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Medical Professionals-Would you Counsel Your Kids to Follow Your Career Path?

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  • Avatar kvpauley 
    Participant
    Status: Financial Advisor
    Posts: 6
    Joined: 08/31/2016
    Earnest refinancing bonus

    Doing a bit of research and would welcome your thoughts!  I am a financial advisor (we are a WCI recommended advisor) and I have a senior in high school considering a career in medicine.   Knowing what I know through my relationship with you (medical professionals) as clients and personally, I am trying to provide sound counsel and perspective (HA!).  That effort has evolved into an article/poll that I’ve forwarded to our own group of medical professionals (clients, friends, and our communities).  Thought I’d throw it out to this group as well.  My daughter is a competitive student – so she ‘qualifies’ at least from that perspective.  Here’s what I’ve come up with so far:

    ———-

    No one knows the costs of your profession better than you.  The rest of us (non-medical professionals) don’t have to look far to find mountains of studies and statistics documenting what you already know; we are aware of the tolls many of you carry.

    • Extraordinary costs (time and money)
    • Extraordinary competitiveness right from the start
    • Constant conflicts between quality patient care and the economics of your practice/hospital/insurance companies/pharmaceuticals
    • Hours – long and hard; lack of control over your schedules and time
    • Time and money spent on non-medical necessities (administrative, HIPAA, EHR, contracts, mergers, insurance, staff, etc).
    • High-stress, and often high emotional tolls (while you can brace yourself against patient/family loss and suffering, it’s simply not possible for it not to take a toll)
    • Uncertainty about the economics of medicine in the United States as we experiment with social programs surrounding healthcare
    • High burn-out and depression rates as a result of all of the above

    *What do these have in common?  They all relate back to finances for you, your practice and your patients.

    Let us not forget, however, the good!  An altruistic desire to heal people and families, the love of science, and the journey of passionately pursuing something meaningful/personal/human.  For many, a (hopefully) secondary benefit is income.  While there are a few (lawyers, high-end sales people, hedge fund managers), there are actually few professions that pay as well as we pay our doctors, even after insurance in-network tight margins. 

    The median physician income is approximately $200,000, and the median household income in the United States is about $52,000 per year, and that often includes two partners working. In fact, only 25% of American households have income over $100,000 and only 6% over $200,000, with half of those between $200,000 and $250,000. The infamous “1%” starts at just $389,000, less than that of many physician households, especially a two-physician household. [WCI Blog: 5 Ways to Get Out of Clinical Medicine]

    Of course, income often in the early years is off-set by significant student loan debt and an appreciable amount of “pent-up spending”; our young medical professionals have been watching their non-medical professional peers buying houses, cars and boats for a few years already.

    That all said, what would you/did you tell your children? 

    At Pauley Financial, among our principals alone, we have 12 up and coming college students – some of whom have expressed an interest in pursuing medicine.  How do we guide them knowing what we know, which is still only a fraction of what you deeply understand? 

    In the words of one of our clients, we started by offering these sounds words of wisdom.  Thank you, Frank.

    • If you realize at any step along the path that you cannot commit to putting patient welfare above your own wealth, comfort or ego, find another career. Some of the most unhappy people we know are physicians who are in the profession for the wrong reasons.
    • Find a mentor.
    • Maintain a life outside of medicine.

    We then added our own perspective, colored naturally by our profession – managing wealth and financial freedom. Here’s a summary of where we landed: (you can ask our kids…it was much longer in person).

    If you choose to pursue this profession, commit to taking the lynch-pin of money out of your equation.  Too many medical professionals feel additional pressure in their careers because they are financially in too deep (debt, golden handcuffs and/or insatiable spending).  And, people that don’t feel like they have choices or control over their lives/time are the ones most susceptible to depression and burnout.  They find themselves torn between families needing time and attention, their own health and well-being, and incredibly demanding jobs. 

