I just wanted to introduce myself. My name is Alicia and I will be a college freshman in the fall. I've been reading this blog for about 2 years on and off. It's funny how I always come across the same blogs and websites over the years as old interests become re-ignited. I rediscovered ERE for the 4th or 5th time a few months ago and I've been checking back everyday since then.
A little bit about my financial situation: It is my goal to graduate college and medical school debt-free (or as debt-free as possible). I currently have a scholarship covering most of my tuition, but I have a chronic illness that prevents me from holding down a job at the moment. My parents are paying whatever incidentals are not covered by my scholarship, but I'm keeping track of the expenses and plan on paying them back in the future (they just don't know it yet).
My ultimate goal is to become financially independent BEFORE I become a doctor. I do not want to rely on my patients for income because I want to be affordable to all. With expenses such as physician's insurance, employee salaries and benefits, medical supplies, rent, etc. there won't be much money left for me--and I'm okay with that. I haven't quite figured out how I'm going to charge my patients yet, but I still have a long time to figure that out.
If you have any questions or comments please post. And thanks for creating this forum, Jacob. I'm very excited!
Alicia
Hello everyone! --introductions from a college student
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Concojones
- Posts: 117
- Joined: Fri Jul 23, 2010 6:57 am
"Affordable to all" ... wow, that's really noble!
A few thoughts:
I suppose you want to be affordable not to insurance companies but to people who are not insured or have to pay a big chunk out of pocket. Now, the income you'll get from insurance companies alone is probably more than adequate for a lavish lifestyle, allowing you to treat the other patients for free. In return, you could require them not to sue you, which might eliminate your insurance partly or entirely. I'm just a layman so you'll want to discuss this with real doctors. You might very well find you don't need financial independence after all.
A few thoughts:
I suppose you want to be affordable not to insurance companies but to people who are not insured or have to pay a big chunk out of pocket. Now, the income you'll get from insurance companies alone is probably more than adequate for a lavish lifestyle, allowing you to treat the other patients for free. In return, you could require them not to sue you, which might eliminate your insurance partly or entirely. I'm just a layman so you'll want to discuss this with real doctors. You might very well find you don't need financial independence after all.
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futuredoctor
- Posts: 34
- Joined: Tue Jul 27, 2010 4:03 am
Note: I changed my user name from alicia to futuredoctor. I figured most of my posts would have something to do with this subject so why not make my username more memorable?
The problem with insurance companies is that they put limitations and quotas on the doctors who "contract" with them. My knowledge on the subject is limited, but most of the specialists I visit don't accept insurance because of these reasons. What my family does is send the receipt to our insurance company, which arbitrarily decides if and how much of the costs they will reimburse.
Having had this experience, I pretty much assumed I wouldn't take insurance as a physician because I don't want the decisions I make for my patients to be controlled by bureaucracy. I think it would be a good idea to talk to some doctors and get a better idea of how this works. Maybe I could take insurance from a few select companies and that would lessen some of my financial needs like you mentioned.
Now, if I didn't take any insurance, the problem of how much to charge arises. Some people do have insurance and after being reimbursed would pay nothing out of pocket. Those without insurance would obviously not have that much money to spend. I don't know if it's really fair to charge some people and not others, like you mentioned, but what about charging on percentage of income? It's just an idea I had but I know that could get complicated.
The problem with insurance companies is that they put limitations and quotas on the doctors who "contract" with them. My knowledge on the subject is limited, but most of the specialists I visit don't accept insurance because of these reasons. What my family does is send the receipt to our insurance company, which arbitrarily decides if and how much of the costs they will reimburse.
Having had this experience, I pretty much assumed I wouldn't take insurance as a physician because I don't want the decisions I make for my patients to be controlled by bureaucracy. I think it would be a good idea to talk to some doctors and get a better idea of how this works. Maybe I could take insurance from a few select companies and that would lessen some of my financial needs like you mentioned.
Now, if I didn't take any insurance, the problem of how much to charge arises. Some people do have insurance and after being reimbursed would pay nothing out of pocket. Those without insurance would obviously not have that much money to spend. I don't know if it's really fair to charge some people and not others, like you mentioned, but what about charging on percentage of income? It's just an idea I had but I know that could get complicated.
