Over the last couple of years I have received feedback from time to time that I may be alienating people who have a lower than average physician income or who have fewer retirement account options than I have. Here's a good example (but certainly not the only one) from a comment left a few months ago:
As a Pediatrician, I don’t make a salary of $200k a year and likely never will so the whole “You too can own a mansion in the mountains, go heliskiing in Japan, drive a luxury car, and give all you want to charity, if you only delay your gratification” pitch is a little hard to listen to. We do delay gratification in all the ways listed above but putting $200k towards retirement a year will never be our reality short of getting another source of income. I think what is hitting me the most this morning is the question of why my time as a Pediatrician is so much less valuable than every other specialty out there. Do I need all the things discussed in the blog? Absolutely not, but it would be nice to be more equally compensated for the work I do. Throwing out numbers that are unattainable for most in primary care does ostracize a significant portion of the potential audience.
In My Defense
Before moving on to the subject of this post, I'd like to give a few points in my defense:
# 1 This is a website directed at high-income professionals.
That generally encompasses a range of income from about $100K to about $1.5 Million. Some posts are aimed more at the $100K PA and some are aimed more at the dual specialist couple with the 7 figure income. Most probably fall somewhere in between. I do not apologize that my posts aren't directed at “Average Joe” who lives in a household making $55K a year. There is probably some useful information for Average Joe on this website, but he isn't the target audience of the blog. There are plenty of financial blogs out there aimed at those who are not high-income professionals. What makes this one unique and useful to its readers is the fact that it isn't. I tell guest posters the same thing and reject guest posts that aren't squarely aimed at high earners.
# 2 Like with any blog, take what is useful to you and leave the rest without feeling offended by it.
The fun thing about reading a blog is the personal aspect of it. You get a glimpse into the personal life of the blogger that you'll never get reading the Wall Street Journal or Forbes. But nobody else is in my EXACT financial situation. Not a single one of my readers. So figure out those ways in which you can relate, and apply them in your life. Some of you are poorer than me. Many of you are richer than me. That's okay. I can deal with it and so can you.
# 3 I am a little unique among attending physicians in that I have been in every single tax bracket.
As an attending. You don't think I can relate to you with your sub $50K taxable income? It wasn't that many years ago that I WAS YOU. Trust me, I haven't forgotten what it was like. We might have a fancy new dining room table, but the couches are all hand me downs. Still. 11 years out of residency.
# 4 Why do I talk about what we spend money on?
Because I am trying to demonstrate a simple point–that if you “take care of business” early on in your professional career, you can enjoy “the good life,” which I defined in The White Coat Investor book as
“…a life free from financial worries, a career where you make a real contribution to society, a few luxuries along the way, the ability to help others financially throughout your life, and a comfortable retirement at a time of your choosing.”
I talk about my boat or my car or my latest vacation to show readers that there is light at the end of the tunnel. I'm not advocating a Mustachian spartan existence here where you live like a resident for decades (although it would probably help the planet if I did.) You may define “the good life” a little differently than I do, and you likely are interested in different luxuries than I am and that's perfectly fine. But my point is that you CAN have them, eventually.
# 5 Why do I talk about my retirement accounts knowing that I have access to more than the vast majority of my readers?
Is it just humble-bragging? No. I view it as teaching. Every time I mention I have more than one 401(k), someone emails or comments to ask “How do you have more than one 401(k)?” Every time I mention a defined benefit/cash balance plan, someone asks, “What's that?” If I casually drop the words “Backdoor Roth IRA,” all of a sudden there is one more physician family who can squirrel away $11K a year in an asset protected account that will never be taxed again.
The Wealthy Pediatrician
Enough of that. Let's move on to the point of this post–pediatricians. I love pediatricians. They are some of the nicest and most dedicated professionals I've ever met. I am particularly in awe of the many pediatric subspecialists who voluntarily underwent years of additional training without any significant income increase for their efforts. But I'm going to be real frank here and just tell it like it is.
Financially speaking, pediatricians are a lot like employee dentists. While medicine generally makes financial sense even if you have to borrow the entire cost of your education, it is getting to the point where that is not the case for dentistry. $500-600K in student loans for a career that might pay $120K? Not wise. As the big squeeze between dropping salaries and rising tuition affects medicine more and more, pediatricians, as the lowest paid physicians, are going to get hit first. This is not surprising to anyone who steps back and takes an objective look at the finances. In fact, I know of at least one physician-focused financial advisory firm who deliberately avoids picking up new pediatrician clients. They know the money isn't there.
Life Isn't Fair
I tell my kids repeatedly- “Life isn't fair.” They don't always get what I'm saying. They usually take it as “I'm getting hosed because life isn't fair,” but at least half the time I use that phrase, I'm indicating something else entirely — “Life isn't fair to your benefit, the more you can do to make it even more unfair, the better off you'll be, and your mother and I are working very hard to keep life unfair for your benefit.” Don't take this the wrong way.
I'm not advocating racism or anything like that. What I am advocating is a worldview where one realizes that not only is life not fair, but it isn't going to be fair any time soon and in reality, when you really think about it, you don't WANT life to be 100% fair in the way most kids think about it–i.e. equality of outcome. Sure, we want everyone to have equal opportunity and should work toward that, but it isn't going to happen anytime soon. Especially with all of us parents trying to give our kids more than their equal share of opportunity.
Choice and Consequences
If you're a pediatrician sitting in your office at 7 pm finishing charts and wondering why that orthopedist makes four times what you do, it may be worthwhile considering a few points. First, that orthopedist had to bust his butt a lot more than you did to get into an ortho residency. Second, he spent 2-3 more years in training than you did. Third, he gets sued more frequently than you do. Fourth, there was no one keeping you from going into orthopedics. Presumably, you chose pediatrics because you love it and I think it is a very rare medical student who isn't aware that most pediatricians make less than most orthopedic surgeons. You get to make the choices in your life, but they are connected to the consequences like two ends of a stick. You can't help but pick up the far end of that stick once you pick up the near one. You can't divorce the consequences from the choices.
How Much Do Pediatricians Make?
Yes, you can earn more than $200k. A lot of relatively low-income professionals such as pediatricians, family docs, dentists, or advance practice clinicians (hopefully that's still the correct term by the time this post runs) have a bit of a defeatist, nihilistic attitude toward their income. “I'll never make more than $200K. Wo is me!” I would submit these two counterpoints:
First, I have always been impressed that the intraspecialty income differences are so dramatic compared to the interspecialty income differences. In the 2017 Medscape Physician Compensation Report, it lists the average orthopedic income as $489K and the average pediatrician income as $202K. That's a pretty big difference, but that's as big as it gets, and there's almost no difference between an ophthalmologist and an oncologist. But I am far more impressed that some orthopedists make $1.3 Million and some make $130K. That's a HUGE range.
So if you're a pediatrician who thinks he'll “never make $200K,” the question you should be asking isn't why orthopedists get paid so much more than you, but why some pediatricians make so much more than you and what you can do to be like them. I mean, Medscape says the average pediatrician salary is $202K. Why can't you be at least average again? That doesn't seem like a big hurdle to me. I mean, you might need a different job, you might need to move, and you might have to work a little harder, but an average salary certainly seems doable. As an example, when I mentioned I was writing this post, a pediatrician sent me this:
Saw you are writing a post about the wealthy pediatrician…a lot don't think it's possible – they are WRONG. I am a pediatrician. 3 years out of residency. Partner in a group of 12 pediatricians in midwest. Made a $490K salary last year and more this year. It's possible and I have a fantastic practice and lifestyle (work 3.5 days per week) and call q11. The most important things that have aided in my success: be in private practice, become a partner, own your building, have mid-levels to help see sick patients, market yourself to healthy patients with good insurance (I do a few prenatal classes at our big hospital per year and get tons of new patients from there – all good parents with good insurance), monitor your sick:well ratio, do procedures.
