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Introduction — Critique Welcome

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  • Avatar PocketChange 
    Participant
    Status: Resident
    Posts: 9
    Joined: 08/07/2018

    Want to do a quick introduction and invite any critique of my current situation/plans.

    The basics: PGY-3 in 4-year emergency medicine program in the cold and cloudy Great Lakes country. Stay-at-home spouse and two daughters (ages 4 and 8 mos).

    Current income: $59k – all W2 money (with nominal moonlighting <$1k)

    Current debt: total — $387k

    • $377k @ 6.25% –graduate ($8.5k) and medical school loans ($the rest); I estimate it will be about $430k by residency graduation. All are federal loans.
    • $8k (family loan for a car)
    • $2k medical bills (still paying off our 8-month old’s birth and our 3-year old’s broken arm last summer)

    Current cash on hand: $6k

    Retirement 403b (not Roth): $4k (100% in VSMPX)

    Budget: We track spending and budgeting using a spreadsheet.

    • Current take home is $3560/mo
    • Total spending about $2900/mo – We live in an apartment, didn’t buy a house 😉
    • Gross savings 18.5%

    After residency plans: Family is all over the country, so not settled on any one location. I’ve started contacting employers, but still too early for some. Thoughts are to chase the $$, but don’t want to end up in a bad/unsafe environment. After not seeing the sun for half the year, we want to move somewhere that’s not by the Great Lakes. Thought about TX, but I’ve been told that jobs are drying up there. Also looking into the Cincinnati area, NC, but honestly are open to most places.

    Ideally we want to get rid of our loans ASAP (within 3 years) after residency. I am registered for PSLF but know it is less likely to work out since most EM groups are not non-profit. I’m hoping to sign early and then we will look into refinancing if not non-profit.

    Any critique is welcome.

    I am really thankful for the community I’ve found. I read White Coat’s website in med school (even got to meet him in St. Louis) but started reading the forum just recently. I’ve been really impressed by the stories I’ve read and the depth of knowledge of everyone who posts. Looking forward to eventually contributing my own success story down the road.

    #179484 Reply
    Liked by mapplebum
    Avatar fatlittlepig 
    Participant
    Status: Physician
    Posts: 468
    Joined: 01/26/2017

    Want to do a quick introduction and invite any critique of my current situation/plans.

    The basics: PGY-3 in 4-year emergency medicine program in the cold and cloudy Great Lakes country. Stay-at-home spouse and two daughters (ages 4 and 8 mos).

    Current income: $59k – all W2 money (with nominal moonlighting <$1k)

    Current debt: total — $387k

    • $377k @ 6.25% –graduate ($8.5k) and medical school loans ($the rest); I estimate it will be about $430k by residency graduation. All are federal loans.
    • $8k (family loan for a car)
    • $2k medical bills (still paying off our 8-month old’s birth and our 3-year old’s broken arm last summer)

    Current cash on hand: $6k

    Retirement 403b (not Roth): $4k (100% in VSMPX)

    Budget: We track spending and budgeting using a spreadsheet.

    • Current take home is $3560/mo
    • Total spending about $2900/mo – We live in an apartment, didn’t buy a house ?
    • Gross savings 18.5%

    After residency plans: Family is all over the country, so not settled on any one location. I’ve started contacting employers, but still too early for some. Thoughts are to chase the $$, but don’t want to end up in a bad/unsafe environment. After not seeing the sun for half the year, we want to move somewhere that’s not by the Great Lakes. Thought about TX, but I’ve been told that jobs are drying up there. Also looking into the Cincinnati area, NC, but honestly are open to most places.

    Ideally we want to get rid of our loans ASAP (within 3 years) after residency. I am registered for PSLF but know it is less likely to work out since most EM groups are not non-profit. I’m hoping to sign early and then we will look into refinancing if not non-profit.

    Any critique is welcome.

    I am really thankful for the community I’ve found. I read White Coat’s website in med school (even got to meet him in St. Louis) but started reading the forum just recently. I’ve been really impressed by the stories I’ve read and the depth of knowledge of everyone who posts. Looking forward to eventually contributing my own success story down the road.

    Click to expand…

    there’s nothing to critique.

    #179486 Reply
    Avatar paramount 
    Participant
    Status: Physician
    Posts: 40
    Joined: 04/24/2016

    Are you paying on your loans now or just deferring them?

     

    If just deferring and definitely not PSLF then might consider refinance or putting them into REPAYE.

    #179491 Reply
    Avatar G 
    Participant
    Status: Physician, Small Business Owner
    Posts: 1320
    Joined: 01/08/2016

    Nice work.

