Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "money"
Asker Anonymous Asks:
Do medical directors make a lot?
wayfaringmd wayfaringmd Said:

Income depends on what you’re medical directing: a nursing home, hospice, rehab facility, medical licensing board, etc.

But in general, if you’re a doctor, yeah, the money’s good. 

Not a good reason to be a doctor though. 

Surely there is something absurd when a nation pays a primary care physician poorly relative to other specialists and then wrings its hands over a shortage of primary care physicians.
Uwe Reinhardt, Princeton University economist (via numberneededtotreat)

(via wayfaringmd)

Hi! This summer I have shadowed a general and colon and rectal surgeon as well as a cardiologist. I’ve been trying to learn about the different fields of medicine and hopefully understand the kind of doctor I would like to become one day. I have noticed that something I really enjoyed was patient interaction and seeing familiar faces. Is this found in every field of medicine?(I would appreciate if you could answer this privately. Thanks) - anon

Um, Greyface, I can’t answer things privately if you’re anonymous. Sorry. So it sounds like you like what we call continuity of care. There is some aspect of continuity in most specialties, but you’ll find the most continuity in primary care. You will see patients for all of their problems rather than those pertaining to one organ system like a specialist would. And you will have the opportunity to see them over many years’ time if you go into Family Medicine or Peds or Internal Medicine. In family medicine you can see entire families (duh) and do cradle to the grave care. For example, I have one family in which I have admitted grandma to the hospital and managed her diabetes and hypertension, followed mom all during her pregnancy, delivered her baby, and now take care of grandbaby, mom, and mom’s 3 siblings as well. All in the span of 2 years. So call some family docs and do some continuity shadowing!

Why did you opt to become a physician instead of a family nurse practitioner? I’m debating between the two and scared of medical student debt! - anon

Links for why I chose to be a doctor, and why I didn’t go the NP or PA route. Yes, the debt is terrible, but NP and PA school ain’t cheap either! Don’t be terrified of the debt. There are plenty of ways to pay for student loans

I just read this article that said being a doctor is a million-dollar mistake because of the high price of medical school and the drop in salaries. Also doctors apparently have to do way more paperwork than years before. Do you have any worries about this too? I’m still in high school, but I was considering becoming a pre-med student and going to medical school in the future. Now I feel discouraged. Is going to medical school still worth it? Do you enjoy your job?-anon

It is slightly worrysome, but I wouldn’t let it keep me from becoming a doctor. I love my job. If you enjoy medicine and can’t see yourself doing anything else, then it will be worth the cost for you. And it’s not like we make chump change. If you live within your means and focus on paying off your loans before buying vacation homes and fancy cars, it absolutely can be done without making your family starve to death.

I have hope that our system will change and that the outrageous cost of medical education will somehow decrease over the next decade or so. It’s true that we do have a ton of paperwork these days, but I also have lots of time for patient care as well (but if Uncle Sam wants to stop killing some rain forests of insurance paperwork, I’d be cool with that too). But don’t forget that there are tons of ways to pay off student loans (or even better, have someone else pay them off for you!) if you’re willing to give up a little more time. 

Asker Anonymous Asks:
A fellow pre-med and I got to talking about illegal immigrants and health care tonight, and I left the conversation feeling so alarmed and upset at what I heard coming from his mouth. He was asking me things like, "Would you treat an American over an illegal Mexican" and "Why should they get free healthcare?" I just kept responding that if someone needed health care I would give it to them. Idc if they're poor, American, or whatever. For whatever reason he could only focus on the money.
wayfaringmd wayfaringmd Said:

Just learn from that experience that that is NOT the kind of doctor you want to be. Remember this down the road many years from now.  

Asker Anonymous Asks:
I heard that family doctors/GP's make $200,000 salary? Is this true? and is this the immediate salary they get after their two or three year residency program? Thanks!
wayfaringmd wayfaringmd Said:

Doctor salaries in the US vary widely based on geographic location, hours worked, years in practice, and practice type (outpatient only, inpatient/outpatient, with/without OB, urgent care, hospitalist, with/without nursing home). But yes, I believe the national average for family doctors is around $185,000 a year. For doctors straight out of residency, it’s a bit lower. The Internet tells me that average starting salary is around $140,000, but in the last few years and my residency program, residents have averaged about $175,000 as a starting salary (and not even working in metropolitan areas). It’s a nice jump from the average $40-$50,000 a year that residents average.

Of course in our current system, salary is based on what you bill for, and procedures generally are reimbursed much higher than office visits. So if you do a lot of procedures, especially if you’ve done something like a sports medicine fellowship and have learned to do ultrasound guided injections or have been trained in endoscopy, your take-home pay will likely be a bit higher.

Asker Anonymous Asks:
Is true that because of Obamacare doctors salaries are going to drop?
wayfaringmd wayfaringmd Said:

Ugh, I kind of hate this question. 

It is IMPOSSIBLE to generalize all doctors. Our incomes are SO different depending on hours, patient loads, specialty, and a hundred other factors. No one change is going to positively or negatively affect ALL doctors.