This doc might be an outlier, but why can't you be an outlier too? (And yes, I asked for a guest post, but that paragraph may be all you get.)
Second, your decision to put bread on your table by working as a pediatrician is not irrevocable. Now, I'm not talking about entering the match and trying to get into an orthopedics residency. I'm talking about changing careers entirely, preferably gradually. I had a conversation with an emergency doc recently who was working 16 nights a month and felt like she was locked into that in order to maintain her family's lifestyle. I pointed out that she was intelligent, hard-working, and apparently willing to endure a great deal of pain in her career and that if she applied those same characteristics to ANY OTHER FIELD such as business, finance, real estate, selling insurance, giving financial advice, etc that she could eventually be making as much or more than she is making shepherding drunks around the ED at 3 am.
The less you make, the more likely it is that you can boost your income or make more doing something else. You don't even have to quit pediatrics. While medicine might not be a great business, it will always remain a great profession and even a calling. I obviously don't have to see patients anymore, and yet I do. Why? Because being a doctor is awesome. Not quite awesome enough to do it for free, but certainly still awesome enough to do part-time if you choose to support your family in another way.
I want YOU to be a pediatrician!
Uncle Sam Loves Pediatricians
Here's another point that most people don't get until they've been there. I always chuckle when I get an email from residents asking what they can do to decrease their tax burden. They have no idea what is coming in a year or two when they'll be paying their entire resident salary plus in taxes. It is the same way for some pediatricians. They see that orthopedist surgeon making $489K and look at their measly $202K salary and assume the orthopedist is making 2 1/2 times as much as them.
In reality, once you start applying that progressive tax code and realize the pediatrician may be paying 24% of $200K ($48K) in taxes and the orthopedist is paying 34% of $489K ($171K) in taxes, the difference still exists, but isn't nearly as big as you might think, especially when you consider the orthopedist's student loans compounded for an extra 3 years during training. To make matters worse, the orthopedist will need to save a larger percentage of his take-home income to maintain his lifestyle because his tax burden in retirement will be larger. And she'll have to do it with less assistance from tax-protected retirement accounts. Bottom line–you always come out ahead with a higher income, but it isn't as far ahead as you might imagine.
You Can Still Be Wealthy as a Pediatrician
But at the end of the day, whether the pediatrician is making a salary of $150K, $180K, $200K, or $230K, that is still PLENTY of money to pay off your student loans, eventually move into your dream house, and retire early as a multi-millionaire. 20% of $150K = $30K. $30K compounded at 5% real for 30 years = $2 Million. $2 Million = $80K in retirement spending + $30K in Social Security = a very comfortable retirement.
You might be worse off than 95% of the house of medicine, but you're still better off than 95% of the US population and 99.5% of the world population. It isn't going to be as easy for you as it might have been in another specialty or if you had married another high-income professional or if you had received a big inheritance, but it is still certainly well within your grasp to be very financially successful.
What do you think? What would you say to your classmates who went into pediatrics? If you're a pediatrician, what do you have to say about finances to the rest of the house of medicine? Can a pediatrician sole earner become a multi-millionaire? Why or why not? Are you a wealthy pediatrician? Tell us your story. Comment below!
I agree with your post. You can maximize income as a pediatrician. I am 4.5 years out of my pediatric subspecialty fellowship and we are nearing a 2 comma net worth. Applying principles like living way below your means and saving a large portion of your income can still allow you to have a great house, take cool vacations, and support your favorite charities. When I was deciding whether to do a fellowship or not, I found many straight pediatrics jobs that were offering mid 200k’s for 3-4 days of work a week.
These jobs aren’t usually on the coasts and will require you to go to deliveries (procedures) and do things in your office–but this helps keep variety in your practice as well!
– Doubtful
The same personal finance principles of investing and personal finance apply to pediatricians and spine surgeons. The scale (i.e. income) is just different, although as the forum poster showed, it is possible to make specialist money as a pediatrician.
By applying simple investment principles (minimize fees, maximize retirement accounts, avoid trading), pediatricians could potentially end up with as much, or more, money than a specialist who fritters away his salary advantage through excessive trading and high-expense ratio mutual funds.
Agreed.
Agreed. Almost all physicians make a high income. If they don’t, they could make a few simple changes to get there. Even at lower ranges of physician incomes, one can amass significant wealth with diligent saving and investing.
I have colleagues in my specialty who complain about the call and the long hours and low pay. I’m scratching my head. I have short hours and no call. My income has always been in the top 10%. And I’m not the hardest working or the smartest by any means. I’m sure there is luck involved but to some extent, we create our own reality.
A defeatist attitude is never helpful. “We’ll never…..” just isn’t productive. Ask “how could we….” and you might find a road to a peds specialty or a side gig etc.
There are so many factors that determine wages in a given specialty, it’s mind boggling. In psychiatry, you sometimes get paid more for inpatient vs. outpatient, call vs. no call, medical directorship vs. not, longevity, and sometimes get a premium for sub-specialization (Child Psych always seemed to pay more).
Then you have to personal factors: excellence, leadership, self-advocacy, personality, and types of experience.
You also have employed vs. independent, employer factors as government and academic jobs sometimes pay less, though not always. Then there is location and regional supply differences.
By sticking to half or full time inpatient, taking call, and being medical director, as well as being willing to drive up to an hour and taking any offer from people who were desperate, I stayed in the top 5-10% of wages in psychiatry.
But to retire when I want and make up for financial mistakes, I have chosen to do weekends and half4 years of the holidays for about a decade and ramped it up to 2 a month for the last four or five years. This moonlighting now provides an additional $150,000 in income and stokes a SEP IRA with $30,000 a year.
Like most things in life, its all about hard work, doing more than average, saving more, and some luck.
I can’t believe the amount of money psychiatrists on this blog make. I’ve always thought it was a low paying specialty but it seems like it’s actually the easiest specialty to work for yourself and some people are killing it.
Psych seems like a great option for someone with the entrepreneurial spirit. This one Edson on the forums says they cleared 700k doing inpatient work.
Look for Lithiums posts on the forum
Psych is “low paying” but a lot of jobs are M-F with no nights or weekends. So if you take a 9-5 M-F job for 200k you can moonlight nights and weekends or open a part time private practice that’s out of network. Few specialties in medicine have so many jobs without call. It’s still hard to make ortho or neurosurgery money but most psychiatrists also have a lot more time off than surgeons, can realistically have longer careers with more part time options as they get older, lower malpractice etc.
Agree with Strider, have been super impressed with Psych people on here. I also had no clue there was such an ability to do more if you wanted and the large benefits from it. That kind of possibility, in any field, really would fit my personality.
As a proceduralist you can get bogged down if you’re busy with follow ups, etc…depending on your typical follow up period, or simply run out of demand. Not as easy to go do surgeries on the weekend somewhere and leave.
I would seriously consider these kinds of gigs if I was choosing today. More control=better.