    So, if you seek to pursue this career, commit to living well below your means for a very long time.  That will afford you more choices to live your life the way you would like (financial freedom), and allow you to enjoy the reasons you got into medicine to begin with.

    For our current and future medical professionals, know that there are resources and options available.  Perhaps you gain more control over your time by doing locum tenens work, have time to work with a coach to prevent burnout (see thehappymd.com), pursue teaching at a university, job share and work part-time, and/or hire competent help at home and the office.

    We’ll let you know how well our advice turned out with our kids in about 15 years – until them, we’ll remain cautiously optimistic!   In a nutshell though, the resulting advice is probably sound for all of us: “Be passionate about what you do, and fix your finances so that you have more choices in your life.”

    We welcome your input and feedback, and we’ll follow up to share your thoughts in an upcoming column.  In any graduation card we send to students (medical or otherwise), we offer this as a place to start.  (Most of them are more appreciative of the also enclosed check, but heck, we’re trying.)

    PS – I just polled my dentist: he said yes for dentistry, no for medical. Why?  Medical was bound so much more tightly by insurance.

     

    #25512 Reply
    Avatar conniebird 
    Participant
    Status: Physician
    Posts: 258
    Joined: 01/08/2016

    You’ll get lots of different answers, probably depends on numerous factors including specialty choice. Many docs graduate with no debt due to state schooling or generous parents.

     

    If my kid wanted to go into medicine. I’d have to see how the state of things are then (we’re talking almost 20 years from now), which will be vastly different than now. But few other professions have the pros of medicine – know that you help people immensely, as you stated above. It has a lot more flexibility than people think on the surface, the MD degree allows you do other things in case clinical medicine isn’t for you.

     

    I love what I do. I am in a good amount of debt with loans. If I knew what I knew now financially a years ago, I would be in a different place.

     

    As for advice, make sure she knows what she is getting herself into – have her shadow, volunteer etc. During college she can explore things more as well. Encourage her to have an open mind. Encourage state schools. Ironically, it was cheaper for me to attend private school than public school in my state…

    “Compound interest is the eighth wonder of the world. (S)he who understands it, earns it ... (s)he who doesn't ... pays it.”

    @ missbonniemd.com

    #25513 Reply
    The White Coat Investor The White Coat Investor 
    Keymaster
    Status: Physician
    Posts: 4601
    Joined: 05/13/2011

    If you can be talked out of medicine, you should be.

    Site/Forum Owner, Emergency Physician, Blogger, and author of The White Coat Investor: A Doctor's Guide to Personal Finance and Investing
    Helping Those Who Wear The White Coat Get A "Fair Shake" on Wall Street since 2011

    #25514 Reply
    Avatar Josh0731 
    Participant
    Status: Physician
    Posts: 98
    Joined: 01/21/2016
    Splash Refinancing Bonus

    If you can be talked out of medicine, you should be.

    Click to expand…

    I have to differ and say I’m not a big fan of this sentiment. There is, and will continue to be, a big need for healthcare providers for our growing and aging population.  My suspicion is there aren’t enough people out there for whom medicine is a passionate ‘calling’ to even come close to meeting society’s needs if that were the standard of entry into the workforce.  It’s therefore important that the healthcare industry and medical profession continue to meet people in the middle, adapting to make medicine a desirable career choice in the future.  The biggest example of this is, as recently discussed on the blog, crushing educational costs/debt.

    As for the broader question of advice to one’s kids, I would hypothetically discourage my child from going to medical school.  The many reasons are too easy to list: crushing debt, declining and confusing reimbursements, increasing regulatory nonsense, long stressful hours, decreasing intellectual stimulation, physical demands of procedural specialties (a big one, seldom discussed), decreased autonomy/respect from growing administrative bureaucracy, a population of patients who increasingly seem to be almost purposefully wrecking their health through bad lifestyle choices leading to difficult to treat chronic illnesses, etc, etc, etc.  I don’t like that I would want to say, “Go ahead and go to med school, but you’d better chose an E.R.O.D.E. specialty.”, so I would just say I’d recommend against it.  Get ready for the future where medicine is no longer something that our school’s best and brightest want to pursue.