Here’s the thing: Doctors offices can choose whether they will accept a certain type of insurance. If they don’t like the way Obamacare reimburses them for their services, they don’t have to accept Obamacare plans. This is why you’ll see that many people with Obamacare still don’t have access to healthcare. 

If docs did accept Obamacare plans, they take the risk that they won’t be well reimbursed for their services. This is a gamble we already play with Medicare and Medicaid, which is why you will find that many doctors (those not in FQHCs) will keep their Medicare/Medicaid patients under a certain percentage of the total. By accepting a majority of privately insured patients, they can make up for some of that “lost” reimbursement from M’care/M’caid patients. Docs who work in FQHCs and hospital owned practices don’t have to worry quite as much about this.

Also — those of us in primary care hope that reimbursement for preventive care and chronic disease management will improve. In the current system, procedures are valued much higher than other stuff. We are now seeing a bit of a downward trend in reimbursement for procedures (though they’re still usually better). So if Obamacare starts decreasing reimbursement for procedures, then doctors who primarily do procedures will start having to see more patients in order to make the same amount of money (kind of how primary care docs have to do now as our reimbursements drop).

Asker Anonymous Asks:
Thank you for being such an inspiration to all, especially to those who are driven to serve! I am 20 and thinking about being a doctor. But I am really worried about capitalism in the medical field, sleep deprivation and staggering student loans. Can I ask for your advice in terms of dealing w/ them in the future or making an attribution to make sure that they're valid/invalid enough to stop me from pursuing medicine. Thank you!!
wayfaringmd wayfaringmd Said:

ADVICE TO PREMEDS: HOW DO I AVOID LETTING MONEY TROUBLES AND SLEEP DEPRIVATION KEEP ME FROM PURSUING MY DREAM?

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Dear, you have just summed up in one short paragraph the reasons why most of us want to be doctors and the reasons why a lot of us get burned out. 

My grandmother once jokingly told me that maybe I should think of a different career pursuit besides medicine because I like to sleep so much. Fear of debt and sleep deprivation are legitimate, but not reason enough to stop you from pursuing a career where you can potentially have a huge impact.

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If you are going in to medicine with the intention to serve people, you have to be sure that you are constantly reminding yourself of that focus. That’s how you keep the capitalism and student loans from bringing you down. Remember, there are PLENTY of jobs you can have as a doctor that aren’t all about the money (hello family medicine!). You can run a free clinic, be a missionary, run an FQHC clinic, do volunteer medicine, or work with public health. Or you could just be a “regular” kick-butt doc who chooses not to let money control them. 

Loans are for most of us an unfortunate inevitability. I got tons of ‘em and I want to be a broke, hut-living missionary.There are tons of service-oriented programs out there that will pay most or at least part of your loans for you in return for a few years of service in an underserved or rural area. I’m not going to let loans get in the way of me helping and serving patients. And you can’t either. 

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Asker Anonymous Asks:
I think a while back you mentioned something about having a free ride scholarship for your undergrad - are there any you could suggest for me? I really need all the help I can get
wayfaringmd wayfaringmd Said:

I pretty much applied for every scholarship that I thought I remotely qualified for. I searched on Fastweb (is that still a thing? I finished high school 10 years ago) and just applied to tons. 

I ended up winning 2 full tuition scholarships, one through my school’s scholarship competition, and one through my stepdad’s employer. One ended up covering my room and board while the other covered tuition. If your parents work for a national corporation, or even just a large local company, many of them have scholarship programs that are not highly advertised. His company rarely advertised the scholarship and it was usually awarded to bigwigs’ kids. I was the first person from his region to win. So check into that. 

Other than that, it’s been so long since I was applying for scholarships, I don’t really know any specific ones. 

Asker bitemebloody Asks:
Do you think it's wise to hold a job while in medical school? I recently got a rough estimate of my undergrad loans and REALLY don't want to drown in medical school as well. The money end of going to school stresses me out far more than anything else. I have bad panic attacks over it every few months, and I want to at least be able to pay for food and rent without resorting to loans, but I don't know whether I should... ~Overly long question giver.
wayfaringmd wayfaringmd Said:

Yeah, it’s generally ill-advised to work while in medical school. Most medical schools actually have a rule against students working.

Consider this: in your first two years you will be averaging 8-12 hours of studying/class a day, 6-7 days a week. Where does that leave time for a job? 

In the third and fourth year, your clerkships will essentially be your job. You will work days anywhere from 8 to 30 hours long, 5-6 days a week. When you have downtime in the hospital and when you go home, you are studying for shelf exams and putting together case presentations. Again, not much time for work. 

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Good god, how are you meant to pay that off?!

That’s the question, isn’t it? Especially considering I aspire to be a missionary family doctor. There are definitely loan repayment options with many jobs, though, especially for folks like me who are willing to work in a rural or underserved area. 

Asker Anonymous Asks:
How much debt did you have after medical school?
wayfaringmd wayfaringmd Said:

At graduation it was about $275,000. Now with interest, it’s about $300,000.

