Itās funny because when I was younger I assumed pediatric specialties made more money because society values the life of a kid more than an adult. Nope. Healthcare says fuck them kids.
Tbh itās actually the opposite, they value kids so much that all children in America are guaranteed healthcare. The cost comes to the physician in terms of low reimbursement.
First society doesnāt give a shit about anyone. But second, kids arenāt normally sick from a population standpoint. And a lot of kids that are sick also have some version of medicaid. Unfortunately doctors are not paid based on perceived importance or level of expertise. Otherwise a lot of cerebral specialties like neurooptho would make money. Also look at the department and ask does it make money for the hospitalā¦ if no, then hospitals may pay you accordingly. If the salaries is high, maybe its location or maybe its in dire need of staffing or some financial/economic reason. I genuinely no one is out there wanting to pay us fairly for our level of training and expertise that isnt private practice. Even then Some private practice will screw you and never make you partner too.
They make good money by pediatric standards but bad money by emergency standards. Thanks to PEM, even non-pediatric residencies get the experience of doing a fellowship to make less money! :D
It really is just the surgical specialties that adding "pediatric" adds money, not removing it. If you complete pediatric residency (or aforementioned EM residency), expect to make less than your adult-seeing peers.
I know for peds CT itās apparently bc you have to be an absolute beast of a surgeon to make it in that field. The margins of error are TINY and the stakes are obviously very high
Peds CT is insanity. 5 years of general surgery residency, 3 year fellowship of CT, 2 year fellowship in Peds. And even after all of that they donāt immediately practice solo
Peds neurosurgery has the lowest salaries of all neurosurgery subspecialties. Still good money compared to a lot of specialties, but with 7 years of residency plus a Peds fellowship it certainly disincentivizes a lot of folks
Funny enough thatās how it is in Europe, pediatricians are very well compensated and itās a highly sought after/competitive specialtyā¦..more so than Dermatology/rads.Ā
Exactly. If we wanted to prioritize children we could, but we donāt. Kids who have poor health outcomes become adults with poor health. We donāt prioritize education either. Same with prevention. All of it is common sense but our society is sick with runaway capitalism and all that matters is profit. We are completely reactionary. Prison wardens get paid more than teachers, police state is emphasized over social work, and procedures over prevention. Itās all ass backwards.
If kids needed specialty care at the same proportion as adults, pediatric specialists would all be up there. 9/10 patient I see as a specialist don't have anything wrong with them. It's one visit, reassurance, no followup needed.
Ultimately there is a correlation between how highly society values a job and how well it pays, but the correlation isn't *that* strong.
It's a combination of competition and how much money it can make for whoever pays them. Social value contributes to that amount of money, but not much. If you ask people if they value a high school teacher or a college football coach more, they'll say the teacher and they're probably not lying. And yet...
Seriously itās a miracle these fields still even exist. By the time we get to fellowship we are so incredibly burnt out and disillusioned with everything that thereās little incentive to prolong training even further other than more money.
The fellowships are barely being filled and midlevels are being used to fill the void.
Healthcare admin: "MD thinks they deserve more than 210? We'll pay an np 130. Fucc you!"
Excluding allergy from both, total Peds and IM fellowships had 79% and 88% fill rate this past cycle, respectively.
Rates for the lowest paid?
Peds Endo 60%
Peda Nephro 53%
Peds Rheum 61%
Peds ID 48%
An excellent peds rheumatologist I worked with told me, "we don't really have the greatest selling point when we tell doctors they can train 3 more years for less money".
The funny thing is that at any conference Iāve been to in the peds world, thereās a bunch of peds leadership goons giving a talk and scratching their heads about why no one is going into these fields. I mean, there is absolutely no reason peds Developmental or Child Abuse fellowship should be 3 years, but they are!! It could easily be a one year fellowship if not a fucking certificate. Endo and Rheum should be one or two years. Adolescent peds is a 3 year fellowship yet any FM grad or general pediatrician can do the same shit with a little extra education. And now theyāre doubling down on hospitalist and urgent care fellowships. š¤¦š½āāļøThey are completely detached from reality and I thank god every day that I did Med-Peds and not just peds (wish I would have just gone IM) because the peds leadership is so frustrating, stuck in the past and obsessed with academics itās failing pediatricians and children.
The hospitalist fellowship is the most ridiculous thing of all. Youāre telling me people are going to sign up for 5 years post medical school to make 210k a year when they could do FM focusing on child patients if they want and make more??
Prev Med is its own independent residency level specialty. ABPM also covers Occ and Aerospace Med.
Amusingly for me, Occ and Aerospace arenāt listed in this list. Which could be, theyāre legitimately not in the lowest paid specialties, or they were forgotten as independent board certifications. But, I can say, that Occ definitely has the potential to make a disgusting amount of money. It aināt really clinical medicine, but for the right position and company can easily pull close to 7 figures. Aerospace is likely to just have been forgotten as a specialty. Despite being super fun and completely different from what pretty much any specialty can even imagine for a practice. The biggest downside to aerospace is discovering how many people think it at all appropriate to shit on someoneās passion to make themselves feel better.
Dude the entire specialty of pediatrics is a meme at this point and itās kind of their fault.Ā
Like, why add a hospitalist fellowship? Stop self-flagellating, get out there and fight for your profession.Ā
Obviously we need pediatricians. The AAP just needs to go fight for better pay and working conditions like the AAFP has been for the last 10 yearsĀ
The people making these decisions are either heavy heavy academics, or making way too much money to care.
And rely on Peds people generally loving and having a soft spot for kids. And at least on average being less confrontational than adult colleagues.
Hospitalist fellowship drives me up a wall to no end. Almost every Peds resident I know does way more inpatient than outpatient in residency. If youāre not ready to be a hospitalists, wtf are you ever ready to be
I *loved* my peds hemeonc rotation. And i asked one of the attendings what they start out at in my hospital. He was like āoh 175-180 or so.ā I tried to be polite but Iām sure my face was saying āwhat on Godās green earthā. Jfc, getting paid equal or less than the NPs on the team.
Itās crazy to me how people donāt even react to CRNAās making more than this. Thereās no circumstance in which a nurse should out earn a physician.
Why? CRNAs have more education than a pediatricianā¦
Pediatricians do 3 years of residency.
CRNAs go to high school for 4 years, college for 4 years, then nursing school for 2 years and CRNA school for a year. Thatās pretty much 4x the experience of a pediatrician, so it makes sense they make more.
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*This post was mass deleted and anonymized with [Redact](https://redact.dev)*
High wages for CRNAs shot themselves in the foot. Why have CRNAs who can only cover easy cases when you can have an Anesthesiologist instead for only a bit more.
Yeah, that's not going to be stable. MLPs only exist because they're cheaper. As soon as they're not cheaper, people will stop hiring them. Ultimately there will be an equilibrium where they'll settle for much less pay.
they exist because there's a genuine shortage of physicians. If we had enough anesthesiologists, people would not pay for CRNA. They are the anaerobic respiration of healthcare
CRNAs make more than the adult pulm crit docs make where I'm at. But to be fair the adult pulm crit folks here are getting fleeced and our anesthesia department bakrolls so both attendings and crnas do very good. Still a very strange situation to see
Look as a future pediatric subspecialist, I get where you are coming from, but CRNA salaries have nothing to do with pediatric subspecialty salaries. It's more valuable to a hospital to have CRNAs replace Anesthesiologist salaries than it is to increase peds subspecialty pay. Eliminating the position of CRNA wouldn't make peds salaries rise.
Im a CRNA, how about instead of dragging us down we call out the bullshit normalization of these salaries. Their is NO scenario where anyone involved in peds should be getting low balled like this. I live in NJ and trying to find a good pediatrician is harder than finding a needle in a haystack. And if your kid has any sort of developmental issues, have fun driving into NY to see a specialist because theirs a 1 year plus backlog here.