The other great thing about blogs like this, hopefully medical professionals can see these issues prior to their desicions. I’m often very upfront that $$$ made a significant aspect of specialty choice. And in 2009 when I started medical school, was on a rural family practice. Luckily, despite knowing little about finances, shadowing FPs and their struggles at the time to make simple 6 figures salaries made me realize that I would be very unhappy if i was like the peds doc above – feeling incompensated for my years of sacrifice & training.
If money doesn’t matter to you, or you are free from massive student loans, by all means pick a specialty without a thought about income. But for most medical students, I encourage salary to be a factor – money shouldn’t be a taboo topic in medicine!
As a current student, we always talk about “what we want to do” and it blows my mind how many people want to do pediatrics, family medicine, or infectious disease. The advice handed down is always “do what you love” but it’s hard for me to believe that there is that big of a difference between the specialties. I feel like the general idea of medicine is similar, and after 10 years of being in practice everything kinda gets boring and life happiness comes down to family, hobbies, and financial freedom.
I’m basically drawing a line in the sand on the bottom 1/3 of specialties and not even considering them except for pm&r, but I believe with a pain fellowship they can still do well.
I’d be careful doing that. I had my own line, but it had nothing to do with salary. I had some weird idea in my head about some doctors being real doctors and some doctors not being real doctors. I threw stuff like Ophtho, Rads, and Anesthesia into that second category. In retrospect, I think I would have really liked anesthesia (although not as much as EM.) It should have been my second choice instead of OB/GYN. But I didn’t even consider it. So I say, take a look at everything. You might be surprised what you end up doing.
A great reply to a great comment in a great post. When I started medical School, I can’t say I didn’t want to be an anesthesiologist – I didn’t really know that anesthesiology existed. And my 20 minute Anesthesia rotation as a third-year student did little to enlighten me. Fortunately, a classmate was obsessed about Anesthesia, and he encouraged me to look into it. 25 years later, I’m very glad he did.
Your comment about the odd similarity between EM and Anesthesia is spot on. I counsel my students that the choice between the two specialties boils down to whether you find addicts and drunks interesting company or not. 🙂
Very interesting response. I think I would really enjoy anesthesia but the doom and gloom from practicing anesthesiologists definitely scares me. There is basically an entire forum on SDN dedicated to stearing students away from anesthesia. I know listening to people whine on the internet isn’t a good way to choose a specialty though.
For sure. It was the same with all of medicine in the 1990s when I was an undergraduate student. Every one said medicine now sucks. Whiners tend to be vocal and the golden age is always 10 years before you started.
Strider, if you think you might like Anesthesia or any other field, you should check it out. I’ve loved my career. The key, I think, is you have to have the right personality. Which is basically the same as the EM personality. Ignore the whiners, for the most part.
You and I are the same age, and I had some really negative experiences shadowing a GP in high school, which led me to dentistry. I ended up doing better than I have any right to for how much fun I (usually) have doing my very specialized procedure, but it really is a shame that a few bitter people can steer things away from what could have been a lot of fun.
I also thought a lot of the pre-med guys were jerks, and the dentists were always up for a beer, so that worked out cool too.
Well, pre-meds are jerks. You definitely got that much 100% right. Stiff competition does bad things to people some times. Glad to hear of your success!
Fair enough.
Interesting advice. You should get a “like function” so people could acknowledge comment replies without actually saying things back.
3 comments, each unrelated:
1. There are definite benefits to being in a specialty that flies under the radar (“some doctors not being real doctors. I threw (out) stuff like Ophtho, Rads, and Anesthesia”)–I’ll leave it at that, I’d prefer my specialty to stay under the radar.
2. My response to my kids when they say something is not fair: “You’re right, it’s not fair, you have way more than you deserve!”
3. My mom’s comment to me and my siblings growing up: “the root of unhappiness is comparison.”
When I decided to leave my general surgery residency spot, and start my ophthalmology residency, the other residents joked “you are not going to be a real doctor anymore you eye dentist”. And to be honest, at that time, it did bother me that I would no longer be knee deep in the “blood and guts”. One of my vascular surgery attending a told my fellow residents “laugh now but he’ll have the last laugh when he starts his career”. Twenty years later, switching to ophthalmology has been the best career choice I could ever make. Your ideas about what you want out of life are a lot different at age 27 vs age 50
Ha, goes to show what surgeons know 🙂
You thought “opthos” are not real doctors? Isn’t the eye one of the most complicated organs (after the brain) in terms of what can go wrong and need operation?
Yea, I was pretty stupid huh? I could list 20 other specialties I didn’t consider real docs too.
Agree with WCI here. Salary should be a factor but not so much that you’re ruling out things. You’ll be much happier doing something you love, because all specialties have the mundane things that will be 75% or more of your practice and you should still like those things. Or have a life of unhappiness. And no, all medicine is NOT the same.
Considering the amount of time you will spend working, if you do not really enjoy (won’t always love, let’s be real) what you are doing, you won’t last. As others have said, your working income is typically your biggest asset and if you burn out early, then that will be the biggest determinant in your finances. ED MD’s as WCI can tell you, have great earning potential, but also suffer from high rates of burnout. Anesthesia is handsomely rewarded but is very high-risk with huge liability potential. I did a fellowship in infectious diseases not to make more money than an internist, but to do a job that I would like much more than being a hospitalist. One of the best decisions I ever made for my long-term work satisfaction.
Longevity matters far more than salary in my opinion. Better to do Peds for 30 years than burn out of ortho in 10. Uncle Sam rewards lower earning for more years than higher earning in fewer years.
My line was not based solely on what I enjoyed and could see myself doing for 20-40 years. It was also trying to decipher which of the fields had the negatives that were least likely to drive me crazy.
I didn’t have a calling — it was a process of elimination to find what fit me. There are other fields I would have enjoyed the positives, but the negatives of those may have driven me out faster. Of course, I didn’t have real experience in my chosen field (peds EM) until my 2nd year of peds residency. I had almost no real exposure to it before then.
I think its totally rational to rule things out based on salary. It’d be irrational not too. At what point is the line? Would you do x specialty for 25k a year? Of course not, so it does matter its just the degree.
As lots of us have admitted years later, there are probably several fields we all would be totally happy doing and dont necessarily believe in only one thing meaning everything, etc….I could be equally/more happy in at least 5 other specialties, everybody does something interesting.
There isnt enough time or opportunity to see all specialties, and financial reasons are just as pragmatic as any other pro/con, but will have better return overall than “passion” or other meaningless reasons for/against something.
What I would say to someone even before getting into medical school thinking about primary care (and the financial ramifications) can be found here https://thephysicianphilosopher.com/2017/12/17/go-medical-school/
The opportunity cost for most pediatric residencies compared to specialist residencies is substantial, particularly considering that taking that way to fellowship is even more costly.
However, I think your point about lost perspective is spot on. People lost site of the fact that 150k or 200k is a substantial amount of money. Now if your debt to income ratio is > 2 that becomes painful quickly. In that situation they should probably do PSLF.
The thing I find ironic is that many get upset about the financial aspect of the decision later, but didn’t decide to go into peds for money. Seems strange to determine your happiness based on finances later when your initial decision was based on a love for the field they were pursuing. The metric was changed and then disappointment was had.
What I would say to someone even before getting into medical school thinking about primary care (and the financial ramifications) can be found on my most recent post from this weekend.
The opportunity cost for most pediatric residencies compared to specialist residencies is substantial, particularly considering that taking that way to fellowship is even more costly.
However, I think your point about lost perspective is spot on. People lost site of the fact that 150k or 200k is a substantial amount of money. Now if your debt to income ratio is > 2 that becomes painful quickly. In that situation they should probably do PSLF.
