Medical Facts and Tips

Sorry about the anonymity.  We’re part of the medical community and need our jobs to pay student loans and support our families.  We will stay anonymous.  We’ve been promised anonymity by the site administrators except for a legal and proper subpoena.

Rich Doctors.  Everybody knows doctors are overpaid and rich, right?  Let’s look at the actual situation.

By the way, all numbers here are attributed to Google (Gemini) for two reasons.  We got the number from Google or we got the number elsewhere but will not reveal the source as it might lead to our identity.

Doctors spend four years of undergraduate college and four years of medical school.  Unless you have rich parents or play football, doctors borrow the money.  When doctors graduate from medical school they take a two-year internship.  Interns are paid $30-47,000.

Using $47,000 and dividing by 12 equals $3916 per month.  Make it 4,000 per month for ease of calculation.  Subtract $1800 rent, $700 car payment, $300 groceries, $400 miscellaneous, $600 child care, 600 medical, life and liability insurance—whoops—this equals negative $400 per month.  The wife works to make up this negative balance.  If you are single too bad, you go in the hole every month.  We’ve left out those pesky student loans, social security and Medicare.  We’ve left out taxes, but taxes do not exist at this low level of income.

According to Gemini loans for undergraduate and graduate (medical) schools, average $240,000.  However, dependent on the school and the student’s situation loans may go as high as $480,000.  Using 10% as a guide for repayment over 20 years, the monthly payment for a just graduated doctor ranges from $2400-4800 per month.  But the doctor is already 400 in the hole so the loan repayment gets set off for two years for the internship and another year or two or more for the residency.  We can another 15% for the interest on the principal.  $276,000-552,000.  Payments on student loans now range from $2760-5520 per month.  Let’s assume payments begin when the doctor has a regular job.

General practitioners make about $270,000 beginning salary according to Gemini.  Take off 35% for income taxes.  $175,500.  House payment $4000, car payment $900, childcare $750, insurance all types $3500, student loan ($350,000 total) $3,500.  Expenses per month times 12 subtracted from 175,500=$23,700.

We need food.  $600 per month times 12=$7200.  Gasoline $600 per month=$7200.  Subtract Social Security $9,100 per year and Medicare $5,000 per year. $4800 left over.   Divide by 12 equals $400 left per month.  We could throw in a second car and entertainment, but with only $400 left each month these become luxury items.

After 10 years of school and a minimum of three years of postgraduate work, the wife is still working if this couple wants to do anything outside of the home. Both parents working will last for 10 years.  We assume the couple pays off the student loans after working 10 years.

Pardon us, but this is like owning two homes when you can afford only one.

Advice for the New Doctor:

Consider beginning your career (private practice/hospitalist/residency) at a “B” market facility/location.  It’s always tempting for young doctors to want to begin their careers at the larger facilities often noted as “centers of excellence” and/or “research centers”.  These facilities are often located in more appealing large metropolitan cities, always a draw for young physicians.  However, spending time in a smaller market for a while allows young physicians to hone their clinical and inter-personal skills, built their reputations and establish valuable relationships that can help when your time does comes to enter those larger markets.  Positions as well as promotions in those larger markets are also hugely competitive.  It may be beneficial for you to get a few years under your belt to enable you to compete and have the experience you need to qualify for those “A” market positions.  Additionally, smaller markets are more open to salary negotiations i.e. paying down your student loans, low interest housing loans, daycare assistance etc.

A few candid words regarding the above narrative concerning the dilemma of student debt young doctors often sustain.  Although nurses do understand and some caeven empathize with student loan debt, it’s unwise for young physicians to talk about it in the company of nurses.  Don’t bring your financial problems to the unit nursing station or the nurse’s lounge.  Young doctors need to be perceived as the leader of their health team—conversations about debt repayment etc. reflect negatively and can even weaken your role as their leader.  Bear in mind, financial success for doctors is usually inevitable, albeit a somewhat painful and long-range game plan; as such, most nurses have little sympathy for their situation.  Additionally, nurses are often unable to relate to such large student debt loan issues as their advanced degrees are often subsidized by employers and/or hospitals.

Other thoughts for young docs just off the top of my head:

• Practice “active listening” with every single person you interact with during your day i.e. other physicians, nurses, patients, administrators, patient families etc. Watch your over reliance on data, be more holistic in your patient care by using your listening skills.
• Remember, you are leading a a health team—your success will depend upon your ability to interact and lead that team all the while making everyone involved feel respected and heard. Remember to praise in public and “educate” in private. Make every moment a teaching moment but do it the right way—this will gain you respect.
• Embrace those additional administrative responsibilities necessary to your practice such as committee work, board work, focus groups, recruitment opportunities, nurse advisory boards etc. Although these roles are often hard to work into your day, they are valuable toward your recognition and can have a huge influence on your career—put yourself out there and strut your stuff! Become that doctor that people gravitate to and seek out for professional help and advice.
• Remember to respect aging/experienced doctors and nurses. Many doctors work well into their 70’s and often early 80’s and retirement can often be difficult for them as their entire self-identity is wrapped up in being a doctor. They are often beloved by many staff members–make sure you give them the respect they deserve and try to extract as much as you can from their years of experience. Remember, you will one day be in their shoes.
• Learn to communicate and work well with nurses—they can be your best asset/friend or can be your worst nemesis. Never play the blame game—instead, work with the goal of resolving challenges that arise.  Look to older, more experienced nurses for diagnostic issues—joint problem solving is important.  Learn to inspire and praise their work as they are an integral part of your team.  Work hard to develop and mentor those relationships.
• Be aware of “unconscious bias” with male and female nurses (and doctors). Male doctors, watch your tendency to gravitate toward male nurses and vice versa with female doctors and female nurses.  Trust me, it exists!
• Young doctors are often the most dedicated (work longer hours) and that is truly an admired trait. Watch out, however, that your work/life balance doesn’t get up-ended.  Be careful to watch out for “burnout” and please, don’t go to work sick!  Take care of your physical needs and your mental health—carve out downtime for yourself, away from the workplace.  You’ll be a more efficient and brighter, more well-rounded doctor if you do.
• Work with and cultivate relationships with your administrators and/or chief medical officers. After some time on the job (9 months to a year), seek help with paying down your student loans—be honest with them about your struggle.  Ask what they can do to help secure reduced loan payments, housing subsidy, childcare subsidy etc.   Seek their help and input when it’s time to renew your contract.

 

Respectfully submitted by older nurses who watched many, many young doctors burdened initially with large student loan payment dilemmas continue forward to become highly respected physicians who eventually enjoy the countless fruits of their labor.  There’s truly a light at the end of the tunnel.