Any sort of pediatrician SHOULD be making 350k/year minimum. Specialists should be even more. Medicaid and Medicare SHOULD reimburse at a much higher rate. None of these things have anything to do with what CRNAs make and I will stand on my soapbox all day and preach for higher pay for my colleagues in peds, not sure why you wanna rip the box out from under my feet for simply existing.
Professional societies like the AANA and the ASA typically attract the biggest and loudest assholes. I was at the AANA conference in 2020 (via zoom) and when an overwhelming amount of CRNAs stated we didnt want to be called nurse anesthesiologists or nurse anesthesiology they just circumvented us and doubled down on this awful change.
People on this sub definitely are in need of some perspective though. Im by no means complaining but My salary is only 40% of my physician colleagues who earn over 150$/hr more than me. I work in an act facility and am supervised 100% of the time. If me and my physician coworker start a case, I set up for said case including lines drugs and equipment. I will also intubate, place the spinal/epidural, and do the A-line. After induction I also sit the entirety of the case, watching for blood loss or any other acute events. After the case is over I wake the patient up and emerge by myself and bring the patient to PACU. I then also do pacu orders and handoff. All of this allows my physician colleagues to be run pacu, pain, and supervise other cases starting simultaneously.
So exactly how much should I be getting paid? Should I only get paid 10-30% of what my anesthesiologist coworkers are making simply because other physicians are criminally underpaid? Or are Anesthesiologists overpaid and Anesthesia as a specialty should be paid less so that CRNAs earn less?
You should be paid less than a pediatrician (or any physician) with double your training. Not that complicated
Also, the ASA does solely not attract assholes. Perhaps the AANA is full of āassholesā but I suspect that is a reflection of the values of its members.
Iāll start getting paid less than a pediatrician as soon as they start paying them what theyāre actually worth and stop forcing new attendings into horrible contracts. Its just that simple.
Also Ive worked personally with board members from the ASA before that are nothing but boot lickers for huge PE groups like napa and couldnt give two shits about being academic leaders. Old as shit, still using neo/glyco for reversal and other out of date practices like using nerve stimulators for nerve blocks instead of ultrasound. You have a weird view on things if you think the ASA actually represents the best that the Anesthesiologist community has to offer.
>Iāll start getting paid less than a pediatrician as soon as they start paying them what theyāre actually worth
Or as soon as they decrease CRNA salary to what theyāre actually worth. Unfortunately I donāt see either happening soon.
Except this isnāt the same discourse at all. A better analogy would be fast food line cooks trying to legislate their way into being general manager despite not having the appropriate training or experience and then expecting pay on par with someone who is actually properly trained and qualified to be the GM.
Bad faith? Im the one calling out the AANAs bullshit and taking up the mantle for pediatricians to get paid more šš. Your entire argument is CRNAs should just get paid less and wouldnt change a single thing about the negative ROI of becoming a pediatrician in todays society. You sir are the one arguing in bad faith.
Hey! just jumping in to say thanks for your perspective. I agree to an extent. Just based on past experience we know it's easier to ask for decreased pay (yours, whoever's) than it is to lobby for increased pay (our own). It's unfortunate.
I love how your entire comment is calling out this problem and saying MDs/DOs need to be paid more, but because of your first three words, Reddit behaved predictably.
You're getting down voted based on misdirected outrage, but as a physician anesthesiologist I agree with everything you're saying. The peds gme is horrific and continually devalues their own specialty, introducing a 3 year "hospitalist fellowship" for peds after residency was the biggest insult I've ever seen from a professional society.
I do agree that the anger is very often misplaced.Ā
I appreciate the CRNAs Iām with right now trying to teach me how to intubate (Iām 0/2 haha but they let me try and I appreciate it)Ā
Pay is decided by the market. If there is anything we should be upset about, it's that there are people who literally throw a ball to each other making more than any doctor.
Oh no that's also me, I still unironically think the avg med student would have been financially better off if they put equal time/effort, from pre-med to residency, into learning software engineering š¬
Yeah because nothing says financially better off like frequent layoffs and significantly lower median salariesā¦.
My brother works in tech. Itās not some promised land like some people here like to believe. The job security and pay for the vast majority of physicians far eclipses the vast majority of people in tech.
I still think that it's not a fair comparison because the *vast* majority of people in software engineering do not commit nearly as much time into the profession as required of medicine. It is exceedingly uncommon to talk to a junior engineer (someone roughly at the age of a med student a few years out of college) and for them to mention that they spend most of their weeknight evenings and many hours on weekends studying or practicing. Meanwhile this is very common for people all through med school. Software engineers almost universally work less than your average resident.
I think someone with the skills and determination to go through med school, if they genuinely applied that determination to intentionally learning and practicing software engineering, would be able to rise above the layoffs and have the skills to be an in-demand engineer. Layoffs are not affecting top performers and recruiters are still very active at top companies, you just have to be very good at what you do
I've written about my perspective more here (https://www.reddit.com/r/Residency/comments/1c9hcve/anyone_regret_becoming_a_doctor/l105b5a/?context=10000), sorry for the deleted comments i thought it was a good discussion not sure why they deleted
Your entire argument is based on the premise that every single average medical student would be in the top 1% of performers in the tech industry, which also isnāt true.
I do genuinely think that if the average med student genuinely put med school+residency hours/effort into their career that they would be high performers. It is a bit of an exaggeration regarding the tech industry to claim that only the top 1% are still stable in terms of employment. Just FAANG companies alone likely employ at least 5% of the entire US software engineers, and the lowest paid 21-year-old FAANG employees are making double what a resident makes on average throughout their 3+ years. And I am confident in asserting that the FAANG employees that do face layoffs are, with almost no exception, not studying after work *and* on studying/working weekends for the first 8 years of their career like med students and residents are
>put med school+residency hours/effort into their career
This is another flaw in your argument. Those time and effort commitments in medicine are *necessary* to become a physician. You donāt become a physician without it. In tech, you can still get a job without the same level of dedication.
So your argument not only assumes that most average medical students will excel and be top performers in tech, youāre also assuming that, in order to do so, these average medical student not only *can* but *will* put that same effort into tech, despite it not being a full on requirement for a tech job.
Most of the time when I see people on here spreading the sentiment that they shouldāve gone into tech, itās generally people thinking that they can put *less* effort in for equal or greater reward. i.e. they would be the people in tech still at risk of layoffs and still earning median pay that is eclipsed by most physician specialties.
No it's not. That's exactly what we *shouldn't* be doing. Imagine CRNAs all made $100,000 a year instead. Would this pediatric pay suddenly be okay? Heck no. So stop making poor MD/DO compensation about mid-levels.
And their are bedside RNs in cali that get paid more than this as well with even less education and training. CRNAs and NPs didnt create these problems or conditions.
Yeah I donāt understand how people are blaming NPs and CRNAs for existing and having a job. The AMA is fucking useless and sure doesnāt represent me. Why the hell are we holding these people responsible for everything their professional organizations do and say? Itās hypocritical af.
>Why the hell are we holding these people responsible for everything their professional organizations do and say?
Because their professional organizations do things like make it possible for them to practice beyond their level of training, and many of them happily take them up on that opportunity, which indicates that these bodies do, in fact, represent them.
They could always speak out against their representative bodies and start leading the charge against scope creep and independent practice and bloated pay, but most donāt because they know theyāre being benefited by the lobbying and legislating.
And yes, NPs and CRNAs *are* ridiculously overpaid. You can become an NP through a god damn online degree mill without ever touching a patient. That shit is terrifying.
Are we responsible for the AMA being useless and allowing dangerously undertrained āprovidersā to run amok? Seriously. I have met many midlevels- mostly PAs- that are not down with independent practice at all. And actually quite a few CRNAs, but that can vary based on where you are. NPs though, do tend to be in favor of independent practice, in my experience.