    #25517 Reply
    Liked by MochaDoc
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6327
    Joined: 01/12/2016

    If you can be talked out of medicine, you should be.

    Click to expand…

    I have to differ and say I’m not a big fan of this sentiment. There is, and will continue to be, a big need for healthcare providers for our growing and aging population.  My suspicion is there aren’t enough people out there for whom medicine is a passionate ‘calling’ to even come close to meeting society’s needs if that were the standard of entry into the workforce.  It’s therefore important that the healthcare industry and medical profession continue to meet people in the middle, adapting to make medicine a desirable career choice in the future.  The biggest example of this is, as recently discussed on the blog, crushing educational costs/debt.

    As for the broader question of advice to one’s kids, I would hypothetically discourage my child from going to medical school.  The many reasons are too easy to list: crushing debt, declining and confusing reimbursements, increasing regulatory nonsense, long stressful hours, decreasing intellectual stimulation, physical demands of procedural specialties (a big one, seldom discussed), decreased autonomy/respect from growing administrative bureaucracy, a population of patients who increasingly seem to be almost purposefully wrecking their health through bad lifestyle choices leading to difficult to treat chronic illnesses, etc, etc, etc.  I don’t like that I would want to say, “Go ahead and go to med school, but you’d better chose an E.R.O.D.E. specialty.”, so I would just say I’d recommend against it.  Get ready for the future where medicine is no longer something that our school’s best and brightest want to pursue.

    Click to expand…

    I think this sentiment is that if talking someone out of medicine works, then they would definitely grind out of it anyway along the path. Medicine is still an obviously great profession income wise. Now with us grumpy codgers telling people to save/invest wildly as opposed to our mentors who suggested we all buy beach houses and ferraris and things will just “work out”….they will be okay. I would definitely make sure they have a financial mindset about it, and choose specialty with a heavy weight on that and length.

    The other likely great gig for less everything but most importantly time is a PA. They will probably be taking over primary care with NPs.

    #25520 Reply
    Avatar GXA 
    Participant
    Status: Physician
    Posts: 211
    Joined: 01/15/2016

    I would encourage my kids if they are interested.  Our full time ED physicians work 12 shifts a month and get paid pretty well to do it.  Many take a week off every month or two.  We also have three in our group who are part time.

    I cannot think of another career with such earning potential and flexibility to work and earn as much or as little as one wants.

    Obviously specialty choice plays into this, but the field of medicine is broad enough that one can find an area that works for them and assures a decent work/family balance with a stable income.

    #25521 Reply
    Avatar YSH 
    Participant
    Status: Physician
    Posts: 108
    Joined: 01/11/2016

    I wouldn’t say I was ever the “best and brightest”, tho, I do think I have some grit in me.  I graduated from a public school with a small amount of debt, and I am also someone who didn’t have middle/ upper middle class parents who rothed or 529ed anything on my behalf.  Actually, as the youngest child and one that was quite mischievous in my youth, my parents were surprised enough that I got out of undergrad in 4 years. Maybe, key to parenting is to set your expectation low?!?!

    I am not in a highly desired specialty, but I do love what I do and do feel fairly (80-85%) appropriately compensated for my skills.  If I were given the chance again, I would still chose medicine.  If my children wanted to go into medicine, I would make sure he/she is fully informed about the pros/cons.  Also, I would enforce the idea that to truly be good and successful at something you have to be willing to put in that time.  There are plenty of people out there who struggles for years before hitting the sweet spot professionally and financially.  We do have a very diverse group of friends (partner not in medicine, which helps), anything from non medical small business owners, artists, investment bankers (like old school residency hours bankers), accountants, phds, to stay at home spouses.  I can say that all professions/ jobs have its pits. Interestingly, sometimes, its our banker friends who complains the most about their work/life/salary satisfactions.