The thing I find ironic is that many get upset about the financial aspect of the decision later, but didn’t decide to go into peds for money. Seems strange to determine your happiness based on finances later when your initial decision was based on a love for the field they were pursuing. The metric was changed and then disappointment was had.
Agreed. It’s kind of like being a public defender instead of going into big law and then complaining about the income. If you choose to be a part-time academic pediatrician with a 95% Medicaid population, you’re probably not going to be in the top quartile of pay.
Exactly.
Left a comment before, but didn’t go through, apologies if it duplicates!
My thoughts on entering the medical field and choosing different specialities from a financial aspect can be found on my most recent post from this weekend on “Should I go to medical school?”
That said, I think that most people enter medicine with altruistic ideas and then later on focus on the financial ramifications of their decisions. I find it interesting that people pursue a field for “the love of it” and then later on try to gauge their joy/happiness based on the “money.” What they really need to ask is, “Did I make the best decision for me that I could have with the information at the time?” No one can go back in a time machine and make the decision again. It seems strange to make the decision on passion and then to gauge it later based on finances.
I also agree that people lose site of 150k to 200k being a lot of money. Now, if your debt to income ratio >2, that becomes painful quickly. That said, PSLF exists still for those already through the process. I think you are spot on in people losing perspective. Additionally, income does not have to be earned through medicine. There are many “side hustles” as passive income MD would point out.
A rarely mentioned aspect of the ACA was a 2 year period of Medicare parity for Medicaid payments. For those 2 years Medicaid was reimbursed at 100% of Medicare rates. In pediatrics, where a high percentage (and growing) of patients are covered via state Medicaid, this was a financial boon. Since the parity expired, Medicaid rates have returned to previous levels with some states reimbursing around 38% of the Medicare rate! Some states have decided to prioritize Medicaid reimbursement (North Dakota, Alaska etc) and pediatric salaries there are very high. Other states don’t reimburse Medicaid well (Rhode Island, New Jersey). This link from the Kaiser Family Foundation’s website shows each state (https://www.kff.org/medicaid/state-indicator/medicaid-to-medicare-fee-index/?currentTimeframe=0&sortModel=%7B“colId”:”All%20Services”,”sort”:”desc”%7D). Listen closely as a pediatrician when politicians talk about cutting Medicaid expenditures for their state because that directly translates to reduced pediatrician salaries. Private practice pediatricians can sometimes choose to see less Medicaid but pediatric subspecialists usually cannot.
Some posters have rightly criticized me for failing to point the issue you’re pointing out right here. Tons of peds patients are Medicaid/CHIP and those don’t tend to pay very well. That is certainly a big reason for the low incomes seen among pediatricians.
Family doc here, worked part time most of my 32 year career, so never over $200,000. Always maxed 403b, but no other retirement accounts. Will retire soon with “enough” (which means enough even when market corrects). So, it can be done.
However, part of my reason for retiring earlier than I planned is the “it’s not fair” feeling. I was turning somewhat whiny about that, so it seemed the right time to go. Why does an internal medicine doc in same organization get more per RVU than family docs and Peds? All have 3 year residencies. And why do the senior administrators make multiples of that? I do understand the factors you mention, but still! I would like for good primary care docs to exist when I need medical care in my aging years, but not sure that is going to happen.
Finishing fam med residency in 5 mths and accepting new pts! Lol 😉
Will happily care for u!
Do tell which of the physician advisory firms wouldn’t want me since I am Peds. That made me laugh. Thanks!
You don’t need one!
If a doc is interested enough in finance to find WCI I would submit that neither does she. As a pediatrician realizing that learning about finance can be a very lucrative hobby is especially important as we have less income to overcome our errors. And I still want to know that firm, WCI.
No dice. I don’t kiss and tell.
Knew u wouldn’t. But had to try.
It sure isn’t ours.
As you well know everyone’s offended by something these days. As i’d suspect most readers here recognize your a 10%er! Buy that I mean your driven to maximize your financial well being & are self motivated, unlike most. I’ve owned 3 income streams in my lifetime and lost it all to health costs and concerns. I recall one of your earlier OP’s claiming a tax rate near 10 %! MY HATS off to you Dr. JimDahle! As one guy I admire says, Thx for what you do and best wishes.
Well, my tax rate is nowhere near 10% now. I expect 34% this year.
I am also guilty of choosing a low paying field. Possibly even worse than pediatrics!
Academic nephrology… Doing research…
I understand the sentiment by the pediatrician who posted, but it is also true that “decisions have consequences”.
So far, my husband (who is also a physician, but with a better income and no loans) and I have been managing financially, although we have made our fair share of mistakes.
Regardless, this website contains a ton of useful information and has probably saved us thousands of dollars, and we are only 1.5 years out of our training. We recently reached a net worth of $100,000 jointly, and if we consider our finances separately, I recently obtained a positive net worth! Take that, student loans!
I don’t agree with several of the opinions posted on this website. If every M.D. took the attitude of WCI or Physician on FIRE, we would not have any primary care docs, pediatricians or researchers. Needless to say, the field of medicine would be in trouble. But, I accept I have things to learn from people with the attitudes of WCI and Physician on FIRE, and so I am grateful that they are sharing their opinions and knowledge. I will not be joining you rock climbing in some exotic location, but it’s all good!
“If every M.D. took the attitude of WCI or Physician on FIRE, we would not have any primary care docs, pediatricians or researchers.” Doubtful. Pay in those fields would likely rise if suddenly everyone decided the remuneration didn’t justify the work and practices or employers decided they really needed them. But before pay rose, you’d most likely just have an influx of foreign trained physicians fill the training spots and jobs as they take advantage of geographic arbitrage, having earned their medical degree somewhere cheap, then coming to build a better lives for themselves and their families here in the US (which, is pretty much what happens currently, just take a gander at the resident list at any state U or lower ranked program in those fields). Or they’d be further replaced by mid-levels, where people with shorter, less costly training routes are’t as put off by the lower pay as it cost them less to get there.
It’s a big world out there, Nephron116, and while it may not make sense financially for someone growing up in the US to spend a bunch of borrowed money to go to a US undergrad and medical school (especially if private or in a high COL area) to choose a low paying medical career path, there are plenty of smart people out there who grew up elsewhere for whom such a career would be an amazing opportunity. That’s what makes personal finance (and more broadly, economics) so interesting as the answer to so many questions in either realm is, “It depends”.
Seriously? Some of us “cheaply educated, foreign trained” invaders were born and raised within the confines of the 48. Clearly your opinion is not factually based since school isn’t cheap, IMGs are less likely to fill training spots than US medical grads, and people still do practice the kind of medicine they want. Pure economics doesn’t apply here. You did get one thing right, though. At the rate my puppy mill school graduates docs, it won’t take but a generation to outnumber you.
Not sure what triggered your comment about invaders and puppy mills. The comment you’re replying too doesn’t seem to say either of those things nor even talk disparagingly toward IMG/FMGs.
Probably will be a lot less on a percentage basis of those specialties in the future as midlevels move up the chain. It just makes sense from an economic and acuity standpoint that doctors move to more complexity and simpler stuff is done by the lowest, most efficient form that can handle it.
Doesnt make it great or the best case, but its likely happening all the same given the global pressures on medicine.
We are a non-physician couple who make $200k (in a hcol area). Obviously there are parts of WCI posts that will never apply to us. But I have learned many valuable things over the years and will continue to follow in the future.