    There are lots of job available all over. You’re gonna have to narrow it down! It’s not too early to start sniffing around. For sure plan on ACEP in October.

    Disability and term life insurance?

    The cash on hand is for E fund? Maybe consider bulking that up to help with interview and moving expenses next year.

    I assume you want to get to your education debt knocked out before kids’ college?

    #179492 Reply
    wonka31 wonka31 
    Participant
    Status: Physician
    Posts: 458
    Joined: 03/24/2018

    In your situation, I would very much consider looking at jobs as an employed physician at a non-profit hospital. This shouldn’t be very difficult to find. You will already have four years completed of PSLF and will likely make more than if you join a mega group. If you have about $400k in debt and can get this forgiven after six years, that’s a pretty good deal. If you find a great democratic group, then fine, but otherwise I’d really look hard at continuing through the PSLF post-residency.

    Why do you want to sign early? There’s not much upside to this for you. There is tons of upside to lock in residents to contracts early for the employer. The $X signing bonus check they send you six-eight months early will be a drop in the bucket in the long run. Figure out where you want to live and take tons of time to investigate your options. You don’t seem to clear on where you want to be geographically, which is even more reason to take this slow. You can start looking at options now, there is nothing wrong with that.

    ACEP’s recruiting is overflowing with the mega groups. They aren’t all bad, but don’t get too excited with the glitz, glamor and ‘parties’ they have there. You’re much better off working for a democratic group or stable hospital system imho.

    #179498 Reply
    Avatar Panscan 
    Participant
    Status: Resident
    Posts: 585
    Joined: 03/18/2017

    I would do some moonlighting and get family car and medical bills out of picture. the med school debt is another story but I would try to simplify as much as possible.

    #179499 Reply
    Avatar PocketChange 
    Participant
    Status: Resident
    Posts: 9
    Joined: 08/07/2018
    Everyone, thank you for all of the advice!

    Are you paying on your loans now or just deferring them?

     

    If just deferring and definitely not PSLF then might consider refinance or putting them into REPAYE.

    Click to expand…

    Good question–I am currently on REPAYE. Still not definitely PSLF, otherwise I would have refinanced. It all depends what kind of group I end up with.

    Nice work.

    There are lots of job available all over. You’re gonna have to narrow it down! It’s not too early to start sniffing around. For sure plan on ACEP in October.

    Disability and term life insurance?

    The cash on hand is for E fund? Maybe consider bulking that up to help with interview and moving expenses next year.

    I assume you want to get to your education debt knocked out before kids’ college?

    Click to expand…

    The beauty (and curse) is that we could literally get a job anywhere! Definitely making it difficult to not have at least a region narrowed down. I currently have term life insurance and am looking into disability insurance. It’s definitely more expensive than I’d like and I’m not sure it’s in the cards right now, but I did recently get some quotes. The cash is basically our emergency fund, and I agree that it needs some bulking up! Haven’t saved up anything for college for the kids–would love to start some 529s, just need some more capital!

    In your situation, I would very much consider looking at jobs as an employed physician at a non-profit hospital. This shouldn’t be very difficult to find. You will already have four years completed of PSLF and will likely make more than if you join a mega group. If you have about $400k in debt and can get this forgiven after six years, that’s a pretty good deal. If you find a great democratic group, then fine, but otherwise I’d really look hard at continuing through the PSLF post-residency.

    Why do you want to sign early? There’s not much upside to this for you. There is tons of upside to lock in residents to contracts early for the employer. The $X signing bonus check they send you six-eight months early will be a drop in the bucket in the long run. Figure out where you want to live and take tons of time to investigate your options. You don’t seem to clear on where you want to be geographically, which is even more reason to take this slow. You can start looking at options now, there is nothing wrong with that.

    ACEP’s recruiting is overflowing with the mega groups. They aren’t all bad, but don’t get too excited with the glitz, glamor and ‘parties’ they have there. You’re much better off working for a democratic group or stable hospital system imho.

    Click to expand…

    Thanks a lot for the suggestions. I think I just want to sign somewhere to have that unknown become a known. Plus I’m somehow afraid that the good jobs will be taken early if I wait, but maybe I don’t need to be as worried about this. At least by looking now I’ll be able to see what’s out there. I have heard mixed opinions of the mega groups and I feel like many of the democratic groups have unreasonable sweat equity requirements, limiting my ability to pay things off early. Now, if I was in a nonprofit hospital system, PSLF would be nice and I like the idea of working for a system.

    I would do some moonlighting and get family car and medical bills out of picture. the med school debt is another story but I would try to simplify as much as possible.