    I would most definitely make sure that my child understands cost/benefit ratio, personal finance and the importance of living well below your means.

    #25522 Reply
    Liked by MochaDoc
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3486
    Joined: 01/21/2016

    If it is their calling, I would not talk them out if it.

    If they are just kicking around ideas of what to do for a living, I would not talk them into it.

    My teens are extremely unlikely to pursue a career in medicine.

    Avatar DoubleMDs 
    Participant
    Status: Physician
    Posts: 98
    Joined: 01/11/2016

    Do they want to go to medical school? I tell everyone aspiring to that I would recommend against it. If they have interest in anything else, pursue whatever that is. There are many professions you can help people (altruistic), make plenty of money (and a lot earlier) and do it all with a lot less stress, debt, sleepless nights and malpractice liability. The golden years of being a physician are long, long gone.

    that being said PAs and NPs do very well at a fraction of the time, cost and effort. If someone is dead set on medicine I would encourage those avenues. Otherwise my advice is virtually always against medicine. And believe it or not, I like what I do, when I’m actually just practicing medicine. But it took too long, is too beuraucratic, cost too much and requires way more then just practicing medicine on a daily basis. Not worth it.

    #25534 Reply
    Avatar akwho 
    Participant
    Status: Resident
    Posts: 14
    Joined: 05/22/2016

    Think about becoming a doctor mathematically (as you are a finance person).

    -> 23% of country has a college diploma (you’ve got be in the top quartile of education attainment to even get started)

    -> My college had 1200 people start in premed, of which 300 graduated with medical school prerequisites done (most transferred to business or other majors)

    -> Of the 300, 250 got into medical school (a very good rate, it was an excellent college)

    -> Of the 250 approximately 225 will graduate medical school

    -> Of the 225 approximately 215 will graduate residency

    -> Of the 215 that will graduate residency, slightly less than half will feel happy with their job (most studies estimate ~45%)

    = 100 happy, graduated, practicing doctors out of the 1200 who even made it to an excellent college to try in the first place.

     

    The odds are stacked against everyone who wants to become a doctor, let alone a happy one.  You give up your nights in college studying much harder than other majors.  You give up your ability to earn income in your 20’s, and all your days and nights in medical school mastering the subject material.  There is constant high stakes testing where failures have huge personal consequences.  You work 100 hours a week in residency making enough to afford rent, food, and make your monthly loan payments.  You are sleep deprived, you work is stressful, you fear being named in a lawsuit, you must accept responsibility for lapses in a patient’s care no matter who was at fault because it is your job to “double check” everyone else’s work.

    Despite all the negatives I listed above, I absolutely LOVE my job.  I get to be in a people facing career making a positive difference in many people’s life every day. My work is meaningful, technically challenging, and provides great benefits to patients.  I get thanked every day by patients and their families, I get positive encouragement from my family, friends, and community due to the nature of my career.  I’m an intern in a surgical residency, supposedly one of the hardest years of training to be a doctor, and I wouldn’t trade it for the world.

    My advice to people considering medicine is do it for the right reasons.  Don’t do it for the money, if you are smart enough to be a doctor you would make waaay more money way sooner in the top echelons of finance, business and real estate.  Don’t do it for the prestige, that wears off quickly and leaves you with nothing.  Don’t do it because your parents want you too, they don’t have to wake up at 245am to get to work by 330am every day, but you will.  The only way you become a happy doctor is to love people and love taking care of them.

    #25537 Reply
    PhysicianOnFIRE PhysicianOnFIRE 
    Moderator
    Status: Physician
    Posts: 1545
    Joined: 01/08/2016

    My boys are more than a decade away from being college aged, so it’s not a decision we’ll be facing anytime soon. If we were at that junction, I would try not to interfere too much, and give the most unbiased information I can. Which would be very difficult.