Yes and no.
Once the speciality is chosen, sometimes there are limits to income, but it almost entirely comes down to geographic arbitrage, with employment status not always a variable.
There are not many places you can do peds oncology, and most are at children’s hospitals, and salaries are artificially depressed.
However there are numerous places you can do gen peds and make a killing without working a zillion hours. If you choose to work in the NE making $150k and want a “doctor” lifestyle, you will feel poor, and frankly WILL be poor by the standards you are chasing.
Plenty of gen peds people make more than me (academic PEM), but that was a choice I made coming out of training for non-salary reasons. I could’ve and still may go elsewhere and make 25-50% more.
Yet our net worth will probably be 7 figures around age 40-41. Low by the standards on this blog, but good compared to other pediatricians.
I am working on rectifying the income issue though. 🙂
I’m not sure what standard you’re seeing or using, but I assure you that the vast majority of the readers of this blog are not millionaires at 40.
Perhaps I should clarify — low by the standards of many of those readers who are active on the forums, where I interact more frequently compared to the readers who comment on your posts.
Also I’ve always had a working spouse — she’s not a physician and is never going to make $200k. She currently is part-time and her take-home pay (after deductions) barely covers chlidcare. During my fellowship we were probably losing money while she was part-time work and part-time school.
However right now at least her income does contribute to our overall wealth because of her retirement plan contributions and because we can fund a Roth for her.
My student loan burden was far less than many others, but even if I had the median debt (from my graduation year) that would only have delayed me a few years at most.
One thing I think people need to remember — a lot of the people in their mid 30’s-40’s who are doing well now are benefiting from years of a bull market. The same person graduating now will see an increase in the market in their lifetime, but they aren’t going to be plowing money in right when the market takes off.
I started as an attending in Jan 2013 — 5 years of maxing 401k/403b/Backdoor Roth (x2) looks a lot better now because of the timing, and has very little to do with any great strategy I had. The DJIA is almost exactly twice its value now compared to when I finished training. Had I finished fellowship in 2007 and looked at my investments 5 years later, I would have felt quite differently.
Even if I am ahead of my peers, I do not credit myself for any special strategy, because there’s nothing special about what I’m doing.
The readers who are a few years behind need to keep that in mind — set it and forget it. Don’t be discouraged by peers who are ahead of you, such as the pediatrician making $400k that you mention in your post.
Even the commenters are a tiny subsection of the readers. I just don’t want a casual reader reading through here thinking they’re way below average when in fact, just the fact that they’re even reading here probably means they’re doing okay or soon will be.
And be careful what you say about your spouse. I didn’t think mine would ever make $200K and here she is making more than many of the readers on this site.
I shouldn’t have to clarify every comment, but I will.
My wife is very unlikely to ever make $200k/year in her current field. She is not looking to switch fields completely and enter something that would substantially increase her pay — she’s happy working part-time, 3-days a week, no evenings, no nights, no weekends, no holidays, no home call, no after hours phone calls.
Sure, if my blog starts making 6-7 figures and she becomes co-owner/employee and is helping run it that may change, but that’s not happening anytime soon.
I recognize the the average reader and average commenter are not the same. I am behind the average commenter (on the forum), however I use it to learn and to see the possibilities. The average reader ideally would do the same — see the comments and not just get depressed, but figure out how to make a change.
It causes *me* pangs to see people my age or a few years older with 5x my net worth, but the second I turn off the screen I go back to focusing on what I can do with *my* life and not theirs.
On the flip side, reading about poor general pediatricians probably makes all the surgeons reading on here feel great. 🙂
Actually one of the richest docs I know is a pediatrician who then founded a neonatology practice and later sold it.
I agree, there is always someone both richer and poorer than you. Focusing on them isn’t very helpful.
Your wife doesn’t need earned income for you to fund a Roth for her (unclear from your comment if you were aware of this).
This post reminded me of two things:
1) Intra-specialty pay variation is huge. We are a a fee for service practice and even within our group there is huge variation in how much people make. Most of it comes down to how much attention people pay to billing properly for what they do (we bill as individuals), whether they do procedures themselves or refer it to someone else to do, and whether they come in and do things in the “unsocial” hours which pays huge premiums or instead use a strategy to deflect that work until daytime. This “fairness” is the good part of fee for service versus salary and the variation is also why we still don’t group bill.
2) Why I always round down what I make when talking with colleagues. It is human nature for many to feel that they work as hard or harder than others regardless of the nuances of reality. Stealth wealth is important even when dealing with others in a high income job.
I had an interesting observation when I was early on in my military career. The densest population of 0-6/COL was in the department of pediatrics (family medicine close as well). As an 0-6 pediatrician the pay wasn’t bad, decent portion of income non-taxable, the benefits, and then just hang on long enough for a full 0-6 retirement and then keep working as a pediatrician on the outside…many of which I know don’t even work full time after leaving the military because their civilian part-time salary plus collecting their pension (and having little to no debt all those years), put them in a fairly strategic financial situation. Keeping people long enough to 0-6 changed quite a bit after 9/11.
For sure, the finances of staying for 20 are much better for primary care than a specialist.
I suspect that one thing that contributes to the “it’s not fair” feeling among some of your readers and maybe is a bit under-acknowledged on both sides is differences in family support and stability. It’s very clear that you and your wife have always basically been on the same team re financial goals. This is not the case for many doctors I know in real life. I can’t count how many would love to move to places with better-paying jobs or do locums or go back to fellowship or whatever, but they can’t because their spouses will not hear of it.
I have no solution, but having been on both sides I can say that having a partner with the same vision as you (or failing that staying single) makes this whole game so much easier.
As a pediatric subspecialist, who makes less than the average pediatrician salary, I thought this was a great post. I am actively working to improve my work situation/income and looking to do some things on the side to supplement. Thanks for this post!
Glad someone liked it!
It’s important not to lose site of job satisfaction. It’s not all about the money sometimes. I chose an academic job at a big university making $250k over a private place making $475k. If your goal is to keep chasing big money, you will never be satisfied with what you have. You will have a Toyota Camry instead of a BMW but you won’t miss it. Plus, those high paying private jobs will always be there if you feel you need it.
I’m an employed pediatrician in a large multispecialty group. <10% of my pedi colleagues locally work full time, but any pediatricians working full time (5 days/week in our group) are making 220k on day 1, established docs obviously making more. No nights, 1 weekend/month. My FP and IM colleagues are dealing with chronic back pain, multiple comorbidities, etc all day long and I'm doing much more preventative management and bread and butter sick care with the occasional odd pathology (kids tend to be healthy) so I understand the $ differential. I live far enough inland to get a lower cost of living but my coastal colleagues making same income do complain about lack of spending power. Recently interviewed a private practice doc looking for a change who was pulling 450k in a rural area so I know that's possible for a hard working pediatrician. I did (somewhat naively) choose peds because it was my favorite: had high board scores, top 3% of my med school class, etc. Coastal peds residencies are pretty competitive though so those credentials helped with the match.
Saving 20%/year (spouse is not a high income professional) and we should be fine, even though I started with a nearly 1:1 debt:income ratio. We've found that hanging out with folks who work at the local university and are in our income brackets and not high-paying medical specialists takes away "keeping up with the Jones'" temptations 🙂
Amazing how much more can be made in the fly-over states in some situations. Too bad physician income doesn’t correlate with housing costs. The Bay Area docs would be killing it.
