Physicians working in private practice have that choice. Though the fact that those private practices are going out of business and are steadily being bought by hospitals is probably a sign as to the long-term viability of private practice as a business model[0].
Don't look at the salary of a physician, because not all doctors are salaried, and even for the ones that are, net worth is a much more meaningful measurement. $250K is a little high for some specialties, and it depends heavily on the part of the country. In any case, once you factor in the massive debt from medical school (plus the amount of time that physicians spend making essentially minimum wage while training in residency), the answer is that many doctors can't afford to make much less than they currently are[1].
(Also keep in mind that most statistics you see for "salary" for private practices are really more equivalent to revenue, since physicians in private practice obviously aren't salaried. Oftentimes, these numbers include only some, not all, of the costs of maintaining a practice.)
[0] This is a trend that is over a decade old (depending on the part of the country) but accelerated in recent years (before the ACA, though the ACA has also contributed to this trend as well)
In countries where it's more socially accepted for doctors to work part time, and where half a doctor's salary is a livable wage (i.e. you don't have to pay off half a million dollars of student loans), a ton of doctors do, especially women who want to stay home with their kids. Hell, here in Germany I know a lot of residents who are happy to take half their €48.000 for half the work hours. (I don't envy American doctor working hours, but I sure do envy their salary.)
I can't remember where I saw the statistic, but the number of years it takes for a physician to have a positive net worth after leaving medical school has been increasing dramatically. (This is because debt from medical school and undergraduate have increased nominally, while the expected income of a physician has dropped dramatically[0])
[0] Again, the magnitude of this effect varies by state, but it's a nationwide trend.
Relative to the income received after qualifying, the debt incurred during training is not so burdensome. That article you linked to cites the average debt of newly qualified doctors as being ~$166,000, and their income averages $270,000 pa., so about 5 months of wages.
> Relative to the income received after qualifying, the debt incurred during training is not so burdensome. That article you linked to cites the average debt of newly qualified doctors as being ~$166,000, and their income averages $270,000 pa., so about 5 months of wages.
$166,000 is the average amount of debt upon graduation[0]
from medical school. You spend several years training gruelling hours for a pittance as an intern/resident/fellow (3 minimum, but after that you're only qualified for the lowest-paying fields - the highest-paying ones require as much as ten years of training).
Even someone who just completed their residency is highly unlikely to make $270,000 (or anything close to that). It takes a long time to work your way up to those sums.
A doctor who has paid off his/her debt by the age of 40 is the exception, not the norm[1][2]. It's not unreasonable for a person considering medical school to have to plan on taking about 30 years to pay it off[3].
I don't know about you, but I'd consider that burdensome.
That is how investment works. You invest money in order to gain a highly lucrative career.
Your first link does not show numbers much different from the previous article linked.
Your second link bemoans that a $100K income (which is below the median for qualified physicians) "goes pretty quick" -- try telling that to the average American worker.
The reddit link doesn't contain anything substantive.
You state that the pay during residencies and fellowships is really low, but in fact it is higher that the median US wage.
Qualifying as a physician in the US is one of the most secure ways to earn a comfortable well above average income worldwide -- US physicians really have nothing to complain about when it comes to finances.
> Your first link does not show numbers much different from the previous article linked.
Correct. I cited that link because it more clearly shows that those numbers refer to the debt upon graduation from medical school, not the date at which the income numbers in the previous article become relevant (which comes several years after the completion of residency).
I'm not sure why you selectively quote that one phrase from the second link (which in context is not saying that $100K isn't a lot; it's really just a warning about how much worse it is to triple the principal on a debt with compound interest), and yet ignore the clear evidence that it does, in fact, take decades to pay off the debt (and even then, that's just to break even). Even if you don't like those particular links, it's pretty easy to corroborate that elsewhere.