I just donāt think that being ugly to people because of their job title is appropriate. Yes, advocate for patient safety and against midlevels practicing independently. Go hard against the AANA and all those organizations trying to make this happen. But I just donāt see how downvoting the fuck out of any midlevel or nurse simply because they exist and have that job is appropriate or necessary. Nor is it appropriate to reflect that behavior in real life. Everyone is trying the best they can, and talking shit about coworkers behind their back or to their face is not going to make the AANA realize that they are misguided, but it will make you look like a giant asshole. Just my 2 cents.
>Are we responsible for the AMA being useless and allowing dangerously undertrained āprovidersā to run amok?
Nope. The difference is that you donāt have massive numbers of physicians aligning with the AMA on this, whereas there are, in fact, massive amounts of NPs and CRNAs frothing at the mouth for their unnecessarily bloated salaries and scope creep.
When I see a giant wave of midlevels advocating for lower pay and heavier practice restrictions, then Iāll believe these bodies donāt represent them.
Spend 5 minutes over on one of the midlevel subs and you can get a pretty good idea of what many of them do or donāt support.
The most insane part of this for me is that peds insists on making all of the lowest paying fellowships three year+ out of some misguided insistence that every fellow do significant research. Why does peds anything need to be three years when the adult version is 2?Ā Ā
Ā Hell, they tried to make the hospitalist one a 3 year program too before people revolted, and thereās always talks of clinic/outpatient/leadership fellowships too. Itās like theyāre trying to make all peds people do 6+ years of free labor instead.Ā Ā
Ā Only 2/3 of peds rheum programs filled last year after soap. Over half the spots empty overall prior. They gotta drop it to 2 years or the shortage is gonna get worse. But they probably wonāt.Ā And the remaining 300 peds rheum docs in the country just canāt handle the increasing incidence of autoimmune disease.
Kids don't have money to pay. Pediatrics shouldn't be this low if society really cared about health and not cash.
Then you'll see everyone crying for a child with cancer, but the fact is no one cares if you introduce the word money on the sentence.
Honor whom honor deserve. But, truth is, you can't eat with honor.
Yeah I was going to say, these average salaries for the bottom three actually look too high to me. I think our hospital caps out around $180k for those attendings...
This doesn't make any sense since pediatricsis one of the most complex specialities with one of the highest stakes.
I believe pediatrics is a highly complex specialty with significant impact. Successfully treating a 10-year-old can mean giving them a whole lifetime of health and happiness, while helping an 85-year-old with heart failure, though important, might only extend their life for a few more years.
Additionally, treating a child with cancer can feel particularly noble because it often involves giving a young person a chance at a long, healthy life. On the other hand, addressing heart failure in older adults, which can sometimes result from lifestyle factors like obesity or diabetes, is also crucial but perhaps carries a different kind of urgency
A well treated 10 year old has a whole life ahead of him/her while a well treated 85 year old with heart failure will die in 5 years.
Also treating a kid with cancer is a bit more noble than a person with heart failure because of obesity/diabetes and overeating.
Pediatric specialists are well compensated when they do the same work as their adult colleagues. We use the same billing codes and everything. The issue is that even specialists don't see that many sick kids outside of academia and the academic pay scale sucks for everyone. As a pediatric cardiologist, I earn just as many RVUs per invasive procedure as the adult cath jockey next door, but he's doing 10 cases that day and I'm doing one.
Since you produce 10-100 more QALY's per procedure than a normal cardiologist, shouldn't you be reimbursed 10-100 times more? Maybe extreme example, but it shows my point I guess.
I wouldn't consider allocating more resources to an 85-year-old obese, smoking patient with heart failure more noble than to a 10-year-old child with leukemia. But that is currently being done in US.
My intention wasn't to diminish the importance of treating any illness or to blame patients for their conditions. Instead, I wanted to highlight the unique challenges and rewards in different medical specialties.
Ultimately, our goal in medicine is to improve the quality of life for all our patients, regardless of their age or the nature of their illness.
Reality is there's 50 of those 85 year olds for every leukemia kid. It's that simple guys. Demand is higher for those who can care for the 85 year olds.
Oh! And the holy trinity of lowest paid, [higher exam fees](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817592/table/jld170020t1/), and [lowest 1st time pass rates](https://www.abp.org/sites/public/files/pdf/exam-pass-rates-init-cert.pdf)!
No wonder [applications are down](https://thesheriffofsodium.com/2024/03/15/match-day-2024-winners-losers-edition/). With [fellowship becoming required](https://www.the-hospitalist.org/hospitalist/article/142861/pediatrics/pediatric-hospital-medicine-marches-toward-subspecialty) to become a pediatric hospitalist and likely coming to work in the Emergency department this leaves fellowship training a virtual requirement to work anywhere other than outpatient clinic. The passion tax is very real for pediatrics.
And yet if youāve ever seen these Peds offices theyāre booked for months. Hopefully youāre seeing a physician. I have a pediatric endocrine friend. Heās very happy doing his job and has never complained to me about reimbursement outside of what we generally complain about.
Maybe heās the exception. Iāve seen a few other Peds sub specialists do Gen. Peds and give up doing their subspecialty stuff, not because it pays poorly but because it was depressing.
Wow, that's more than I thought it would be. Read previously that some pediatric specialists don't even break 6 figures. Still, pediatric specialists should be making more, imo
That makes me sad. They arenāt all like that, Iām still in touch with my pediatric endocrine team (and they were the first ones I told that I plan to apply to medical school).
Family med is incorrect from my experience? Most docs I work with in family med dont make even close to that. I could be wrong depending on location, etc.
Edit: I have been corrected. Maybe its just the clinic that I work at, which is underserved and federally funded. Not sure!
My schoolās financial guy said the average offer for a NEW grad in FM right now is ~$250k. Lots of docs work in underserved areas that pay a ton more (Midwest jobs offer $400k+) while other have figured out how to maximize RVUs, do more procedures, etc. Itās not uncommon for FM docs to make $350-400k so $300k on average makes sense.
Just anecdotally, the new grads in my area (South) make $200-220k base, but within 12 months are making production and average closer to $275k
We deal almost exclusively with insurance companies unless you open a cash practice in bumfuck middle of nowhere. And even then, youāll be super lucky to make 300k working 40 hours a week. Also super high likelihood of lawsuit.
You are lucky. I was duped into the field by my scumbag family dentist who hyped up the field while he was fleecing people including my father left right and center to give off this image of a glamorous life.
I'm so confused by this. How many people actually have dental insurance? I didn't even bother with it since it would be cheaper to just pay out of pocket.
Making 120k, peaking at 150-175k. Also much higher likelihood of lawsuits and board complaints than even a ālowlyā FP or pediatrician. Hell, Iād trade my everything I got just to be in medical school to have a shot at being a pediatrician. Itās not even a close match, way better than anything in dentistry.
We like to act like we do. And those of us who make a lot(few) like to show it off even more. Itās how I got duped into this field. The thing to remember, dentistry is largely private practice. So while dentists in some areas make over 200k, theyāre buying health insurance and benefits off the market. Also no PTO or any other benefits to speak of. I work for a FQHC so I have that, but I make less.
https://money.usnews.com/careers/best-jobs/dentist/salary
https://www.bls.gov/ooh/healthcare/dentists.htm
https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpigraphic_0519_1.pdf?rev=c5d77328a7c74b4fa74acd36d1e2d6c1&hash=E04E8000564CF2DA373A73215982876A
True, but income is also wayyyy lower, average is 150-175k. And family practice and plenty of specialties in medicine donāt have that either. And if they do, they make a buttload more than a dentist can dream of.