    Click to expand…

    Good points–that would simplify things. The moonlighting I do now really doesn’t bring in much, so I’m going to look into some other options. Earlier in residency I wanted to moonlight like crazy during 3rd and 4th year and actually make a dent in my loans, but fear of malpractice issues as a resident have kind of limited me from pursuing that idea more. There are some urgent cares I could try to moonlight now, but more opportunities open up as a PGY-4. Need to feel a little more confident by then though.

    #179503 Reply
    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 1970
    Joined: 05/01/2017

    I’m an APD in EM who spends a good part of my time advising our 4s on the job search.

    One thing I would tell your for sure is to not “chase the $$” when you are looking for a job. EM is pretty simple, if someone is going to pay you an over the top salary it’s for a good reason. Look at things like group stability, partner track, attrition, night shifts, etc. The name of the game in EM these days is mega groups which is my experience have variable quality even among them.

    In our job it’s better to take a job w/ 50th percentile comp that you can stay in for 10-15 years (or life) than to burn the candle at both ends. Part of the problem you realize pretty quickly is that you can’t have it all. Places where you have a lot of “fun” clinically (drop off GSW, stemis left and right) are generally going to have issues that make working there long term tough.

    I think the optimal job model for a new EM grad is to shoot for a dream job and then find your high paying side hustle in an area where they have a hard time attracting docs, bonus if this is a busy high acuity shop where you can fine tune your clinical skills, efficiency, airway management etc. Then as you stabilize your finances and life you just cut back on the side hustle and settle into your sustainable nice job. You are far less likely to burn out at a side hustle b/c you have far more control over it. You start to feel burned out? Just cut back for a month or 2, you might even find yourself missing it!

    It’s really tough as a young EM attending not to view a day off as wasted time “I could have made [insert shift compensation here] today.” Fight against that and go to the park with your kids — easier in TX or NC than in my beloved Great Lakes!.

    #179517 Reply
    PhysicianOnFIRE PhysicianOnFIRE 
    Moderator
    Status: Physician
    Posts: 1488
    Joined: 01/08/2016

    Want to do a quick introduction and invite any critique of my current situation/plans.

    The basics: PGY-3 in 4-year emergency medicine program in the cold and cloudy Great Lakes country. Stay-at-home spouse and two daughters (ages 4 and 8 mos).

    Current income: $59k – all W2 money (with nominal moonlighting <$1k)

    Current debt: total — $387k

    • $377k @ 6.25% –graduate ($8.5k) and medical school loans ($the rest); I estimate it will be about $430k by residency graduation. All are federal loans.
    • $8k (family loan for a car)
    • $2k medical bills (still paying off our 8-month old’s birth and our 3-year old’s broken arm last summer)

    Current cash on hand: $6k

    Retirement 403b (not Roth): $4k (100% in VSMPX)

    Budget: We track spending and budgeting using a spreadsheet.

    • Current take home is $3560/mo
    • Total spending about $2900/mo – We live in an apartment, didn’t buy a house
    • Gross savings 18.5%

    After residency plans: Family is all over the country, so not settled on any one location. I’ve started contacting employers, but still too early for some. Thoughts are to chase the $$, but don’t want to end up in a bad/unsafe environment. After not seeing the sun for half the year, we want to move somewhere that’s not by the Great Lakes. Thought about TX, but I’ve been told that jobs are drying up there. Also looking into the Cincinnati area, NC, but honestly are open to most places.

    Ideally we want to get rid of our loans ASAP (within 3 years) after residency. I am registered for PSLF but know it is less likely to work out since most EM groups are not non-profit. I’m hoping to sign early and then we will look into refinancing if not non-profit.

    Any critique is welcome.

    I am really thankful for the community I’ve found. I read White Coat’s website in med school (even got to meet him in St. Louis) but started reading the forum just recently. I’ve been really impressed by the stories I’ve read and the depth of knowledge of everyone who posts. Looking forward to eventually contributing my own success story down the road.

    Click to expand…

    You know, it’s only that cloudy on the east side of the Great Lakes. We get more sun on the west side here in MN. It’s not Arizona, but it’s not as gray as the Pacific NW or rust belt.

    It sounds like you’re doing the right things with your finances. Your salary will be going up probably 6x or more when you finish residency. Keep the same mindset when you finish and your loans will be gone in short order.

    40-something anesthesiologist and personal finance blogger @ https://physicianonfire.com [Part of the WCI Network] Find me on Twitter: @physicianonfire

    FIRE. Financial Independence. Retire Early.

