post simply titled Dear Readers.
I love springtime and the mercury topped 70° yesterday for the first time in over five months. We marked the occasion in the way we celebrate many fine evenings — with a campfire, marshmallows, good beer, and good people to take it all in with us.
In addition to the grass greening, the trees budding, and the morels and ramp sprouting, this is also the time of year that Medscape releases its annual Physician Compensation Report. Thank you to Future Proof MD for alerting me to its release.
The report is behind a “login wall,” so I’ll give you some of the highlights and insights that I garnered from a perusal of the 43 slide report.
The results come from a survey voluntarily filled out by 19,270 physicians. I participated for the first time this year. I thought I should contribute, given that I’ve used the data in a previous post on the salaries of different specialties.
Although it may not be the most comprehensive data, it is available for free, and it tends to look more realistic than some of the salaries reported in the national media, which are often adjusted downward to account for a “typical” 40-hour workweek (a what now?).
Here are some factoids and insights from the report:
- Specialists average $316,000 in compensation, 46% more than primary care physicians averaging $217,000.
- Reported salaries have risen steadily and consistently, from an average of $206,000 in 2011 to $294,000 in 2017.
- Orthopedics make the most ($489,000) followed by Plastic Surgery, Cardiology, Urology, ENT, Radiology, Gastroenterology, and Dermatology.
- My specialty, Anesthesia, comes in ninth at $364,000, a 1% increase from last year. I earn more due to geographic arbitrage, and according to my Mom, being generally above average in every conceivable way.
- Pediatricics was the only specialty reporting a decreasing (by 1%) salary.
- Salary varies by race, but it seems proportional to the percentage of specialists by race. More specialists = higher average pay. Only 20% of White / Caucasian physicians surveyed are in primary care, versus 30% of Black / African American physicians.
- The highest salaries are in the North Central and Great Lakes regions.
- Broken down by state, Alaska, Utah, and New Hampshire also crack the top Ten.
- Self-employed specialists earn much more than employed specialists: $368,000 compared to $287,000. The primary care gap is only $9,000 in favor of self-employed.
- Men earn quite a bit more than women, and are half as likely to work part-time.
- Emergency Medicine docs feel fairly compensated (68%), tops in the survey. Nephrologists are at the bottom, with 44% responding in the affirmative.
- ACOs are taking over. In 2012, 3% participated in one. Now, it’s 36%.
- About a quarter of physicians say they charge for patient no-shows. Good luck collecting!
- 57% of physicians spend more than 10 hours a week on paperwork and administration. 19% report 20 or more hours.
- Gratitude / Relationships with patients is the most rewarding aspect of surveyed physician jobs (ranked highest by 33%).
- The most challenging part? Having so many rules & regulations (28%)
- Most would choose medicine again. Neurologists were the least likely to say yes, but said so at a rate of 71%. Rheumatologists topped the scales with 83%.
- 96% of dermatologists would choose the same specialty again. Lowest by a wide margin were family medicine (67%) and internal medicine (64%).
It’s interesting to see the results in the last two bullet points, as they are drastically different than the data presented in Mescape’s 2016 survey. I would guess the questions were asked differently, because I don’t think there’s been a sea change in medicine that would explain this newfound happiness. Here are last year’s career satisfaction results.
Readers, are you satisfied with your career? Would you choose the same career path if you were given a do-over?
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Have a great week!
-Physician on FIRE
I work with some high-income folks, and I can assure you they are stressed, sometimes, as well. I am OK for income, just high enough to qualify to read high-income parent’s blog 🙂
Would I do it again, study accounting and work in corporate finance? Why not? That’s impossible to answer. I may have considered computer science but my parents never had a PC in our house, so I studied accounting instead. I learned the PC part of it while in college, which mostly involved working in excel.
My non-linear career is leading me to, knock on wood, a fantastic severance package here, and an early retirement at 41. That’s hard to say, along with marrying my also astute wife, I could have done any better.
Truth be told, I work in a field that isn’t attractive to most people. We deal with numbers more than people, and have to present numbers to corporate executives who are very hard to please. In this situation, even being the messenger isn’t easy. I must explain all of our results, even though I don’t always have control over what has occurred. I feel responsible if something goes wrong, and I even get blamed for things that weren’t my fault.
All of the hardships, ironically, is also why this is an attractive field to go into. Job security, should one want a job, is nearly 100%. Accountants and finance positions usually endure even during bankruptcy proceedings. We almost never get laid off. We almost never get help either (being viewed as a cost center and not a profit center). So pay tends to be high, and supply isn’t where it needs to be for demand.
That Medscape data is interesting. I would have thought it would be much higher for ortho, derm, anesthesia. Also hospitalist at some point need to get their own slot. We’re technically primary care (I’m an internist), but we make considerably more than outpatient docs. In my group everyone will easily make $300,000K and some much more, which feels good knowing no fellowship was needed to get to that salary. I guess it’s expensive to get doctors to do the admissions ,discharges, shifts, times no one else wants to do. ?