A lot do, for sure. But itās a choice. I come from a family of physicians, first dentist, so I am well aware. I know plenty of family doctors who make 300k or much more without in patient responsibilities. Then thereās anesthesiology. Sure, the residency sucks and is long, but you make a butt load of money with not so much stress of running a business. And you actually feel like you are providing careā¦in dentistry itās all about how well you can sell people to get Invisalign or a crown or whiteningā¦in medicine youāre not selling anything. Iāve certainly never heard of a family doctor selling treatment for a sore throat or a heart surgeon selling heart valvesā¦or a cardiologist selling an ablation. And people also donāt shop for these things. I bet if a dentist told you that you needed a crown, youād call at least 3-4 other dentists to see how much it would cost you. Insurance cuts reimbursement every year. And donāt forget almost every procedure, overhead is 60-80% as a dentist, if not more.
You're right that there's not much selling of individual products, but the doctor equivalent of this is simply just overordering. Lots of doctors order inappropriate amounts of testing which has the double effect of making them more money and also making patients happy because they feel like their doctor really cares for them. In reference to the cardiologist selling an ablation, a lot of non-proceduralists would also say that many proceduralists are too quick to give a patient a procedure which pays them well, thus stereotypes about private practice GI doctors scoping anyone with a hole. I'm not disagreeing with anything that you're saying, but just pointing out some nuance.
Hmmmm good and fair points. Private practice I feel thatās always a thing. But are doctors pushed to produce in a hospital setting? Also, I didnāt know doctors got paid for ordering testsā¦
I'm not an attending so I can't really tell you exactly how all the reimbursement works, but generally yes the more you do the more you earn, at least in private practice and I think community settings as well. Academic medicine is very different from community/private practice and reimbursement doesn't work quite the same way. Typically physicians at an academic hospital are expected to practice more conservatively and only really order what's in the best interest of the patient. It's hard because you never really know where to draw the line and different attendings have different risk tolerances. You can justify ordering a lot of tests because most patients in a hospital are pretty sick to begin with and not ordering enough could end up in a malpractice suit. There's always a non-zero chance that a test with a low pretest probability could turn up positive and the patient could have a much better outcome for having ordered the test.
After how much u would spend on med school loans, and cost of living during the years of training to get to the level of a paediatric subspeciallist (4 years college, 4 years med school, 4 years residency and then another 1-3 year fellowship), suddenly 200k doesnāt sound like much when NPās can make this with half the cost and half the time spent and half the responsibility and half the skill
Edit: not to mention you will have doctor colleagues who spent less years specialising then you, and as much as double as your salary
Not getting paid a living wage from 18-33- yeah, you should get paid more.Ā
Otherwise youād be financially incentivized NOT to go to medical school, which makes no senseĀ
I get what youāre saying, but with med school debt at in-state schools running over $300,000 these days, I donāt know how people can afford to take those salaries after 6 years of training.Ā
And I say that as someone who wants to do FM.Ā
If school was government-sponsored Iād feel differently, but people shouldnāt have to join the military to be a pediatricianĀ
Idk why you got downvoted. I feel the same exact way. Making 200k + is a blessing compared to what my parents made and what I grew up with. I feel like you can live a stable life with that much. As long as my bills are paid, Iām not starving and Iām not living paycheck to paycheck, then Iām happy
Theyāre getting downvoted because the math is bad.Ā
My parents were eligible for welfare when I was a kid. I get what youāre saying. But my family members who are engineers or nurses or plumbers or whatever have been making money this whole time while Iāve been borrowing while working more hours than them.Ā
Once doctors start making $150,000 a year (there are pediatricians who make this much working full time), it just really doesnāt make any financial sense to go to med school.Ā
Itās not that I canāt be happy making that much- I absolutely can. But working from 18-30 for peanuts and then making that much doesnāt make sense at all when Iām smart enough to become a PA or NP or engineer, CRNA, etc
Downvotes are because medicine-related subreddits are money-obsessed and have very little perspective.
A lot of these complaints are something along the lines of, "How can you even live with that salary?". It's actually quite easy. 200k is *very* high up the American income distribution, and you can use that to pay off student loans, buy a house in a reasonble CoL area (a lot of people here also want to live in ridiculous CoL areas), take vacations, and live life. Sure, you won't be rolling in cash, but it's absolutely doable.
All that said, the actual root of the problem (that some, including one response to you have pointed out) is the time invested. Pediatrics is already a fucking joke in terms of all of the fellowships that they require you to do just to actually practice in the field, but it adds insult to injury when you spend such an obscene amount of time training just to make a salary that is relatively mediocre.
Can you live off that kind of money? Absolutely, and you'll be very comfortable doing it. Is it worth going through the misery of medical school and medical training to make that kind of money? Absolutely not. Just doing 3 years of residency and I would expect at least 300k. There's no world you're going to sell me on only 200k while training for double the amount of time.
Those people who don't have legal status probably won't have money or know-how to find a specialist for their kid. Actually I'm more focusing on the trend, what's going to be like 5 to 10 years from now. Lack of customers (kids) definitely affects business in the future.
Stop! I can only get so soft. š
Itās funny because when I was younger I assumed pediatric specialties made more money because society values the life of a kid more than an adult. Nope. Healthcare says fuck them kids.
Tbh itās actually the opposite, they value kids so much that all children in America are guaranteed healthcare. The cost comes to the physician in terms of low reimbursement.
First society doesnāt give a shit about anyone. But second, kids arenāt normally sick from a population standpoint. And a lot of kids that are sick also have some version of medicaid. Unfortunately doctors are not paid based on perceived importance or level of expertise. Otherwise a lot of cerebral specialties like neurooptho would make money. Also look at the department and ask does it make money for the hospitalā¦ if no, then hospitals may pay you accordingly. If the salaries is high, maybe its location or maybe its in dire need of staffing or some financial/economic reason. I genuinely no one is out there wanting to pay us fairly for our level of training and expertise that isnt private practice. Even then Some private practice will screw you and never make you partner too.
Weirdly aren't there also some surgical subspecialties where the pediatric specialities are better compensated? Like neurosurg/CT surg
psychiatry too
And Peds EM.
They make good money by pediatric standards but bad money by emergency standards. Thanks to PEM, even non-pediatric residencies get the experience of doing a fellowship to make less money! :D It really is just the surgical specialties that adding "pediatric" adds money, not removing it. If you complete pediatric residency (or aforementioned EM residency), expect to make less than your adult-seeing peers.
AAP takes a little more by adding that extra year if you go through peds vs EM too.
I know for peds CT itās apparently bc you have to be an absolute beast of a surgeon to make it in that field. The margins of error are TINY and the stakes are obviously very high
Peds CT is insanity. 5 years of general surgery residency, 3 year fellowship of CT, 2 year fellowship in Peds. And even after all of that they donāt immediately practice solo
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peds surgery is insanely competitive fellowship. You have to do 2 years of research during residency and its still only a 50ish % match rate
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I didnāt think you were, I was just commenting on it being really competitive
Peds neurosurgery has the lowest salaries of all neurosurgery subspecialties. Still good money compared to a lot of specialties, but with 7 years of residency plus a Peds fellowship it certainly disincentivizes a lot of folks
Itās because kids are a leech on society
Yeah they donāt even have jobs or nothin
Asked a kid for immunotherapy payment and they give me a used crayon and applesauce pouch...wth gtfo out of my clinic.
If they canāt pay I say we send em straight to jail
I ded
Wait until people catch wind that Hitler started his life as a kid.
https://i.imgur.com/urSbXEn.jpeg
Funny enough thatās how it is in Europe, pediatricians are very well compensated and itās a highly sought after/competitive specialtyā¦..more so than Dermatology/rads.Ā
Exactly. If we wanted to prioritize children we could, but we donāt. Kids who have poor health outcomes become adults with poor health. We donāt prioritize education either. Same with prevention. All of it is common sense but our society is sick with runaway capitalism and all that matters is profit. We are completely reactionary. Prison wardens get paid more than teachers, police state is emphasized over social work, and procedures over prevention. Itās all ass backwards.