Jim,
I love your work as WCI, but I have to say I don’t think you have any idea what you are talking about when it comes to incomes of dentists.
I know most don’t make $120K, but I’ve met enough new associates whose guaranteed salary was $120K that I thought it was a fair figure to use. Most pediatricians don’t make $120K either.
The ADA data shows that the median private practice generalist income was $180K ($145K employees) and the median private practice specialist income was $298K ($170K employees). If the ADA can’t get it right, I guess I won’t feel badly about not being able to either.
http://www.ada.org/en/science-research/health-policy-institute/data-center/dental-practice
Don’t feel too bad. There are two problems with income stats in dentistry. The first is that there just aren’t that many dentists (compared to physicians, for example). This means you are starting with a much smaller potential pool of data. The response rate to these surveys is such that in the end the survey you referred to by the ADA, for example, had a total of around 100 responses from oral surgeons and orthodontists. 100 total. Think about how few that really is. And they say in the methodology section they had to do statistical weighting because they oversampled specialists relative to general dentists. So the sample size is just too small. The second problem is that unlike most MDs, most DDSs own their own businesses. This makes it even less likely the surveys will get good info. It’s one thing to disclose (even anonymously) income when you are reporting the pay you receive from a large hospital or corporate entity. It’s different when you are disclosing financial details about your own business. I’m a paranoid business owner. Why would I ever take the time to respond to an ADA survey and why would I ever put down on paper details about my business finances? For employed physicians the story is different. There are many large hospitals and corporate entities competing for physicians. There are headhunters and good data is crucial to the recruitment of physicians. Because there is a demand for good income data on physicians and there are many more employed physicians out there, the data is much better. Nothing like that exists in dentistry.
So don’t feel too bad. However, even using the crappy data from the ADA, it’s obvious most dentists don’t make 120K. So your overall appraisal of the situation of the average dentists falls far from the mark and that–in addition to my personal experience in dentistry–led me to say you don’t know much about dentist finances. I stand by that assertion. But like you said, there isn’t much good data out there (no MGMA, for example) so don’t feel bad.
You said regarding dentistry: “$500-600K in student loans for a career that might pay $120K? Not wise.”
Few dentists graduate with 500k + in debt. Some perhaps, but not many. Some dentists START out at 120k, true. But these dentists are working and earning a decent wage while their physician counterparts are toiling away in a residency earning 50k. You of all people should see the opportunity cost there. By the time the MD finishes a four year residency, the general dentist who has been out for four years is no longer earning only 120k.
Anyway, my point is that you seem dismissive of dentists and that’s odd since your web site at times seems to try to be inclusive. Maybe we just need our own version of WCI?
I think you’re misunderstanding what I wrote. Surely you agree a dentist might get paid $120K, right? Would you like me to introduce you to some making $120K? I don’t recall ever stating the average dentist makes $120K. I have no idea why you feel like I’m dismissing dentists by discussing their incomes, but you’re in good company. I’ve pissed off all the pediatricians today too.
The ADA info is flawed due to insufficient data and the limited real world applicability of the methodology used. In dentistry we don’t have the same kinds of systems you do in medicine in terms of physician recruitment and all that entails in terms of physician income data.
When comparing a general dentist and a pediatrician keep in mind the general dentist will have most likely spent no time doing a residency. Also, they might start at 120k but their incomes will increase significantly over time. So there are some major differences.
Most dentists I know earn between 300k-1M.
Wish I could say the same. I assure you I run into plenty with mid 100s kind of income. They’re generally employees of the national companies to be fair.
You must live in Utah;) Even so, there are many successful dentists there as well. I know a few of them. Still, starting at 120k is one thing. Remaining there for a long period of time is quite another. Conservatively, I think general dentists earn at least a little more than what the ADA says–maybe 200k+. Specialists nationally are around 400+.
So I have you up to “mid-100s” now. That’s progress. I agree with you that if you have to take out 500k in loans to get a job that pays 120k you have not been wise in your decision making. If you are intelligent enough to get into medical or dental school then you ought to have virtually no debt from undergrad. It isn’t that difficult to get 4 years of tuition paid for at a decent state school. Attend the least expensive medical/dental school and then make reasonably good financial decisions from there–with the help of a finance guru like WCI. Specializing is a good idea. Owning your own business is usually a good idea as well.
Wow! I just found a dozen comments on this post in the trash folder. I wonder what triggered that. This was one of them.
My point isn’t that all dentists make $120K. It’s that some dentists do. So you started talking about averages. So I went to the only source I know of that gives averages and provided that. But if you want to use your multi-anecdotal information, knock yourself out. If you have some sort of an objective survey supporting your assertions, I’d be a little more impressed with it.
But it doesn’t really affect the post. The point is that whether you’re a pediatrician or a dentist or anything else, realize that there are people with your training that make a lot more than you. Do what they do and you’ll make more too.
Last reply on this:
You call my evidence anecdotal. You are correct. The ADA survey is also anecdotal. For example, they include responses from 100 orthodontists. I personally know close to that many. So my numbers are pretty much in the same league as the ADA. My point is that we don’t have the same kind of data in dentistry as you do in medicine when it comes to income data. For orthodontics there is better data out there from the J of Clinical Orthodontics, but the info is still fairly limited.
You seem to be basing your arguments on the experiences of dentists in Utah who choose to work at corporate offices. That’s a miiscule subset of the overall dentist population and it’s the group most likely to have the lowest incomes.
What has motivated me to respond is that on more than one occasion you have either implied or just come right out and said choosing dentistry is a foolish financial decision. I’m just here to say if you are interested in the wonderful profession of dentistry then the sky is the limit financially—as long as you are willing to work for it, which generally means owning your own business. Dentistry is definitely not as rewarding for those who don’t own their own practice.
Orthodontics is like the orthopedics of dentistry. If you’re struggling as an orthodontist, you have a spending problem, not an earning problem!
I agree that owning your practice is a very good idea in dentistry.
Not sure what you’re referring to about me saying dentistry is a foolish financial decision. What I do say (and say frequently) is running up $400-600K in debt for a job that may pay $120-200K may not be the best idea. I don’t think I’m nearly as hard on dentistry as I am on some other stuff- law and veterinary science in particular. At least a dentist can get a job (which is a real issue in law) and 20% of vets graduate owing over $200K for a job that pays less than $100K for half of vets. And as you mentioned, with similar incomes to pediatricians but a 3 year earlier start, even a general dentist may be coming out ahead of the average pediatrician.
Here’s another survey. Shows how much variation there is depending on the sample and methodology. It also show general dentists aren’t necessarily that far behind dental specialists. Check it out when you get bored.
http://www.cainwatters.com/wp-content/uploads/2016/08/CWA-How-Does-Your-Dental-Practice-Compare_2015-Digital-Edition_DISTF.pdf
Cain Watters is the Cadillac of dental CPA and financial planning. They are not going to have an associate dentist straight out of school as their client. Their clients, as you can see from the surveys, are dentist/business owners who can make 500k before debt service. Remember though that the 500k they are showing as profit is before any doctor expenses, including debt service on the million dollar practice loan to buy the practice.
I think the take away is be an orthodontist or an oral surgeon for a 50-100% increase in salary!
Othodds, thanks for injecting some humor on the thread! You’re adamant defense of ‘dentists make way more money than you think, and I know a whole bunch of them’ really settled a point…about what, exactly, I remain unsure. I’m sure that none of the ‘almost 100’ fellow ortho guys you know never inflated their income figures when discussing money with you, I mean, nobody ever tells fish stories when talking about dollars, right?
