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What kind of physician makes this kind of money?

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  • What kind of physician makes this kind of money?

    May seem like an ignorant question to some, but apparently I didn't hang with the right crowd in medical school because I had no idea it was possible for a physician to make this kind of money.  No one I knew ever talked about this stuff.  But, then again, I was 22 years old when I started medical school and came from a family in which I was the first to go to college so I was pretty blind coming into it.

    Anyway, this guy is making a killing at $1.8 mil a year!  WTF??  Educate me on what specialty can pull in this sort of cash so that I can inform every medical student I meet to gun for it, lol!  I'm guessing it's a private practice in which he is a partner, maybe plastic surgery? Wow is all I can say.  2 years of work in his job and I'd be ready for retirement.

    https://www.bogleheads.org/forum/viewtopic.php?f=1&t=220344

  • #2
    These are some examples that I've known :    dermatologist with ancillary cosmetic products business,   employed trauma surgeon who bamboozles his administration to believe his unique managerial skills are irreplaceable, administrative neonatologist who recruits referrals from wide referral area,    high volume spine surgeon.

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    • #3
      Probably not applicable to the original poster, but a "founding father" practice owner with multiple employed physicians working would also get into that ballpark. My guess is spine surgeon since he finished residency at 35 and reports that he works ALL the time.

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      • #4
        And I thought I was doing pretty good. Sheesh! Anyone who can earn 1.8 mil a year and spend 70k doesn't really need any kind of a plan. Those numbers just kinds work themselves out.

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        • #5
          Busy private practice spine surgeon with ancillary revenue? Some guys I work with make more than him

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          • #6
            Our practice has 4 plastic surgeons, 1 of which is the owner and works about 1 day a month. We generate about 8.5-11 million a year in revenue just on the surgical side. I myself am producing a bit over 2 million and will only take home about 400k of that. I will probably be leaving in the next year or two to do my own thing as I dont feel adequately compensated and some other minutiae that is just annoying. Overall get paid well for time I spend but still, could do much better on own and my own terms.

            Its not impossible, but you have to step out of the ordinary employed and never think about it again. Im continually surprised at the money "ordinary" specialties seem to be able to make like people on this forum and elsewhere. I mean there are psychiatrists that are out there absolutely crushing it.

            If I could go back and start over I would probably do a shorter residency in one of the fields that allows a greater freedom for locums or highly paid shift work that could allow a motivated person to really crush it. For more traditional specialties it becomes a problem of linearity and consult/follow up, and not enough time in the day.

            If anything, the forum and just hanging around finance sites has shown that it is indeed possible to make far more, but you have to risk being the owner or some other aspect (practice setup, location, specialty, etc...). Part of the problem is people dont think its possible. My friend who left a dysfunctional practice to be on his own tells me how flabbergasted other surgeons in his field are when he tells them the number of pts he sees a week, types and that he wont be increasing his workload because the balance is fine, etc....

            Lots of people have difficulty cutting out the poorly paying plans, procedures, etc...and just seeing the big picture. I quit doing face procedures almost immediately because they made no economic sense at all. They paid 50% less than body procedures, took a long time in OR and consults, follow up was really long relatively with lots of complaints (validated less satisfaction rates than body), revision rates high. Cut and never missed.

            Someone else wasted their time in the practice seeing and operating on them, following up and appeasing them. This meant I saw more body cases, did more, got more referrals, etc...and every one of those hours was worth 150% more. Realize your own market, whats zero sum and how to tilt the better stuff to you and worse stuff elsewhere. This meant I was paid more per hour than anyone who chose to do those face cases, it was really simple but the other guys didnt see that, while they kept pushing those high paying cases to me because they saw face.

            There are things like that in everyones practice/specialty that you can tilt in your favor that other people arent paying attention to. You want to do x procedure/disease, well focus on it. Every time you do something else it takes away and increases odds you see something else again.

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            • #7
              To echo some of the comments already made, it's really not that uncommon.  I know many docs who make over 2 million per year.  And there are multiple ways to accomplish it.   Don't feel bad, though.  It's not exactly common knowledge.  If you read WCI articles from several years ago, even he dismisses such individuals as practically urban legends.  It took me at least 4 years of practice in my own specialty before I figured out its economics precisely.

              I think the prime reason why this type of earning capacity is not common knowledge is because the most common (but not only)  way to achieve it is on the backs of other docs (and there are a variety of ways to accomplish this).  But if you want to pull this off, you can't have it be obvious to those below you.  So publicizing it in any way is counterproductive.

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              • #8
                Some highlights from that thread that help to explain his income:

                ...have a x% loan on MY office building

                Small town in Texas

                I work constantly

                 

                Like Zaphod said, the opportunities are out there.  But are you willing to move to a small TX town to do it?  Assume greater risk for the greater reward?  Also agree with THP - this guy could throw darts at Vanguard's fund lineup and do better than most out there.

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                • #9
                  Great post. Really good information


                  Lots of doctors are risk averse. Lots think they could make more if only ... but they are not truly cut off for risk and might not do well on their own.

                  While if I had to do it over again I would like to think I would do shorter training more flexibility, the truth is the circumstances would have to change for me to truly be willing to pursue that. Less debt, less responsibilities, less kids. I'm not that brave.

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                  • #10
                    That great post reply was in response to post by zaphod

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                    • #11
                      I have known doctors in that income stratosphere.  They were mostly Ortho-Spine, neurosurgery, or other.  The "other" either had a glamorous practice like cosmetic surgery on the rich or they set up a business with a lot of income streams.

                      The unusual part is this guy spends 70K.  I don't know anyone like that.  PoF is the closest thing to this unusual ideal.  I kind of like the idea of writing an annual check.  They don't even need to budget if they are frugal.  I haven't heard of people doing that.

                      This guy worked only 3 years and is FI.  Amazing.  Based on his current investments and lack of debt he could draw out 3% per year and do fine without working.  Wow.  High income, low expenses + investing = Freedom to choose.

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                      • #12
                        I believe the 90%tile spine surgeon was over $2mil in the most recent MGMA income survey.  I agree that's probably the most common way to get there.

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                        • #13
                          I have known people who made that kind of money but not right out of residency.  I agree that the model is either spine surgery, radiation oncology (if owner of equipment), or making it off of young employees.  The specialities do rotate.  I was making around 1 mill/year in inflation adjusted terms when I opened my solo ob practice.  I was in the right place at the right time.  I was one of 2 female obs in my geographic area.  I was doing > 20 deliveries /month plus gyn surgery and was department chief.  I had zero time.  I figured out that  investing was much easier than getting up in the middle of the night and worrying about being sued.

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                          • #14


                            I think the prime reason why this type of earning capacity is not common knowledge is because the most common (but not only) way to achieve it is on the backs of other docs (and there are a variety of ways to accomplish this).
                            Click to expand...


                            Seven years before becoming employed in my current job, I was contracted at the same facility as a locum for a couple months. I worked directly with the anesthesiologist who had the contract and accepted a lower than expected rate because I wanted to be here for the summer.

                            As a locum on a per shift basis, I earned less than half what I do now as an employee. And now I have paid benefits, too.

                            The doc that I worked for the first time around later let my wife and I stay at one of his very large beachfront homes in Hawaii. So there's that.

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                            • #15
                              What is point. I mean being FI in 3 years is amazing but that's as much due to his/her extreme frugality as their income. Most people who work that much just spend spend spend, have no free time, divorces etc..
                              Making typical doc money and being half decent with money you will have more than enough and hopefully some free time.

                              Also I don't look at it as "only working 3 years" when you include extra grueling years of residency. One year of surgical residency is not equal to one year of other residencies.

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