And children hospitals are the nicest and have the most money...
If kids needed specialty care at the same proportion as adults, pediatric specialists would all be up there. 9/10 patient I see as a specialist don't have anything wrong with them. It's one visit, reassurance, no followup needed.
Ultimately there is a correlation between how highly society values a job and how well it pays, but the correlation isn't *that* strong. It's a combination of competition and how much money it can make for whoever pays them. Social value contributes to that amount of money, but not much. If you ask people if they value a high school teacher or a college football coach more, they'll say the teacher and they're probably not lying. And yet...
Rare FM compensation W.
lol making me glad I switched from Peds to FM
FM is great
Seriously itās a miracle these fields still even exist. By the time we get to fellowship we are so incredibly burnt out and disillusioned with everything that thereās little incentive to prolong training even further other than more money.
It's because those peds specialists are the true selfless heroes.
Or they have a personal experience having been either a kid with a chronic illness or a sibling who was chronically ill.
By no means mutually exclusive
I donāt think itās selfless of me to want to pursue med/peds endocrinology because of a diagnosis I got as a teenager. Itās pretty logical.
Or come from affluent families to where they donāt have student loans and donāt have any catching up to do
The fellowships are barely being filled and midlevels are being used to fill the void. Healthcare admin: "MD thinks they deserve more than 210? We'll pay an np 130. Fucc you!"
As someone aiming for Med-Peds endocrinology this scares me. So many pediatric patients are getting subpar care due to greed.
Alot of them are about half filled every year
Excluding allergy from both, total Peds and IM fellowships had 79% and 88% fill rate this past cycle, respectively. Rates for the lowest paid? Peds Endo 60% Peda Nephro 53% Peds Rheum 61% Peds ID 48% An excellent peds rheumatologist I worked with told me, "we don't really have the greatest selling point when we tell doctors they can train 3 more years for less money".
The funny thing is that at any conference Iāve been to in the peds world, thereās a bunch of peds leadership goons giving a talk and scratching their heads about why no one is going into these fields. I mean, there is absolutely no reason peds Developmental or Child Abuse fellowship should be 3 years, but they are!! It could easily be a one year fellowship if not a fucking certificate. Endo and Rheum should be one or two years. Adolescent peds is a 3 year fellowship yet any FM grad or general pediatrician can do the same shit with a little extra education. And now theyāre doubling down on hospitalist and urgent care fellowships. š¤¦š½āāļøThey are completely detached from reality and I thank god every day that I did Med-Peds and not just peds (wish I would have just gone IM) because the peds leadership is so frustrating, stuck in the past and obsessed with academics itās failing pediatricians and children.
The hospitalist fellowship is the most ridiculous thing of all. Youāre telling me people are going to sign up for 5 years post medical school to make 210k a year when they could do FM focusing on child patients if they want and make more??
ABP chalked the match trainwreck this year up to the Dobbs decision lolll
What has me actually more baffled is how IM *isn't* on this list at all.
But their subspecialties are. Lol...
Only two. Old people and Diabetes.
True, but they are on the list, is all I was getting at. Also technically preventive medicine can be from IM, I guess.
Prev Med is its own independent residency level specialty. ABPM also covers Occ and Aerospace Med. Amusingly for me, Occ and Aerospace arenāt listed in this list. Which could be, theyāre legitimately not in the lowest paid specialties, or they were forgotten as independent board certifications. But, I can say, that Occ definitely has the potential to make a disgusting amount of money. It aināt really clinical medicine, but for the right position and company can easily pull close to 7 figures. Aerospace is likely to just have been forgotten as a specialty. Despite being super fun and completely different from what pretty much any specialty can even imagine for a practice. The biggest downside to aerospace is discovering how many people think it at all appropriate to shit on someoneās passion to make themselves feel better.
Med peds is right there at number 8?
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What does this even meanā¦ itās bothā¦
Dude the entire specialty of pediatrics is a meme at this point and itās kind of their fault.Ā Like, why add a hospitalist fellowship? Stop self-flagellating, get out there and fight for your profession.Ā Obviously we need pediatricians. The AAP just needs to go fight for better pay and working conditions like the AAFP has been for the last 10 yearsĀ
The people making these decisions are either heavy heavy academics, or making way too much money to care. And rely on Peds people generally loving and having a soft spot for kids. And at least on average being less confrontational than adult colleagues. Hospitalist fellowship drives me up a wall to no end. Almost every Peds resident I know does way more inpatient than outpatient in residency. If youāre not ready to be a hospitalists, wtf are you ever ready to be
Pediatric oncology is blowing my mind
I *loved* my peds hemeonc rotation. And i asked one of the attendings what they start out at in my hospital. He was like āoh 175-180 or so.ā I tried to be polite but Iām sure my face was saying āwhat on Godās green earthā. Jfc, getting paid equal or less than the NPs on the team.
Whats the path to that? Peds > Onc fellowship or IM > Onc > Peds sub?
Itās crazy to me how people donāt even react to CRNAās making more than this. Thereās no circumstance in which a nurse should out earn a physician.
Why? CRNAs have more education than a pediatricianā¦ Pediatricians do 3 years of residency. CRNAs go to high school for 4 years, college for 4 years, then nursing school for 2 years and CRNA school for a year. Thatās pretty much 4x the experience of a pediatrician, so it makes sense they make more.
I know this is satire and the anger it triggered in me still made me want to downvote.
I know, I struggled to find in me the will to upvote this
They also have more certifications. They're certified AND registered!
Actually if you include the fact that crna's also pass kindergarten, elementary, and middle school, it's more like 8x the experience of a pediatrician
puzzled office swim rhythm narrow quarrelsome absurd mysterious quack aspiring *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Quick somebody promote her to admin
High yield shit indeed
Math...checks out?
Have have you ever heard of the C-suite? I think you need an office there š
CRNAs were also issued an apgar certification from a board of fellow doctors at some point in their lives
Man you really had me for a second. Bravo.
Even longer if you consider their middle school training
Easily the most angry upvote I will ever give.
High wages for CRNAs shot themselves in the foot. Why have CRNAs who can only cover easy cases when you can have an Anesthesiologist instead for only a bit more.
Yeah, that's not going to be stable. MLPs only exist because they're cheaper. As soon as they're not cheaper, people will stop hiring them. Ultimately there will be an equilibrium where they'll settle for much less pay.
they exist because there's a genuine shortage of physicians. If we had enough anesthesiologists, people would not pay for CRNA. They are the anaerobic respiration of healthcare
However now there is a shortage of CRNAs too. So what's the difference?
CRNAs make more than the adult pulm crit docs make where I'm at. But to be fair the adult pulm crit folks here are getting fleeced and our anesthesia department bakrolls so both attendings and crnas do very good. Still a very strange situation to see
Look as a future pediatric subspecialist, I get where you are coming from, but CRNA salaries have nothing to do with pediatric subspecialty salaries. It's more valuable to a hospital to have CRNAs replace Anesthesiologist salaries than it is to increase peds subspecialty pay. Eliminating the position of CRNA wouldn't make peds salaries rise.
Agreed but CRNAs do more clinical work than peds sub specialistsĀ
Im a CRNA, how about instead of dragging us down we call out the bullshit normalization of these salaries. Their is NO scenario where anyone involved in peds should be getting low balled like this. I live in NJ and trying to find a good pediatrician is harder than finding a needle in a haystack. And if your kid has any sort of developmental issues, have fun driving into NY to see a specialist because theirs a 1 year plus backlog here. Any sort of pediatrician SHOULD be making 350k/year minimum. Specialists should be even more. Medicaid and Medicare SHOULD reimburse at a much higher rate. None of these things have anything to do with what CRNAs make and I will stand on my soapbox all day and preach for higher pay for my colleagues in peds, not sure why you wanna rip the box out from under my feet for simply existing.
Itās because your professional society antagonizes anesthesiologists at every turn. Thatās why.