    #179520 Reply
    Avatar G 
    Participant
    Status: Physician, Small Business Owner
    Posts: 1320
    Joined: 01/08/2016

    Interesting map. Although I live in a yellow zone now, after living in two different red zones, it feels like it is NEVER cloudy!

    #179527 Reply
    Avatar ZZZ 
    Participant
    Status: Spouse
    Posts: 308
    Joined: 06/18/2018

    “2k medical bills (still paying off our 8-month old’s birth and our 3-year old’s broken arm last summer)”

    Tangential, but is this typical for training programs to offer such horrible insurance coverage?

     

    Also, to the OP, somewhat contrarian advice, but I’d suggest not worrying about your savings rate now. Saving $600/mo is a noble effort, but you’re not really ‘saving’ since you’ve got massive debts at high interest rates accruing more than that in interest every month. The marginal utility of that $600 for you right now is far greater than it will be 5 years from now when you’ll make as much in a good month as you make in a year currently. Don’t blow it on useless stuff, but make sure your wife and young children are well taken care of.

    #179537 Reply
    Liked by Anne, G
    Drop it into MD Drop it into MD 
    Participant
    Status: Physician
    Posts: 440
    Joined: 09/20/2018

     

    Click to expand…

    You know, it’s only that cloudy on the east side of the Great Lakes. We get more sun on the west side here in MN. It’s not Arizona, but it’s not as gray as the Pacific NW or rust belt.

    It sounds like you’re doing the right things with your finances. Your salary will be going up probably 6x or more when you finish residency. Keep the same mindset when you finish and your loans will be gone in short order.

    Click to expand…

    Now I get why I never see the sun.  😛

    To the OP-  You are doing great.  Live like a resident until the loans are paid off and it should not take long.

    I thought EM was only 3 years?

    #179539 Reply
    Dreamgiver Dreamgiver 
    Participant
    Status: Physician
    Posts: 632
    Joined: 03/09/2017

    That is an interesting map. We live in a white area but feel like I go crazy in the summer with all the constant sun light. I actually work through the whole summer with no days off because of that, I like the cold darkness of the OR. All my vacation happens in the fall and maybe some in the spring. My wife has adapted to my quirkiness but she loves the unlimited sunlight.

    #179589 Reply
    Liked by jz
    portlandia portlandia 
    Participant
    Status: Physician
    Posts: 344
    Joined: 07/07/2017

    Need to make this into a giant billboard at the California/Oregon border as a friendly reminder!

    #179652 Reply
    Liked by Lithium
    Avatar PocketChange 
    Participant
    Status: Resident
    Posts: 9
    Joined: 08/07/2018
    Thanks again for all of the comments, everyone. I really appreciate it. Even though you are all “strangers,” I respect your opinions and your suggestions have changed the way I think about these things. This is info I don’t readily get from my attendings (I feel like they are all living pretty expensive lives, but that may be compared to my resident situation).

    I’m an APD in EM who spends a good part of my time advising our 4s on the job search.

    One thing I would tell your for sure is to not “chase the $$” when you are looking for a job. EM is pretty simple, if someone is going to pay you an over the top salary it’s for a good reason. Look at things like group stability, partner track, attrition, night shifts, etc. The name of the game in EM these days is mega groups which is my experience have variable quality even among them.

    In our job it’s better to take a job w/ 50th percentile comp that you can stay in for 10-15 years (or life) than to burn the candle at both ends. Part of the problem you realize pretty quickly is that you can’t have it all. Places where you have a lot of “fun” clinically (drop off GSW, stemis left and right) are generally going to have issues that make working there long term tough.

    I think the optimal job model for a new EM grad is to shoot for a dream job and then find your high paying side hustle in an area where they have a hard time attracting docs, bonus if this is a busy high acuity shop where you can fine tune your clinical skills, efficiency, airway management etc. Then as you stabilize your finances and life you just cut back on the side hustle and settle into your sustainable nice job. You are far less likely to burn out at a side hustle b/c you have far more control over it. You start to feel burned out? Just cut back for a month or 2, you might even find yourself missing it!

    It’s really tough as a young EM attending not to view a day off as wasted time “I could have made [insert shift compensation here] today.” Fight against that and go to the park with your kids — easier in TX or NC than in my beloved Great Lakes!.

    Click to expand…

    Thanks for taking the time to write this–this is gold! Really makes me think about changing the way that I’ve been thinking about a job. I really like the idea of finding something I feel like I can do for a long time and supplementing that with higher volume/acuity. I think I’d definitely last longer doing something like that. I was hoping I’d hear from you as I’ve enjoyed some of your other comments, so thank you for the suggestions. As for the time at the park–summers here are incredible and cannot be beaten. Nothing like the time playing at the lake and the park, even the chilly pool in the summer. It’s these 6 months of clouds that seem so long.