If I can inject some humor then that’s fantastic. The world could use more of it. My point is just to respond to Jim, who since I started following the WCI web site a couple months ago, has on more than one occasion indicated he thinks going into dentistry is not a good decision financially or that among the health professions dentistry is one of the least desirable in terms of financial rewards. In the current post Jim says “While medicine generally makes financial sense even if you have to borrow the entire cost of your education, it is getting to the point where that is not the case for dentistry.” That’s a strong statement to make. He assumed the ADA income numbers were accurate and also referred to other dentists he knows. I think his statement isn’t entirely accurate, and I wanted to point out what most dentists have been aware of for many years which is that the ADA income data is fatally flawed.
I only have lots of anecdotal information–most of which is not “water cooler” talk, but rather from being involved directly and indirectly in a number of practice transitions. I have business interests in dentistry which are outside of my own clinical practice that have been the source of most of this info. Anyway, I don’t have what I would call solid data, but neither does anyone else. So my point is without good data, maybe we shouldn’t assume dentists earn “x” amount. If we admit there isn’t good data, then we should probably resist the impulse to repeatedly use dentists as an example of a poor career decision. I know Dr Dahle lives in Utah which is notoriously one of the toughest markets in the nation for dentists. My guess is that most of his personal experience with dentists is with those who practice in that state.
Jim is awesome and has made a meaningful contribution to the financial lives of many through WCI. I just don’t think he necessarily has a good handle on the finances of dentistry. My primary purpose in posting on this blog thread was to help make sure it hit 100+ posts. If I can help some of you laugh while I’m at it, then all the better.
My calculations are definitely garbage in, garbage out. If dentists are really making $250K on average, then perhaps $500K in student loans isn’t as insane as it otherwise appears.
No it most definitely is insane Jim, when calculate the payback on 500K which is becoming more and more common to become a GP it doesn’t make a lot of financial sense. Go on DT and you will see.
I think as an Ortho you may be overestimating what dentist make. The average for ortho is much higher, but I’ve seen plenty of new grads come out with a guarantee of less than 100k with a 5 day week. Haven’t seen an ortho come out for less than 200 on a 4 day work week though. Specializing makes a big difference, as does owning your business.
ADA surveys are flawed. Sample size is tiny. Who really responds to a mailed survey anyway? Nobody I know.
I know many, many dentists who practice around the country. I don’t know a single one who took a job paying less than 100k for full time (unless it was an academic position). Zero.
Most dentists I know well are earning in the 300-500k range for general and 500k-1M for specialists. If there were headhunters in dentistry like there are in medicine who placed dentists in positions and reported the stats to an entity like MGMA then maybe we would have better numbers.
I would love to meet a dentist who took a job outside of academics or government for less than 100k. I can’t imagine why anyone would do that. Who are these people?
Specializing does make a difference. Owning your own business also helps. Most dentists do own their own business, by the way.
I have yet to meet a dentist who took a job outside of academia/government who earned less than 100k for full time work. Are you saying they earn only slightly more than a dental hygienist? Hygienists earn 40+ dollars per hour. Working full time they would earn around 80k.
I have met many dentists who earn over 1M per year. I never personally met one who made less than 100k outside of academia/government and I know a LOT of dentists from around the country.
Who are these “plenty of people” you know taking sub 100K jobs? They must be either desperate and in unique circumstances or seriously lacking any motivation.
Being an orthodontist I’m sure you are really nice in person, but you come off really harsh online. Simply saying that you don’t know anyone with a guaranteed salary of under 100k doesn’t make them not exist. In fact, saying that the dentist you know make 300-500 as a GP and 500-1M as a specialist shows that you don’t know many dentist that are just starting. Look through the dental classified adds to see what they are offering and they are not offering any GP close to 300K a year.
I agree that the end of the year they don’t make the 100k, but that’s the guaranteed amount. But, there are plenty that make 120-150 after bonuses are met etc. We do have a plenitude of Dentist here, which I’m sure brings down the average, but the corporations will hire many a new grad at 25% of production with a smaller guaranteed rate. I’m not saying that it won’t increase with time, but many GP’s come out working for the big companies and they can’t command a $2000 a day minimum like an ortho in Washington can. Shoot, even the ortho here can’t demand 2000 a day guaranteed.
So in conclusion, Yes, there are a lot of dentist that make 500K or more, but I wouldn’t go around promising dental students that they are going to be averaging that during their career, specialist or not. That sounds like a recipe for disaster.
Sorry, this is going longer than I planned. US Department of Labor puts average dentist income at $159,770 per year or $76.81 per hour, so we can keep going back and forth about who we know or don’t know, but unless some group comes out with a higher number, I’ll have to stick with what the surveys and government statistics shows.
US Department of Labor puts Dentist at $159,770 per year or $76.81 per hour. That is double what hygienists make on average, and we have twice as much post college education. Throw in a couple more years for residency and you can be way higher, but to say that most dentist make 300K to 1M depending on specialty and work ethic etc. is silly when every survey, study, website government agency puts the average general dentist under 200K.
Maybe we run in different circles, but I don’t know any GP that gets a guaranteed salary of 300K after graduation. Maybe an ortho in Washington or other high paying state, but even most specialist won’t have that guaranteed out in the southwest. They can grown into that range, but not come out of school and expect it to be there.
Anyways, there is nothing left to argue anymore. Being a dentist is great, money can be made, specializing helps guarantee that as does a good work ethic, but I still wouldn’t want to graduate dental school with 500K in loans unless I was Ortho or another specialist.
I don’t think we disagree all that much. I was probably not as clear as I could have been. I realize starting out dentists will earn less. All I’m saying is that using an extreme example of debt (500-600k) and applying it to a brand new dentist working as an employee making 100-120k isn’t a good way to determine whether dentistry as a whole is a wise choice for a career or not. The underlying principle of not biting off more debt than you can reasonably chew (dental pun intended) is one I think we can all agree on. You said “to say most dentist make 300k to 1M….is silly…” Well, that’s not actually what I said. What I said is that the range of incomes for MOST dentists I KNOW (so in my generally more favorable geographic area and in a little older demographic) is 300k-1M. I didn’t say this is a national average. In fact, elsewhere I said multiple times I believe the national average for general dentists is likely in the 200-250k range which is a little higher than the ADA numbers, but not much. I’m just a little dubious when the ADA says the average is 180k and that would likely be around the 20th percentile where I live.
I’m not arguing that a survey like the Cain/Watters survey is applicable to most dentists. What I’m getting at is that there is no good income survey of dentists. The ADA survey has it’s flaws and gives a low-ball estimate. Cain Watters is flawed and clearly it targets higher income dentists. We don’t have companies that specialize in getting good income numbers for dentists like they have in medicine. There is no equivalent to MGMA numbers, for example, in dentistry. Nobody knows with any degree of certainty how much an average general dentist or specialist earns in a given part of the country. You don’t hear people who are looking for jobs as a dentist saying “just refer to the latest ADA income survey to get an idea of what is reasonable.” I don’t think I have ever heard the ADA numbers used for anything other than basic info they give to predental students. BLS numbers are baloney. They say an oral surgeon earns on average 280k. Really? There is no way that’s accurate. Incidentally, the ADA says OMFS average is 518k. Cain Watters OMFS guys are averaging 900k. The surveys might not reflect actual national averages, but what is clear is that OMFS does the best in dentistry for sure–far beyond what average orthodontists or other specialists earn. As with general dentistry I would guess ADA is a little low and Cain/Watters is pretty high, so educated guess for OMFS would be 600+k average.