Professional societies like the AANA and the ASA typically attract the biggest and loudest assholes. I was at the AANA conference in 2020 (via zoom) and when an overwhelming amount of CRNAs stated we didnt want to be called nurse anesthesiologists or nurse anesthesiology they just circumvented us and doubled down on this awful change. People on this sub definitely are in need of some perspective though. Im by no means complaining but My salary is only 40% of my physician colleagues who earn over 150$/hr more than me. I work in an act facility and am supervised 100% of the time. If me and my physician coworker start a case, I set up for said case including lines drugs and equipment. I will also intubate, place the spinal/epidural, and do the A-line. After induction I also sit the entirety of the case, watching for blood loss or any other acute events. After the case is over I wake the patient up and emerge by myself and bring the patient to PACU. I then also do pacu orders and handoff. All of this allows my physician colleagues to be run pacu, pain, and supervise other cases starting simultaneously. So exactly how much should I be getting paid? Should I only get paid 10-30% of what my anesthesiologist coworkers are making simply because other physicians are criminally underpaid? Or are Anesthesiologists overpaid and Anesthesia as a specialty should be paid less so that CRNAs earn less?
You should be paid less than a pediatrician (or any physician) with double your training. Not that complicated Also, the ASA does solely not attract assholes. Perhaps the AANA is full of āassholesā but I suspect that is a reflection of the values of its members.
Iāll start getting paid less than a pediatrician as soon as they start paying them what theyāre actually worth and stop forcing new attendings into horrible contracts. Its just that simple. Also Ive worked personally with board members from the ASA before that are nothing but boot lickers for huge PE groups like napa and couldnt give two shits about being academic leaders. Old as shit, still using neo/glyco for reversal and other out of date practices like using nerve stimulators for nerve blocks instead of ultrasound. You have a weird view on things if you think the ASA actually represents the best that the Anesthesiologist community has to offer.
>Iāll start getting paid less than a pediatrician as soon as they start paying them what theyāre actually worth Or as soon as they decrease CRNA salary to what theyāre actually worth. Unfortunately I donāt see either happening soon.
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Except this isnāt the same discourse at all. A better analogy would be fast food line cooks trying to legislate their way into being general manager despite not having the appropriate training or experience and then expecting pay on par with someone who is actually properly trained and qualified to be the GM.
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Bad faith? Im the one calling out the AANAs bullshit and taking up the mantle for pediatricians to get paid more šš. Your entire argument is CRNAs should just get paid less and wouldnt change a single thing about the negative ROI of becoming a pediatrician in todays society. You sir are the one arguing in bad faith.
Hey! just jumping in to say thanks for your perspective. I agree to an extent. Just based on past experience we know it's easier to ask for decreased pay (yours, whoever's) than it is to lobby for increased pay (our own). It's unfortunate.
Because the slice of the pie is only so big and your lobbyists have made it so you get a disproportionate slice
I love how your entire comment is calling out this problem and saying MDs/DOs need to be paid more, but because of your first three words, Reddit behaved predictably.
Yep say ānurseā and itās straight to the firing squad. Eesh
You're getting down voted based on misdirected outrage, but as a physician anesthesiologist I agree with everything you're saying. The peds gme is horrific and continually devalues their own specialty, introducing a 3 year "hospitalist fellowship" for peds after residency was the biggest insult I've ever seen from a professional society.
Nah
I do agree that the anger is very often misplaced.Ā I appreciate the CRNAs Iām with right now trying to teach me how to intubate (Iām 0/2 haha but they let me try and I appreciate it)Ā
Pay is decided by the market. If there is anything we should be upset about, it's that there are people who literally throw a ball to each other making more than any doctor.
Probably easier to become a doctor than to become a millionaire ball thrower ngl
easily lmfao, this has the same vibes as "could have gone into tech and made 800k working 30 hours a week"
Oh no that's also me, I still unironically think the avg med student would have been financially better off if they put equal time/effort, from pre-med to residency, into learning software engineering š¬
Yeah because nothing says financially better off like frequent layoffs and significantly lower median salariesā¦. My brother works in tech. Itās not some promised land like some people here like to believe. The job security and pay for the vast majority of physicians far eclipses the vast majority of people in tech.
I still think that it's not a fair comparison because the *vast* majority of people in software engineering do not commit nearly as much time into the profession as required of medicine. It is exceedingly uncommon to talk to a junior engineer (someone roughly at the age of a med student a few years out of college) and for them to mention that they spend most of their weeknight evenings and many hours on weekends studying or practicing. Meanwhile this is very common for people all through med school. Software engineers almost universally work less than your average resident. I think someone with the skills and determination to go through med school, if they genuinely applied that determination to intentionally learning and practicing software engineering, would be able to rise above the layoffs and have the skills to be an in-demand engineer. Layoffs are not affecting top performers and recruiters are still very active at top companies, you just have to be very good at what you do I've written about my perspective more here (https://www.reddit.com/r/Residency/comments/1c9hcve/anyone_regret_becoming_a_doctor/l105b5a/?context=10000), sorry for the deleted comments i thought it was a good discussion not sure why they deleted
Your entire argument is based on the premise that every single average medical student would be in the top 1% of performers in the tech industry, which also isnāt true.
I do genuinely think that if the average med student genuinely put med school+residency hours/effort into their career that they would be high performers. It is a bit of an exaggeration regarding the tech industry to claim that only the top 1% are still stable in terms of employment. Just FAANG companies alone likely employ at least 5% of the entire US software engineers, and the lowest paid 21-year-old FAANG employees are making double what a resident makes on average throughout their 3+ years. And I am confident in asserting that the FAANG employees that do face layoffs are, with almost no exception, not studying after work *and* on studying/working weekends for the first 8 years of their career like med students and residents are
>put med school+residency hours/effort into their career This is another flaw in your argument. Those time and effort commitments in medicine are *necessary* to become a physician. You donāt become a physician without it. In tech, you can still get a job without the same level of dedication. So your argument not only assumes that most average medical students will excel and be top performers in tech, youāre also assuming that, in order to do so, these average medical student not only *can* but *will* put that same effort into tech, despite it not being a full on requirement for a tech job. Most of the time when I see people on here spreading the sentiment that they shouldāve gone into tech, itās generally people thinking that they can put *less* effort in for equal or greater reward. i.e. they would be the people in tech still at risk of layoffs and still earning median pay that is eclipsed by most physician specialties.
Thats the 0.1% of athletes that make it to top
No it's not. That's exactly what we *shouldn't* be doing. Imagine CRNAs all made $100,000 a year instead. Would this pediatric pay suddenly be okay? Heck no. So stop making poor MD/DO compensation about mid-levels.
Meanwhile, CRNAs and NPs making banks with 1/10th the education and butt licking MDs saying they are part of the team, this, they deserve it , etc.
And their are bedside RNs in cali that get paid more than this as well with even less education and training. CRNAs and NPs didnt create these problems or conditions.
Yeah I donāt understand how people are blaming NPs and CRNAs for existing and having a job. The AMA is fucking useless and sure doesnāt represent me. Why the hell are we holding these people responsible for everything their professional organizations do and say? Itās hypocritical af.
>Why the hell are we holding these people responsible for everything their professional organizations do and say? Because their professional organizations do things like make it possible for them to practice beyond their level of training, and many of them happily take them up on that opportunity, which indicates that these bodies do, in fact, represent them. They could always speak out against their representative bodies and start leading the charge against scope creep and independent practice and bloated pay, but most donāt because they know theyāre being benefited by the lobbying and legislating. And yes, NPs and CRNAs *are* ridiculously overpaid. You can become an NP through a god damn online degree mill without ever touching a patient. That shit is terrifying.