    I think I made the right choice in pursuing medicine, and I’m quite happy with where I am today and glad to know all the people I’ve met along the way. I might have done just as well taking a different path, but it hasn’t been so bad that I would try to talk my kids out of it. I would show them a thread like this one, so they could see some differing opinions.

    Best,

    -PoF

     

     

    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.

    #25542 Reply
    Avatar jhwkr542 
    Participant
    Status: Physician
    Posts: 1331
    Joined: 02/15/2016

    Even with all its flaws, I still think medicine is a good field to go into. People complaining about the nuances of medicine would probably also complain about the nuances of many other fields. I probably wouldn’t encourage primary care unless they go to a cheap medical school. That mountain of debt is hard to tackle starting under $150k. As for me, I don’t know many other non medical fields I could work in making $200k+ at age 31 in an 8-5 job with the intellectual intrigue that is pathology.

    #25561 Reply
    Avatar squirrel 
    Participant
    Status: Physician
    Posts: 78
    Joined: 01/26/2016

    If you can be talked out of medicine, you should be.

    Click to expand…

    I have to differ and say I’m not a big fan of this sentiment. There is, and will continue to be, a big need for healthcare providers for our growing and aging population.  My suspicion is there aren’t enough people out there for whom medicine is a passionate ‘calling’ to even come close to meeting society’s needs if that were the standard of entry into the workforce.  It’s therefore important that the healthcare industry and medical profession continue to meet people in the middle, adapting to make medicine a desirable career choice in the future.  The biggest example of this is, as recently discussed on the blog, crushing educational costs/debt.

    As for the broader question of advice to one’s kids, I would hypothetically discourage my child from going to medical school.  The many reasons are too easy to list: crushing debt, declining and confusing reimbursements, increasing regulatory nonsense, long stressful hours, decreasing intellectual stimulation, physical demands of procedural specialties (a big one, seldom discussed), decreased autonomy/respect from growing administrative bureaucracy, a population of patients who increasingly seem to be almost purposefully wrecking their health through bad lifestyle choices leading to difficult to treat chronic illnesses, etc, etc, etc.  I don’t like that I would want to say, “Go ahead and go to med school, but you’d better chose an E.R.O.D.E. specialty.”, so I would just say I’d recommend against it.  Get ready for the future where medicine is no longer something that our school’s best and brightest want to pursue.

    Click to expand…

    I think this sentiment is that if talking someone out of medicine works, then they would definitely grind out of it anyway along the path. Medicine is still an obviously great profession income wise. Now with us grumpy codgers telling people to save/invest wildly as opposed to our mentors who suggested we all buy beach houses and ferraris and things will just “work out”….they will be okay. I would definitely make sure they have a financial mindset about it, and choose specialty with a heavy weight on that and length.

    The other likely great gig for less everything but most importantly time is a PA. They will probably be taking over primary care with NPs.

    Click to expand…

    I agree with what I think is the intent of WCI’s comment.  If someone can be talked out of it, they may not have the commitment it takes to get through it.  I was originally pre-med, and talked myself out of it.  I still worked in healthcare for almost a decade, then finally came to the realization I did want to go to med school so went back to school and pushed through it. I am glad I went this route.  I don’t think I had what it takes when I was 22 years old.  There is a chance I would not have been able to hack it and stopped halfway, and been in debt with no means to earn to pay it back.  Personally I also felt this made med school and residency easier. I viewed it as a job that required a certain amount of hours and was able to balance life fairly well and build a family at the same time.  I was never one of those studying endlessly into the night spinning my wheels getting stressed out the night before exams.