    Want to do a quick introduction and invite any critique of my current situation/plans.

    The basics: PGY-3 in 4-year emergency medicine program in the cold and cloudy Great Lakes country. Stay-at-home spouse and two daughters (ages 4 and 8 mos).

    Current income: $59k – all W2 money (with nominal moonlighting <$1k)

    Current debt: total — $387k

    • $377k @ 6.25% –graduate ($8.5k) and medical school loans ($the rest); I estimate it will be about $430k by residency graduation. All are federal loans.
    • $8k (family loan for a car)
    • $2k medical bills (still paying off our 8-month old’s birth and our 3-year old’s broken arm last summer)

    Current cash on hand: $6k

    Retirement 403b (not Roth): $4k (100% in VSMPX)

    Budget: We track spending and budgeting using a spreadsheet.

    • Current take home is $3560/mo
    • Total spending about $2900/mo – We live in an apartment, didn’t buy a house
    • Gross savings 18.5%

    After residency plans: Family is all over the country, so not settled on any one location. I’ve started contacting employers, but still too early for some. Thoughts are to chase the $$, but don’t want to end up in a bad/unsafe environment. After not seeing the sun for half the year, we want to move somewhere that’s not by the Great Lakes. Thought about TX, but I’ve been told that jobs are drying up there. Also looking into the Cincinnati area, NC, but honestly are open to most places.

    Ideally we want to get rid of our loans ASAP (within 3 years) after residency. I am registered for PSLF but know it is less likely to work out since most EM groups are not non-profit. I’m hoping to sign early and then we will look into refinancing if not non-profit.

    Any critique is welcome.

    I am really thankful for the community I’ve found. I read White Coat’s website in med school (even got to meet him in St. Louis) but started reading the forum just recently. I’ve been really impressed by the stories I’ve read and the depth of knowledge of everyone who posts. Looking forward to eventually contributing my own success story down the road.

    Click to expand…

    You know, it’s only that cloudy on the east side of the Great Lakes. We get more sun on the west side here in MN. It’s not Arizona, but it’s not as gray as the Pacific NW or rust belt.

    It sounds like you’re doing the right things with your finances. Your salary will be going up probably 6x or more when you finish residency. Keep the same mindset when you finish and your loans will be gone in short order.

    Click to expand…

    Holy smokes! Physician on FIRE replied! My wife was also very impressed, haha. We’ve actually been looking at Minnesota a little. Wouldn’t mind a little of the “Minnesota nice” everyone talks about! Looks like a beautiful place to live. My wife’s parents are in AZ but will retire soon so they’re not sure where they will end up.

    “2k medical bills (still paying off our 8-month old’s birth and our 3-year old’s broken arm last summer)”

    Tangential, but is this typical for training programs to offer such horrible insurance coverage?

     

    Also, to the OP, somewhat contrarian advice, but I’d suggest not worrying about your savings rate now. Saving $600/mo is a noble effort, but you’re not really ‘saving’ since you’ve got massive debts at high interest rates accruing more than that in interest every month. The marginal utility of that $600 for you right now is far greater than it will be 5 years from now when you’ll make as much in a good month as you make in a year currently. Don’t blow it on useless stuff, but make sure your wife and young children are well taken care of.

    Click to expand…

    Good observation–this is a sore subject as I missed the 30-day window to get our newest daughter enrolled in our decent insurance. Hopefully not a mistake I will ever make again. Costs should improve this year as she’s back on my insurance. As for the broken arm, little bills just keep trickling in even though we are 5 months out at this point. Ended up needing surgery, etc, so it ended up being pricey.

    It’s good advice about not going to crazy at this time. I think we feel fairly pinched for the time being, but are careful to make sure we aren’t being too crazy, i.e. we’re still eating, have a great apartment, reliable cars (although my check engine light did come on this morning). I have the lucky problem of a frugal wife, but like I said, not overly so. Honestly I can’t think of any “things” I want, just places I’d like to travel. We are looking forward to a great trip after residency, just don’t know where at this point. Right now there just isn’t much money or time for travel. .

    Drop it into MD  I got lucky 😉 and matched into a 4-year program. I think it will work out in the end. They say the ideal length is 3.5 yrs of training, so I’m sure I’ll feel pretty ready to spring the coop by the time 4 years is over. But for now I feel like I still have a lot to learn, so I’m fine with it.

    #179698 Reply

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