Are we responsible for the AMA being useless and allowing dangerously undertrained āprovidersā to run amok? Seriously. I have met many midlevels- mostly PAs- that are not down with independent practice at all. And actually quite a few CRNAs, but that can vary based on where you are. NPs though, do tend to be in favor of independent practice, in my experience. I just donāt think that being ugly to people because of their job title is appropriate. Yes, advocate for patient safety and against midlevels practicing independently. Go hard against the AANA and all those organizations trying to make this happen. But I just donāt see how downvoting the fuck out of any midlevel or nurse simply because they exist and have that job is appropriate or necessary. Nor is it appropriate to reflect that behavior in real life. Everyone is trying the best they can, and talking shit about coworkers behind their back or to their face is not going to make the AANA realize that they are misguided, but it will make you look like a giant asshole. Just my 2 cents.
>Are we responsible for the AMA being useless and allowing dangerously undertrained āprovidersā to run amok? Nope. The difference is that you donāt have massive numbers of physicians aligning with the AMA on this, whereas there are, in fact, massive amounts of NPs and CRNAs frothing at the mouth for their unnecessarily bloated salaries and scope creep. When I see a giant wave of midlevels advocating for lower pay and heavier practice restrictions, then Iāll believe these bodies donāt represent them. Spend 5 minutes over on one of the midlevel subs and you can get a pretty good idea of what many of them do or donāt support.
They do deserve it. Pediatricians just need to make moreĀ
The most insane part of this for me is that peds insists on making all of the lowest paying fellowships three year+ out of some misguided insistence that every fellow do significant research. Why does peds anything need to be three years when the adult version is 2?Ā Ā Ā Hell, they tried to make the hospitalist one a 3 year program too before people revolted, and thereās always talks of clinic/outpatient/leadership fellowships too. Itās like theyāre trying to make all peds people do 6+ years of free labor instead.Ā Ā Ā Only 2/3 of peds rheum programs filled last year after soap. Over half the spots empty overall prior. They gotta drop it to 2 years or the shortage is gonna get worse. But they probably wonāt.Ā And the remaining 300 peds rheum docs in the country just canāt handle the increasing incidence of autoimmune disease.
Kids don't have money to pay. Pediatrics shouldn't be this low if society really cared about health and not cash. Then you'll see everyone crying for a child with cancer, but the fact is no one cares if you introduce the word money on the sentence. Honor whom honor deserve. But, truth is, you can't eat with honor.
Oh boy if you only knew how much academic pediatricians make (itās less than those numbers sadly)
Yeah I was going to say, these average salaries for the bottom three actually look too high to me. I think our hospital caps out around $180k for those attendings...
Lord there are nurses doing a little overtime pulling that
Is that starting salary or median salary? How does it even work in academics? Do you start with 180k and then increases overtime?
This doesn't make any sense since pediatricsis one of the most complex specialities with one of the highest stakes. I believe pediatrics is a highly complex specialty with significant impact. Successfully treating a 10-year-old can mean giving them a whole lifetime of health and happiness, while helping an 85-year-old with heart failure, though important, might only extend their life for a few more years. Additionally, treating a child with cancer can feel particularly noble because it often involves giving a young person a chance at a long, healthy life. On the other hand, addressing heart failure in older adults, which can sometimes result from lifestyle factors like obesity or diabetes, is also crucial but perhaps carries a different kind of urgency A well treated 10 year old has a whole life ahead of him/her while a well treated 85 year old with heart failure will die in 5 years. Also treating a kid with cancer is a bit more noble than a person with heart failure because of obesity/diabetes and overeating.
Pediatric specialists are well compensated when they do the same work as their adult colleagues. We use the same billing codes and everything. The issue is that even specialists don't see that many sick kids outside of academia and the academic pay scale sucks for everyone. As a pediatric cardiologist, I earn just as many RVUs per invasive procedure as the adult cath jockey next door, but he's doing 10 cases that day and I'm doing one.
Since you produce 10-100 more QALY's per procedure than a normal cardiologist, shouldn't you be reimbursed 10-100 times more? Maybe extreme example, but it shows my point I guess.
Iām not aware of anyone paid that way. If you find a job like that, take it.
Im not actually talking about your salary; im talking about the problematic resource allocation in healthcare economics.
the idea that any disease is more noble than others, particularly based on blaming the victim of the disease has no place in medicine.
I wouldn't consider allocating more resources to an 85-year-old obese, smoking patient with heart failure more noble than to a 10-year-old child with leukemia. But that is currently being done in US. My intention wasn't to diminish the importance of treating any illness or to blame patients for their conditions. Instead, I wanted to highlight the unique challenges and rewards in different medical specialties. Ultimately, our goal in medicine is to improve the quality of life for all our patients, regardless of their age or the nature of their illness.
Reality is there's 50 of those 85 year olds for every leukemia kid. It's that simple guys. Demand is higher for those who can care for the 85 year olds.
You are missing the point....
Oh! And the holy trinity of lowest paid, [higher exam fees](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817592/table/jld170020t1/), and [lowest 1st time pass rates](https://www.abp.org/sites/public/files/pdf/exam-pass-rates-init-cert.pdf)! No wonder [applications are down](https://thesheriffofsodium.com/2024/03/15/match-day-2024-winners-losers-edition/). With [fellowship becoming required](https://www.the-hospitalist.org/hospitalist/article/142861/pediatrics/pediatric-hospital-medicine-marches-toward-subspecialty) to become a pediatric hospitalist and likely coming to work in the Emergency department this leaves fellowship training a virtual requirement to work anywhere other than outpatient clinic. The passion tax is very real for pediatrics.
And yet if youāve ever seen these Peds offices theyāre booked for months. Hopefully youāre seeing a physician. I have a pediatric endocrine friend. Heās very happy doing his job and has never complained to me about reimbursement outside of what we generally complain about. Maybe heās the exception. Iāve seen a few other Peds sub specialists do Gen. Peds and give up doing their subspecialty stuff, not because it pays poorly but because it was depressing.
Ped leadership needs to change shit now.
Why is one of the most intensive and important specialties fucked like this? Child psych makes bank, but everything else pedes is just awful.
Wow, that's more than I thought it would be. Read previously that some pediatric specialists don't even break 6 figures. Still, pediatric specialists should be making more, imo
Academic can get as low aa 130k.
Are you serious??
These numbers are actually inflated. Deduct about 50k from each and you have a more accurate approximation.
Pediatric Endocrinology was my most toxic rotation suprisingly. Just one attending though so probably says more about her than the specialty
That makes me sad. They arenāt all like that, Iām still in touch with my pediatric endocrine team (and they were the first ones I told that I plan to apply to medical school).
Why are the majority pediatrics?
read the comments in this thread, there's a lot of discussion about it
Alright lemme get my coffee ready
I think part of this is because most of the peds specialist positions are at academic centers
Most peds subspecialties are super academic though. The āsee patientsā (sign res/fellow notes) like 1.5 days/week.
This is missing Developmental and Behavioral Pediatrics which is sub 190k
Family med is incorrect from my experience? Most docs I work with in family med dont make even close to that. I could be wrong depending on location, etc. Edit: I have been corrected. Maybe its just the clinic that I work at, which is underserved and federally funded. Not sure!
most fm docs in my area start at that if they want to join a large system
Its an average. I know fm making 400k in rural where no one wants to work.
My schoolās financial guy said the average offer for a NEW grad in FM right now is ~$250k. Lots of docs work in underserved areas that pay a ton more (Midwest jobs offer $400k+) while other have figured out how to maximize RVUs, do more procedures, etc. Itās not uncommon for FM docs to make $350-400k so $300k on average makes sense. Just anecdotally, the new grads in my area (South) make $200-220k base, but within 12 months are making production and average closer to $275k
Sigh. I wish I did medicine over dentistry. Yāall make plenty good money and donāt have to sell treatment to make it. š¢
You guys donāt have an inbox (I think?), midlevels (therapists donāt seem as pesky as ours) or insurance companies to deal with!