I think we can agree that dentists start out at relatively low salaries. I’m sure many dentists start out making something close to 120k. Over time that 120k number will increase significantly in the vast majority of cases. Even in a corporate environment an experienced associate general dentist will earn 200k+. If the dentist becomes an owner then the sky is the limit, really. It will be easier to do well in less competitive markets, obviously, but 200-250k is a conservative estimate of an overall average for general dentists. Any income numbers are going to be very situation-specific. It depends on the individual doctor, the specific location, the type of practice etc.
My contention is that on ON AVERAGE dentistry is still a good financial decision. Sure, taking on 600k of debt and then working as a perpetual associate earning 120k is a bad financial decision. I’m not sure what that has to do with whether dentistry in general is a good or bad choice. There MIGHT be a couple dentists out there earning less than 100k in private practice working full time, but they are a rarity. Whether there is a 100k guarantee as a base salary or not makes no difference since I’m referring to what dentists earn, not how their contracts are structured. A DO or MD or OD or DPM or anybody else CAN rack up that kind of debt and then go on to work for a low salary in perpetuity, but what’s the point of dwelling on those particular circumstances? How is that relevant? It’s much more relevant to say AVERAGE dental graduate debt is 280k, and AVERAGE general dental income is 200-250k (or if you truly believe the ADA, then 180k overall and 200k for owners) while AVERAGE dental specialty income is 300-500k. Starting salaries will of course be lower than the averages. That kind of info would be a decent starting point for a conversation on the financial merits of dentistry.
Lastly, I think medicine is more of a sure bet than dentistry in terms of financial rewards and obviously physicians earn, on average, more than general dentists. Dentistry is best suited to someone who is willing to become a business owner and willing to put in the extra work to make that business a success. That was the deciding factor for me in choosing dentistry over other healthcare professions. I wanted to have control over my destiny and I wanted the opportunity to own and build a business. I am in agreement with WCI, you and others that the ballooning student debt is scary. I totally agree with that. 280k is a lot. The few who have 500k plus in debt really put themselves in a tough spot–unless they become oral surgeons!
I don’t know why your posts keep going to the trash folder. Maybe it’s the length, dunno.
I know this has been expressed numerous times but I think dentistry is a lot more lucrative than you think. My dad works less than part-time in the office (~16 hours) and makes around $200k. Other dentists I know earn multiples of that. Of course, this is anecdotal, but dentistry is honestly ridiculous when you consider hours worked:income produced.
Glad to hear it. Unfortunately, there are a fair amount making much less in associate positions.
Loved this from the last paragraph
“You might be worse off than 95% of the house of medicine, but you’re still better off than 95% of the US population and 99.5% of the world population.”
I think one of the main things overlooked in personal finance is the personal part. You have to figure out how to use money as a tool to bring you time, security, and happiness.
Your tone and attitude is rude and very offending. You should know better than others that physician’s income is based on insurance reimbursements and has nothing to do with how hard you work in residency. Pediatrics is one of the toughest residencies with brutal months of wards and PICU rotations but you wouldn’t know it, right? By this logic derm and psych should be the lowest paid specialities but yet they are not. Pediatricians chose that field because they love what they do and certainly not for financial reasons. If you look at job satisfaction surveys they usually are on top of the charts. Guess why? I think you should apologize for your words.
I went through two years of pediatrics residency as part of my pediatric neurology residency. I have several friends who are in surgical specialties. I decidedly did NOT work nearly as hard as those in surgical fields. Not that this should dictate salaries…
I apologize for offending you. That was not my intent. In fact, I specifically stated that in the post:
The way any specialist can increase their pay is to work both harder and smarter. Not sure why you would assume I think pediatricians are not hard working. That is certainly not the case.
Like any post and any blog, take what is useful, leave the rest.
Jim, I do not think you have been rude at all. Your post is full of respect.
He was a bit rude. Automatically assumed a orthopedic resident works harder than a pediatric one. Ortho is hard. So is pediatrics when you’re dealing with dying children. We work hard too thank you very much.
Peds salaries are better than 95% of the general population but that population also doesn’t have crazy amounts of loans to pay back. Yes our choice to do Peds not ortho. But in the end, medicine in this country is a mess. I shouldn’t have to consider going into a field I’m not passionate about to make more money when the one I am passionate about should be fairly compensated in the first place.
And your Mescalero reference we all know it’s biased. $200K if far from the salary most pediatricians make.
Btw, I’m in private practice and making decent money. I’m not saying it’s not impossible. But your response to pediatricians advocating for themselves was rough.
You are entitled to your own opinions, but not your own facts. Per Medscape, Peds average salary is now $232K.
https://www.medscape.com/slideshow/2020-compensation-overview-6012684#5
If you are a pediatrician making much less than $200K, you might want to consider looking around for another job, asking for a raise etc.
200K is accurate. I’m peds too. i know plenty of new residency graduates who right off the bat got salaries above 200K for a 40h work week job. One was in dallas suburbs, Maybe you should move instead of being locked in to a poor paying geographic location.
I’m peds. PEDs is not one of the toughest residences (if you choose the right program)
Overall a peds residency may not be as hard as Ob/Gyn or surgery. But then I remember my rotation in the NICU and that was as hard as any surgery rotation.
PICU is a tough rotation too. But if you add up the tough inpatient rotations in a 5 year general surgery program and the tough inpatient rotations in a 3 year pediatrics residency, it’s pretty obvious which one is tougher to complete.
I went through what may be the most grueling peds residency in the US at Texas Children’s Hospital (at least at the time — no idea about now).
Started off with 7-8 months q4 call, most of which at the big hospital, managing 30+ bed units by myself. One senior resident supervised multiple interns, each with their own floor.
I had ~9-10 total months of ED time, 2/3 of which was in their incredibly busy and high acuity ED (higher acuity than many adult EDs). Also had PICU and NICU time, and had to do ED shifts on the weekends/evenings of some of the non-call rotations.
However my third year was relatively tame/slow, with all my elective time backloaded to then.
The surgery residents there had it far worse than me. If an “easy” surgery residency exists than maybe I was close to them in effort, but hard to imagine that such a thing exists.
Sometimes incomes are not based on insurance reimburesements, in the field of hospitalists, especially in high uninsured areas, hospitals subsidize significant amount of money to hospitalist companies, why do they do that? Because hospitalists can shorten length of stay, and since hospitals get paid by DRG, they can save significant amount of money by having a well run and efficient hospitalist company.
I don’t think WCI posts are offensive or rude, I certainly didn’t feel it that way and internal medicine is considered a low income medical field, if anything his posts helped me and many others including you on how to better manage our money.
If I never offended anyone, I’m not being harsh enough to reach some people. Just gotta do the best I can to help as many as possible. I hate to offend, but if you always use soft soothing words and tone, some people don’t make the changes they need to in order to be successful.
Why should he apologize? I, for one, think it is a choice to be offended. So I would offer you the choice to stop choosing to be offended. It is just someone else’s opinion, afterall. When you compare the ortho Step I scores to peds, average grades the research requirements, and the number of available positions, I think it goes without saying that it is more difficult to get into an ortho residency than a peds residency. There will be a bell curve, but we all know how those curves align. That really isn’t a mystery. The real point of the post in my eyes is to stop feeling sorry for one’s self and to optimize opportunities, wherever you are in the game.