I think you’ve found a good group, Drsan1, and I agree hospitalist (and peds hospitalist) should be categorized as a distinct specialty as it is a very different job compared to a clinic based primary care doc (who may never step foot in a hospital). I know some anesthesiologists who earn less in academics, and some who earn about twice the reported salary by working longer than average hours, higher acuity cases, and having a great payor mix.
Best
-PoF
Fascinating data there at the PoF. I wonder why dermatologists are so satisfied with their work. My guess is — it’s highly paid work, that’s relatively low stress. AKA the best of both worlds.
I highly doubt you’d find anyone in the engineering field that satisfied with their career.
I wonder how other careers like a dentist would compare?
A+ list this week. I am quite surprised at the pediatrics numbers shown in the survey…
Also loved the note from Amanda’s sister. Great news!
Great news, indeed, Ryan.
What aspect of the pediatrics numbers surprise you? They’ve always had among the lowest salaries (since I’ve been paying attention, anyway).
Best,
-PoF
I was surprised that only 55% were satisfied with their career.
As you mentioned, its common knowledge that they have one of the lowest salaries. The physicians that choose to be a pediatrician must REALLY love what they do, otherwise why would they guarantee themselves a lower salary compared to their peers? Maybe the work schedule is a bit less demanding, less call etc, but that doesn’t seem to be the major driver in their decision to work in pediatrics.
My wife is a pediatric pulmonologist and a great majority of our friends work in peds as well. They didn’t choose pediatrics for the money, they really are passionate about helping children. Seeing that only 55% are satisfied seems low based on my small sample size (wife, friends and clients), or maybe they are all glass half full people.
So honored to be a part of this weeks “Sunday Best”. In such good company as well. I’m a huge fan of what you’re doing here, it is really inspirational.
Thanks, MSF!
That was a great post, and I dig your logo. Looks a lot like me a couple years ago.
Cheers!
-PoF
There seems to be a huge jump this year in the percentage who would choose medicine again. I wonder if it’s real, if last year was an anomaly, or if the ones who wouldn’t have FIREd.
By next year, it should be well above 100%. 200% is possible by then end of the decade.
😉
-PoF
I’ve always been a bit skeptical of this information, but my reasons for skepticism have changed over time. I can remember as a student wondering how it was possible to make $250000 and not feel well compensated for your work. Now I question who answers these surveys and why they would have any incentive to give accurate numbers. While I see the burnout on the faces of some of my colleagues, I feel handsomely rewarded for a job that, most days, I thoroughly enjoy. I live in a rural area where there are almost no other professionals around and I hope my neighbors have no idea how much I make. I enjoy the “stealth wealth” lifestyle.
For the record, I am an employed urologist in my 4th year of practice. I made about $675000 last year and have not answered a salary survey in a while.
I would agree that you are handsomely rewarded! Nice work, rodsquad. Geographic Arbitrage, no doubt.
The salary numbers are reasonably similar to survey data, if not a bit on the low side. About 20% were part-timers, so that will drag the numbers down a touch.
As you point out, some of the outliers may choose not to participate. Those who do take the time to partake would have no incentive to lie about their salaries.
Keep up the good work, and stealth wealth mentality.
-PoF
Geographic arbitrage is part of it, though I live in central North Carolina. Cost of living is low but we are not known for having the most generous physician salaries. I personally ascribe it to training in a truly malignant residency where i had to become very efficient to survive, particularly if i ever hoped to see my family. When i started in my practice i decided to work half as hard as i did in residency. I still occasionally feel guilty to be home during daylight hours but am consistently above MGMA 90%ile for rvus. Being paid on production has been good to me so far.
Thanks for the mention PoF. I’m a bit skeptical of those Medscape reports. Voluntary survey data that is self-reported seems murky to me. It is especially strange when the numbers change dramatically from year to year, big red flag for selection bias. There is just no logical reason for the numbers to jump all over the place.
I have a tough time answering the would you do it all again question. I’m where I am today because of all my prior decisions, and I don’t think I would go back and change anything. As I’ve written before, I think our ego and identity becomes pretty strongly tied to our profession (and specialty) as physicians, so it’s hard to picture myself anywhere else. In an alternate universe I probably would have advised my identical clone to try something else other than medicine.
I agree on the survey data. Something is better than nothing, I guess.
You probably would not have met your wife if you had taken a different path, right? That’s true for me, at least. No regrets.
Cheers!
-PoF
Glad to see I am in the top specialities. I knew I should have interviewed for a job in Utah when I had the chance! Low taxes and high wages make for supercharged growth in net worth.
Thanks for sharing the DWM post too. It saddens me every time I think how young she passed.
Don’t forget a lower cost of living in Utah compared to California, as well!