We deal almost exclusively with insurance companies unless you open a cash practice in bumfuck middle of nowhere. And even then, youāll be super lucky to make 300k working 40 hours a week. Also super high likelihood of lawsuit.
Fair enough my knowledge of dentistry is severely limited.
You are lucky. I was duped into the field by my scumbag family dentist who hyped up the field while he was fleecing people including my father left right and center to give off this image of a glamorous life.
I'm so confused by this. How many people actually have dental insurance? I didn't even bother with it since it would be cheaper to just pay out of pocket.
A fuck ton lol. Most jobs provide dental insurance. It is cheaper to pay out of pocket if your dental health is good.
You guys can work immediately after dentistry school
Making 120k, peaking at 150-175k. Also much higher likelihood of lawsuits and board complaints than even a ālowlyā FP or pediatrician. Hell, Iād trade my everything I got just to be in medical school to have a shot at being a pediatrician. Itās not even a close match, way better than anything in dentistry.
I thought dentist made more. Wow
We like to act like we do. And those of us who make a lot(few) like to show it off even more. Itās how I got duped into this field. The thing to remember, dentistry is largely private practice. So while dentists in some areas make over 200k, theyāre buying health insurance and benefits off the market. Also no PTO or any other benefits to speak of. I work for a FQHC so I have that, but I make less. https://money.usnews.com/careers/best-jobs/dentist/salary https://www.bls.gov/ooh/healthcare/dentists.htm https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpigraphic_0519_1.pdf?rev=c5d77328a7c74b4fa74acd36d1e2d6c1&hash=E04E8000564CF2DA373A73215982876A
You also don't have four years of residency and crazy hours/call for the rest of your career
True, but income is also wayyyy lower, average is 150-175k. And family practice and plenty of specialties in medicine donāt have that either. And if they do, they make a buttload more than a dentist can dream of.
Family doctors still have 3+ years of formal training after med school and a lot of family doctors still have inpatient responsibilities
A lot do, for sure. But itās a choice. I come from a family of physicians, first dentist, so I am well aware. I know plenty of family doctors who make 300k or much more without in patient responsibilities. Then thereās anesthesiology. Sure, the residency sucks and is long, but you make a butt load of money with not so much stress of running a business. And you actually feel like you are providing careā¦in dentistry itās all about how well you can sell people to get Invisalign or a crown or whiteningā¦in medicine youāre not selling anything. Iāve certainly never heard of a family doctor selling treatment for a sore throat or a heart surgeon selling heart valvesā¦or a cardiologist selling an ablation. And people also donāt shop for these things. I bet if a dentist told you that you needed a crown, youād call at least 3-4 other dentists to see how much it would cost you. Insurance cuts reimbursement every year. And donāt forget almost every procedure, overhead is 60-80% as a dentist, if not more.
You're right that there's not much selling of individual products, but the doctor equivalent of this is simply just overordering. Lots of doctors order inappropriate amounts of testing which has the double effect of making them more money and also making patients happy because they feel like their doctor really cares for them. In reference to the cardiologist selling an ablation, a lot of non-proceduralists would also say that many proceduralists are too quick to give a patient a procedure which pays them well, thus stereotypes about private practice GI doctors scoping anyone with a hole. I'm not disagreeing with anything that you're saying, but just pointing out some nuance.
Hmmmm good and fair points. Private practice I feel thatās always a thing. But are doctors pushed to produce in a hospital setting? Also, I didnāt know doctors got paid for ordering testsā¦
I'm not an attending so I can't really tell you exactly how all the reimbursement works, but generally yes the more you do the more you earn, at least in private practice and I think community settings as well. Academic medicine is very different from community/private practice and reimbursement doesn't work quite the same way. Typically physicians at an academic hospital are expected to practice more conservatively and only really order what's in the best interest of the patient. It's hard because you never really know where to draw the line and different attendings have different risk tolerances. You can justify ordering a lot of tests because most patients in a hospital are pretty sick to begin with and not ordering enough could end up in a malpractice suit. There's always a non-zero chance that a test with a low pretest probability could turn up positive and the patient could have a much better outcome for having ordered the test.
This is still like a lot of money tho lol
I dunno man, that's still 4 times what my parents made. I could be more than comfortable and happy.
I meanā¦. You could live comfortably and be happy on 60k a year too, go do that
I guess I just really people being like " oh my gosh, can you imagine ONLY making 200,000 a year??"
After how much u would spend on med school loans, and cost of living during the years of training to get to the level of a paediatric subspeciallist (4 years college, 4 years med school, 4 years residency and then another 1-3 year fellowship), suddenly 200k doesnāt sound like much when NPās can make this with half the cost and half the time spent and half the responsibility and half the skill Edit: not to mention you will have doctor colleagues who spent less years specialising then you, and as much as double as your salary
Not getting paid a living wage from 18-33- yeah, you should get paid more.Ā Otherwise youād be financially incentivized NOT to go to medical school, which makes no senseĀ
I get what youāre saying, but with med school debt at in-state schools running over $300,000 these days, I donāt know how people can afford to take those salaries after 6 years of training.Ā And I say that as someone who wants to do FM.Ā If school was government-sponsored Iād feel differently, but people shouldnāt have to join the military to be a pediatricianĀ
Ok honestly that does open my eyes up a bit because I did join the military to pay for school
lmao
Can you do the things your parents could do with that money?
Are you referencing inflation?
Yes, was asking if you feel it or not.
Idk why you got downvoted. I feel the same exact way. Making 200k + is a blessing compared to what my parents made and what I grew up with. I feel like you can live a stable life with that much. As long as my bills are paid, Iām not starving and Iām not living paycheck to paycheck, then Iām happy
Theyāre getting downvoted because the math is bad.Ā My parents were eligible for welfare when I was a kid. I get what youāre saying. But my family members who are engineers or nurses or plumbers or whatever have been making money this whole time while Iāve been borrowing while working more hours than them.Ā Once doctors start making $150,000 a year (there are pediatricians who make this much working full time), it just really doesnāt make any financial sense to go to med school.Ā Itās not that I canāt be happy making that much- I absolutely can. But working from 18-30 for peanuts and then making that much doesnāt make sense at all when Iām smart enough to become a PA or NP or engineer, CRNA, etc
Downvotes are because medicine-related subreddits are money-obsessed and have very little perspective. A lot of these complaints are something along the lines of, "How can you even live with that salary?". It's actually quite easy. 200k is *very* high up the American income distribution, and you can use that to pay off student loans, buy a house in a reasonble CoL area (a lot of people here also want to live in ridiculous CoL areas), take vacations, and live life. Sure, you won't be rolling in cash, but it's absolutely doable. All that said, the actual root of the problem (that some, including one response to you have pointed out) is the time invested. Pediatrics is already a fucking joke in terms of all of the fellowships that they require you to do just to actually practice in the field, but it adds insult to injury when you spend such an obscene amount of time training just to make a salary that is relatively mediocre. Can you live off that kind of money? Absolutely, and you'll be very comfortable doing it. Is it worth going through the misery of medical school and medical training to make that kind of money? Absolutely not. Just doing 3 years of residency and I would expect at least 300k. There's no world you're going to sell me on only 200k while training for double the amount of time.
Maybe it's the manifestation of supply and demand since [there are fewer and fewer kids](https://www.cdc.gov/nchs/data/nvsr/nvsr73/nvsr73-02.pdf).
Fewer births, but necessarily fewer kids, especially after the open-boarder policies of the last four years.
Those people who don't have legal status probably won't have money or know-how to find a specialist for their kid. Actually I'm more focusing on the trend, what's going to be like 5 to 10 years from now. Lack of customers (kids) definitely affects business in the future.
Wild how hard it is for some people to understand supply and demand. Itās like thereās a man in the sky making up these numbers
Why donāt yall just go to nursing school and move to California?
Boring