Earning a "comfortable income" on paper is not very meaningful when you could be well into your fifties and still be behind where you would have been at 25 had you dropped out of college at 20 and gone to work for Wall Street or a startup, or pretty much any other high paying job that someone of that caliber would also be capable of. On top of that, as I already said, the income statistics for private practice physicians don't factor in many of the costs associated with maintaining a practice, so it's more like talking about the revenue of a small business than the income of an individual.
Medicine isn't really that secure a job anymore, either, contrary to popular belief. That's why so many practices have had to close in the last ten years, and why physician salaries, for those not in private practice, have been on a sharp decline.
It's really popular to hate on physicians for supposedly making a lot of money for a supposedly cushy job. That may have been true once, but it's not really true anymore, and it's becoming even less and less true very quickly.
I am very familiar with the medical profession, I teach them and review their grant and fellowship applications.
In no way conceivable is the debt incurred by medical students an irrational one, unless they hate medicine and wish they had chosen a different career.
The only way on which the debt incurred becomes an unusual burden is if they don't subsequently obtain positions commensurate with their training.
Comparing the income of Wall Street traders to physicians is bogus, the skills required are very different , and Wall Street is much more competitive and cut-throat than the medical profession is.
"It's really popular to hate on physicians for supposedly making a lot of money for a supposedly cushy job." Medicine is still a very well paid and cushy job: try asking qualified lawyers doing document review for $20 an hour with equivalent debt to newly trained physicians what they think of the matter.
> Comparing the income of Wall Street traders to physicians is bogus, the skills required are very different , and Wall Street is much more competitive and cut-throat than the medical profession is.
It's really not a bogus comparison. Comparing to the average wage of all professions is meaningless, since a prospective doctor would be capable of getting a top paying job if he decided not to go to medical school. The proper comparison is between two jobs that a prospective doctor might choose.
More than half of all medical school applicants take a year or more off in between college and medical school, and Wall Street and medical schools are indirectly competing for a lot of the same talent - a person who decides medical school is too heavy of a financial burden may very well choose to work in finance instead. Students graduating from top-tier engineering schools, for example, are prime candidates for both fields (and it is not uncommon for someone with an engineering degree to work for a few years in finance before deciding to go to medical school)
As I said before, it easily takes 30 years or more before medical school starts to look like a good financial decision, and that's assuming you make it that far without burning out and leaving the profession (as many do). That time frame is increasing, not decreasing, which means medicine is becoming a less attractive or sensible financial decision for the top-tier candidates, who are theoretically the very people one would most want to be performing one's open-heart surgery twenty years from now.
>a prospective doctor would be capable of getting a top paying job if he decided not to go to medical school.
This is not strictly true. To make an analogy, a marathon runner is not the best athlete for cycling, and most physicians would make lousy engineers. The biggest advantage of the medical profession is how secure it is relative to other highly skilled white-collar jobs, where climbing the ladder is a much less certain endeavor than medicine is.
> Specialist medicine beats finance in many ways, particularly lifestyle. (Autonomy, work hours, vacation).
If you're in private practice, maybe, but that's really not the case anymore. And in any case, private practices are a dying breed. If you're an employed doctor, you have essentially zero autonomy with regards to your practice, your work hours aren't that flexible (or forgiving), and you don't get that much vacation time.
What you describe certainly did apply to doctors one or two generations ago, and still applies to some of the outliers today, but it's not true for the vast majority of doctors anymore, and the direction of the trend is very clear and has been for many years.
> As always going to a top school changes the calculus significantly compared to everywhere else.
Not as much as the residency and/or fellowship does. The top schools charge more, but ceteris paribus, the residency is a better predictor of how much money you can make. Both of those effects, however, are swamped by whether or not a doctor actually lasts long enough after their fellowship to become one of those incredibly lucky high-earners. As much as people might not want to believe it, specialty medicine is a very competitive and cut-throat world, and there's a reason that so many would-be doctors burn out before ever seeing the thick paychecks referenced in this thread.
> I don't believe the 30 year figure for specialists
It's true, though if you choose not to believe it, I'm not going to argue the point further.