It’s not too late, is it? Although, I imagine you want to see those trees you planted grow. And you do live in a pretty swell community.
Cheers!
-PoF
It’s never too late I guess, but you are right, the fruit trees need to grow. I just added a lime, mandarin orange, and a regular orange tree! Plus the vegetable garden was planned this weekend. Not too shabby living on the left coast.
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Thanks for including me in the Sunday Best!
I love following and promoting other high-income blogs. Now I just need to convert hat income into a net worth that is even remotely close to yours. The good news is that I am only 30, so I got time.
I was just reading the Money Commando’s update over the weekend and he is looking to increase his net worth by almost $640K this year, those are some gains to lust for 🙂
Keep killing it!!!
You’ve got a decade to make that happen, Dom. When I was your age, I had a zero net worth. Probably slightly negative, actually.
If the market keeps up this pace, a $640k gain isn’t entirely out of the question for me this year. I’ll probably add about $200k from income. Gains of 4% to 5% per quarter (repeating Q1 2017) would get me there. I realize that’s unlikely.
Cheers!
-PoF
Thanks PoF for letting me be a part of The Sunday Best.
There are a couple of things that stood out to me about the survey.
1. It looks like most of us have “Grass is Greener” Syndrome. A majority of us would still choose medicine, but when asking about going into the same specialty, the numbers drop.
2. I would like to see numbers compared to lawyers, engineers, MBA’s and other higher paid professionals on the satisfaction with income. When the general public looks at a bunch of fancy pants doctors not being satisfied with our sometimes mid six-figure incomes, that doesn’t do a great job in the PR department.
For what it’s worth, I chose Yes — I would choose medicine and anesthesia again. As Joe Walsh once said, “Life’s Been Good to Me So Far“.
Cheers!
-PoF
That last table you shared was very interesting. I’ve often wondered how internal medicine physicians like their jobs. Especially now that many hospitals have patients give feedback on their visit. That seems like it would put pressure on those doctors to give the patients what they want vs. what they need. Which with our cultures obsession with having a pill to do with everything, would seem extra challenging.
Regarding my own career, I am generally happy with my decision to pursue engineering. However, I’m open to the idea of having multiple careers in my lifetime since I have broad interests that often fall outside of the engineering field. I’m currently reading a great book called “Designing Your Life” by Bill Burnett and Dave Evans. So for anyone who feels stuck in their current job/life (or just wants to look at their current career with a designers mindset), I would highly recommend this book!
Engineering seems like a great career path, and it’s one that many personal finance bloggers and FIRE fans have chosen.
You are absolutely right about the patient satisfaction scores. Some employers even tie your pay to certain metrics, including survey results. It’s maddening.
Best,
-PoF
Wow internal medicine folks seem to be very unhappy. Kind of scary when you remember usually that’s your normal doctor. I guess the demands of dealing with the general public when they need to be persuaded to be preventative is not much fun.
Interesting story. A relative and I were in an outpatient care the other day. The person in the next room had some sort of major surgery. The doctor was advising him he should no longer be drinking. The individual, never saw him, kept asking about drinking later today and was insistent on drinking regardless of the cost. He got loud enough we could hear him from the next curtained area. I imagine that’s internal medicine daily.
I’m happy with my career choice, I just wish I’d found my career direction a few years earlier. I started in something completely unrelated. Then again I might not be as successful in my current career without hat start.
One aspect of anesthesia that I thoroughly enjoy is the fact that I carry out my prescribed anesthetic and see the result within seconds or minutes.
In a clinic situation, you prescribe a medication or treatment, which may or may not be acted upon, and hope to see results months or years down the road.
I much prefer the instant gratification we see in the O.R.
Oh, and that beligerent patient insisting on drinking his favorite beverage that day? That was me.
Cheers!
-PoF
Thanks for including me in The Sunday Best, PoF! I really enjoyed writing that article, and I’m glad you liked it.
My guess for why there was an increase in overall job satisfaction in the survey is that they changed with they included as a yes answer for “choosing your own specialty again.” Was this question asked as a yes or no question, or was it a very likely, somewhat likely, kinda sorta likely, somewhat unlikely, and very unlikely? They may have included the kinda sorta likely as a yes answer this year, while they did not last year.
That, or people are really excited about Donald Trump being president. I can’t think of anything else that has changed in the last year.
Given the president’s approval rating, I don’t think excitement is the culprit. I imagine the questions (or possible answers) were phrased differently from one year to the next, although I don’t recall the details from when I took the survey.
Good luck at the poker table! 😉
-PoF
Excellent wrap-up post, PoF! It was nice to see the quick note from Amanda’s sister.
Of course, I love Mr. 1500’s post on open NW (not just because I was included too) because I really believe transparency and hard numbers are super helpful to those seeking FIRE.
Thank you, Michael.
I’m a numbers guy, and it’s hard to talk about financial independence without attaching a dollar amount to it.
Cheers!
-PoF