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I’ve heard that now isn’t the best time to become a doctor, financially speaking. Thoughts? -anonymous


It’s never a good time to go into medicine if you’re going into it solely for money. If you want money, get a business degree. It’s cheaper and takes less time. 

If you love medicine, it shouldn’t matter how much money you make. Yeah, it’s expensive to get an MD. But if you live responsibly and not above your means, or if you’re smart about your repayment options, the loans can be repaid in a reasonable amount of time. 

worth of CME (continuing medical education) money left for the year after buying Step 3 World QBank. I can use it for books, medical equipment (like a new stethoscope, which I don’t really need), or conferences mainly, and the money doesn’t roll over. We get $500 in first year and $1000 each subsequent year. I don’t really have any time available that I can take off for conferences, so I should probably stick to books and equipment. I’m specifically trying to think of books that could be helpful on the mission field. 

Any suggestions for how to spend it?

Things I’m thinking about getting: 

Procedures for Primary Care

A Practical Guide to Joint and Soft Tissue Injection and Aspiration

Oxford Handbook of Tropical Medicine

Using the money to pay for InMed courses. 

 My plan for third year is to use my CME money to buy a 3 year subscription to UpToDate (that is if whatever job I go to doesn’t pay it…).

HI! I'm currently a senior and about to take the MCAT in the fall but considering switching to PA school or pharm school for these reasons: Cost ( lot of debt out of med school esp if you want to become a family prac/pediatrician like I do). 2. Stress and lifestyle. I don't know if I'll be able to handle another four years of med school and 3 years of 80+ hour work weeks for residency. I need 8 hours a night to function. 3. Timeline. When do you have time for family and relationships. Thoughts?
wayfaringmd wayfaringmd Said:

1. Yes, medical school is expensive. But so is PA school and so is Pharmacy school. Don’t pick your career based on how much money you will or won’t make. I’m in family medicine residency right now, eventually planning to be a missionary making next to nothing, and I probably have more loans than any of my classmates. But I’m not really worried about the money. There are TONS of places out there that will give you money to help with your loans if you sign to work with them for a few years. 

And let’s not forget the 10 year income based loan repayment plan. For more posts to help calm your fears on the money issue, check here

2. Welcome to being a grown-up. You think PAs and Pharmacists aren’t stressed out? Trust, they are. And their school is hard too. And the hard work doesn’t end with school or residency. The hours can get even longer when you’re out in practice (depending on how you want to work).

I totally understand needing 8 hours. I generally require more sleep than the average housecat, too. But I’m also realistic enough to know that it’s not always going to happen. I’ve made sacrifices and dropped some social things so I could sleep, but there are some days that it just can’t be done, and you have to be okay with that.

 

3. There will be time for what you want to make time for, whether it’s sleep, fun, family, volunteering, extra studying, whatever. If something is important to you, you’ll make time for it. Obviously, some sacrifices do have to be made along the way, but you can still have a family and be a doctor. Dr. Cranquis and Wife of a Doc Star have some excellent old posts on maintaining healthy relationships and getting married while in medical school. 

All the concerns you have are valid, but they can be overcome. People do it every day. If you really want to be a doctor, you’ll make some sacrifices along the way. However, if these things are too much, don’t be a doctor (but don’t kid yourself into thinking that PAs or pharmacists have it super easy, either).  And please don’t pick your career based on money or stress level. If you do what you love, the stressful stuff becomes much more do-able. 

Do you think $8,000 might be enough to survive a school year on for room board and transportation. I'm trying to avoid at all costs getting a private loan, and I'm considering keeping a job through the school year. Do you think it possible or just failure waiting to happen?
wayfaringmd wayfaringmd Said:

Ooh, 8 grand would be REAL tight. 

If you plan on living at home, rent and utility-free, and walking most places, it may be possible. But otherwise, I’m not really seeing it happening. 

Keeping a job with the hours needed to actually support yourself in medical school is near-impossible, unless your job involves dealing drugs or selling yourself ;). At my school we weren’t allowed to work. 

I had no family contribution to my med school expenses, so I got all the loans. It’s terrible, and I owe nearly 300K, but my perspective is that as a physician (even in the lowest paid specialty, family medicine), I should be able to pay off the loans in a reasonable amount of time if I live well within my means. Check out that new 10 year income-based plan with loan forgiveness for people who work for non-profits…

Anyway, I lived off about $22,000 a year and I certainly wasn’t living extravagantly. I had a roommate all 4 years and lived in a fairly cheap city, so my rent + utilities came to about $500/month. Then add about $400 a month for car payment, insurance, and gas. That alone is over $10,000 a year. 

Then add internet, cell phone, food, books, clothes, medical, and the occasional surprise car/medical expense, and it comes to about $1400 a month. Plus you know you’re going to spend some money on random stuff. And then there’s boards, which is crazy expensive. I also saved a little money every month for fourth year, when life gets much more expensive because of interviews, boards, and moving. I’m just not sure it can be done for $8,000. I’m sure there are exceptions, but they’re not the rule, for sure.