    Despite what some people have expressed in terms of not putting off med school in order to get into higher income earning years earlier, I am a big proponent of people taking time to work in between college and med school. IT seems crazy to me that work experience is required before going into school to be an NP or PA but not for a physician.  It allows a period to save (and therefore borrow less for med school, like I did and came out with very very little debt).  It also provides a time to develop maturity and responsibility of having a boss, answering to other people, etc.  IT also allows a true look into the system (provided one is working in healthcare) and therefore one is choosing medicine with eyes wide open and not some romanticized view of being a doctor.  I have found a lot of immaturity in medicine and I feel part of this is people on the fast track since high school, who may have never had a job or a boss, then are spit out at the top of the medical food chain(meaning as the doctor usually dictating care and giving orders).  I think this leads to people as docs not being emotionally mature, and plays a part in a lot of the unprofessional interactions between doctors as well as docs and other people in the health care field (nurses, techs, LPNs, etc).  I believe this is one of the reasons I come across docs almost every day who seem miserable in their jobs (and I am not talking about docs who have been around a while, Im talking about younger docs and even residents too!).  As we all know, many are saddled with a heavy debt burden, then take on a “doctor’s lifestyle” then probably feel stuck and have no other choice but to grind it out and be miserable.  Obviously this has a lot more to with lifestyle choices etc, and not solely going straight through at a younger age.

     

    At any rate, I know I am making some huge generalizations, and there are obviously exceptions to what I am talking about but just my two cents.  And to reiterate the whole point, those who choose medicine should be ones who can’t easily be talked out of it.

    #25564 Reply
    Liked by hatton1
    Avatar kvpauley 
    Participant
    Status: Financial Advisor
    Posts: 6
    Joined: 08/31/2016

    First, sincere thanks to all those that responded.  Your counsel is thoughtful and clearly heartfelt.  I will definitely share this thread with my daughter.

    She has volunteered, shadowed and just recently started a job at a pediatric clinic serving very low income families…she LOVES it.

    I thought the point about recognizing the down-sides to other professions was valid.  Also the point about work experience.  I started to pursue my Master’s degree in Mathematics right out of college, but only was going to receive half the money I needed to live as a stipend, so, I decided to go work full-time for a while instead (I was getting very tired of eating Rice-a-Roni after four years undergrad).  Very grateful I did; when I did go back to school, I studied and approached learning in a very different way than I had previously.

    We have a close family and my children have watched me manage a career/business alongside being Mom.  She seems to see the value of that and wants to do the same.  To that end, she has been considering strongly the NP/PA path in the hopes that those careers might offer her more control over her time.  Interestingly, she has received a LOT of pressure from her peers/school to do pre-med (she’s a very strong student); the implication being that she’s taking the easy way out if she does anything less (eg start with a BSN).  I disagree.  So many of her peers seem to be choosing pre-med by default – as if it’s just expected.

    At the end of the day, it seems like if you love what you do, it’s not really work.  That’s not to say there aren’t crummy days!  As an advisor, I too have compliance burdens, clients that don’t seem to want to help themselves, long days …BUT, the majority of the time, it’s good, I’m helping people live their lives the way they want to, and constantly learning (I really love this part as well).

    As stated, I’ll let you know in about 15 years how it all worked out!  🙂  When they are all about 35 years old and upstanding citizens, I might consider taking a small victory lap, but until then…

     

     

     

    #25572 Reply
    Avatar Allonblack 
    Participant
    Status: Resident
    Posts: 59
    Joined: 02/12/2016

    Divide the total number of people from your daughter’s college by the total enrollment in introductory biology classes multiplied by 2 for 2 semesters. That is the odds of your daughter getting in to medical school. If she is okay with that percentage my advice is don’t put yourself in a position where you have to go to medical school to have a career you’d be happy with. So don’t be a bio major with no exposure to other fields. Cant comment on being a doctor because I’m still training, but I will say this: be wary of all the advice to become a PA or NP. When you have a field with low barriers to entry and high salaries people will flood into it and eventually salaries and job opportunities will go down. It happened to pharmacy and it’s going to happened to mid levels. There are already online NP degrees .

    Also as a parting thought, no one crushes it like a successful salesman. Maybe do that.

    #25582 Reply

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