Hey everyone, it’s Medicine Mondays again. Today I’m going to talk a little bit about “Your Medical Career”.

Your Medical Career

I’ve talked about it a little bit before in my previous posts The New Meta of Medicine and The 20 Year Career. However, I think it’s good to re-evaluate the lives of the 4th year medical students currently in The Match.

If you haven’t read any of these Match posts before, here ya go:

My prior posts gave an introduction to the Match, how to approach interviews, and how to travel for interviews.

• 4th Year, ERAS and the NRMP
• Residency Interviews
• Traveling for Interviews
• Mid #Match2017 Evaluation
• Rank Order List for the Match
• Match Day Anxiety
• Congratulations You have matched!
• Post-Match Senioritis
• Post Match Checklist
• How’s The Match Going?  (2018)
• Lazy Monday Reposts 
• Did you match? (2018)
• Match Time Again?
• The Week Before the Match 
• Did you match? (2019)

Now then, I realize that right now the singular thing on your mind as a 4th year medical student is probably The Match. If you haven’t taken Step 2 quite yet, that might be on your mind as well. There may not be that much more room in your attention span for anything else. I understand all of that.

However, I would advise you to take some a morning and do some self-reflection about where you are and what you want. Basically, try to figure out what you want out of your medical career.

Is this supposed to be a “feel good” motivational post?

No.

Definitely not.

This post is about the reality of medicine. The starting line for young doctors is very, very different based mostly on two factors. One large factor is how much student loan debt you have. The second factor is how much money you will make as an attending.

There is a large gap between a pediatrician coming out with $500k in student loan debt versus a orthopedic surgeon coming out with zero debt. Yes, I realize that there is a difference in amount of time for training. However, I am simply distilling this down to the difference of young doctors coming out of their residency.

The cold harsh truth is that the pediatrician with $500k in debt will have a much more difficult time achieving financial independence than the orthopedic surgeon with no debt. This is just simply mathematics. When you start behind and earn less, it makes it very difficult to “catch up”.

Everyone knows this, why are you telling me this?

Well, the common sense of those who came before us (our parents) doesn’t necessarily apply anymore. In our parents’ day they will likely remember their doctors as very happy and making a good amount of money — likely fulfilled. To them, the idea is that you go to medical school, do residency, come out and start making lots of money with a nice stable life.

It’s not that simple anymore. You need to temper your expectations and be aware of how far behind you are. Six figure student loan debt is pretty ubiquitous nowadays for medical students. I would venture to say the average is probably $200k. Then if you were to exclude medical students that don’t have any debt, then that average number is probably much larger. My guess would be around $250k.

Failure to plan is a plan for failure

Right now, as a 4th year medical student you need to make some decisions on what you want to do for residency and after. You need to set realistic expectations for what kind of work you do, your salary, where you want to live, etc. etc. Then, after you look at those realistic expectations, you should probably make more conservative ones.

People tend to be optimistic about how much money they will be paid or how much money they can save. Usually, they underestimate how much they will make and overestimate how much they can save. If the MGMA tells you that your salary makes $250,000 or so as a median, it’s probably wise to assume that you won’t make more than that. You need to take into account that for many specialties, experience does matter. Your first 3-5 years out of residency you will probably make less than you expect.

The first question you need to ask yourself is:

“How long am I going to do this medicine thing for?”

In my anecdotal experience, I think that people used to underestimate this number, assuming they would work for 25-30 years. They would then end up working 30-40 years instead. I see a lot of older attendings in their 70s, especially in my specialty. However, I think this will probably change in my lifetime. More and more I see people wanting to retire in < 25 years, or go part time earlier in their careers for a 30 year career. My generation of doctors may be a change in expectations for career longevity. I’ve already discussed my plan for a 20 Year Career before. However, that is a decision I made a long time ago.

While it may seem like a superficial question, it really provides you the framework for everything that comes after The Match. If you’re like me, and want to do a 20 Year Career, then after the match you will have all the pieces in order to figure out how to make that happen.

On a site note: It’s hard, but too many people tend to chase a “number” when it comes to a a salary. One number will never tell the whole story of a job. Please remember that when choosing your first job.

It’s just math.

You choose Your Number, figure out your plan for Student Loans, and make a reasonable estimate for how much money you will be earning.

What do you need to do in order make your salary cover your student loans and build to your number in the amount of years you want to work — while still maintaining a reasonable lifestyle.

Then after looking at all that, you need to decide whether living in a high cost of living area is worth it to you. More than likely, living in a high cost of living area will add more years to your career than an are with a lower cost of living. Depending on all the factors, it might even change your career plan by 10 years or so. That said, these are all choices that will need to be made for your medical career.

I don’t have time for this right now…

I understand.

However, when will you have time? For me, 4th year of medical school, especially after the match, I had more free time than any other time in my life, except for maybe kindergarten.

As an intern, resident, and young attending, you will have significantly less time than you do as a 4th year medical student. Take a morning and decide how you want to structure your career after the match. The career plan doesn’t have to be perfect, it just needs to be written down somewhere, so you don’t venture too far off the path you’ve chosen.

It could be as simple as writing down a few numbers and a few wants:

$300k Student Loan Debt
$300k Annual Salary
25 Year Career

Live on the West Coast
4 Bedroom 3 Bathroom house
2 Kids

Now then, the first 3 are the numbers that matter. The next three are the wants. Like I said before, having a “want” is fine, but you may need to temper your expectations. If West Coast to you is the “only the Bay Area”, you may need to reassess your 25 year career.

The “Number” you choose may also make a difference. Like I said my number is $5 million. However, for those who are currently medical students, 10 years my junior, that may not be enough for them once they reach retirement age. Or it could be too much, it will depend on where they plan to retire to and their lifestyle.

I see.

Sometimes life may make you make some unexpected turns, like sending you to the Caribbean for medical school, for example. Or maybe instead of getting a 3rd child, you get a 3rd and 4th in the setting of twins.

However, as long as your plan that you wrote way back when you were 4th year medical student is still there, you can modify it — it’s meant to be flexible. It’s just a plan, it’s not written in stone. However, it is and always will be your plan which you wrote back as a 4th year medical student.

The 4th year medical student you are now, and the attending you will become will probably have very different priorities. Having that rough plan to fall back on will remind you of what “past you” really wanted.

TL;DR

Write down a rough plan of your medical career as a 4th year medical student.

Once you have an understanding of your student loans, how long you want to work, and how much you’ll be paid — you’ll have clearer understanding of what is possible or not — and where you may need to compromise on your wants.

This career plan isn’t mean to be set in stone, it’s meant to be flexible.

The 4th year medical student you are now, and the attending you will become will probably have very different priorities. Having that rough plan to fall back on will remind you of what “past you” really wanted in your medical career.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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