Futuredoctor, your goals are noble, and believe it or not there are many, many people who go into medicine with the same idea. Sadly, most stray from the path... There are a million reasons for this, some of them are actually quite sad. Some people do make it work though, and there's no reason you can't be one of them.
You can get medical training without debt by doing an MD/PhD program. Sometimes these are called MSTPs (medical scientist training program). It's a long haul though--7 or more years before residency, and you'll probably need at least a 3 year residency to do what you're talking about. You can also get your education through the military. There is a military medical school-- USUHS? I think it's called, in Maryland. You owe service for your time in, but not money. In fact you can get the military to pay for you to go to other schools too, but you owe service in return. Also, there are currently government sponsored loan repayment programs for those who work in underserved areas, but these can be quite tricky, and who knows if the programs will still exist in 7 plus years. If you can get citizenship in another country (the EU, for instance) you could theoretically train in Ireland or England and save a lot of money, but you'd be a bit out of place there, and might have a hard time getting accepted. It is possible to do it though-- my cousin moved from Canada to Ireland to get into medical school.
As far as I know, in order to charge people what you want you do have to avoid participating in some insurance plans-- most notably medicare. Medicare has strict rules about charges, and you can get into a lot of trouble, and even go to jail for violating them if you're a participating provider.
In days gone by there were doctors who charged based on income-- the wealthy were charged more than the not wealthy. Initially insurance was actually a really good deal for doctors (and patients), and the profit margins were thick so doctors could collect from insurance companies and make a great living. If a few patients didn't pay, the business was still profitable. Over time though, the margins have been trimmed such that many doctors only make a slim profit on a patient with commercial insurance (why some docs see a patient every 10 minutes, it's not because they want to burn out). Medicare is often a break-even service, and Medicaid is usually a money losing service (this is for the doctor, not the hospital, clinic, drug company, etc...). It can be a difficult choice-- you help no one if your practice goes bankrupt, so often you have to at least limit the amount of free care you provide.
Also, realize that it can be a very difficult task to work tirelessly for years, while bringing home a small salary, but at the same time paying employees who put less effort into the clinic a salary that is 3 or 4 times more than you pay yourself.
On the positive side know this, if you're willing to work for very little or nothing you'll always have job.
You can get medical training without debt by doing an MD/PhD program. Sometimes these are called MSTPs (medical scientist training program). It's a long haul though--7 or more years before residency, and you'll probably need at least a 3 year residency to do what you're talking about. You can also get your education through the military. There is a military medical school-- USUHS? I think it's called, in Maryland. You owe service for your time in, but not money. In fact you can get the military to pay for you to go to other schools too, but you owe service in return. Also, there are currently government sponsored loan repayment programs for those who work in underserved areas, but these can be quite tricky, and who knows if the programs will still exist in 7 plus years. If you can get citizenship in another country (the EU, for instance) you could theoretically train in Ireland or England and save a lot of money, but you'd be a bit out of place there, and might have a hard time getting accepted. It is possible to do it though-- my cousin moved from Canada to Ireland to get into medical school.
As far as I know, in order to charge people what you want you do have to avoid participating in some insurance plans-- most notably medicare. Medicare has strict rules about charges, and you can get into a lot of trouble, and even go to jail for violating them if you're a participating provider.
In days gone by there were doctors who charged based on income-- the wealthy were charged more than the not wealthy. Initially insurance was actually a really good deal for doctors (and patients), and the profit margins were thick so doctors could collect from insurance companies and make a great living. If a few patients didn't pay, the business was still profitable. Over time though, the margins have been trimmed such that many doctors only make a slim profit on a patient with commercial insurance (why some docs see a patient every 10 minutes, it's not because they want to burn out). Medicare is often a break-even service, and Medicaid is usually a money losing service (this is for the doctor, not the hospital, clinic, drug company, etc...). It can be a difficult choice-- you help no one if your practice goes bankrupt, so often you have to at least limit the amount of free care you provide.
Also, realize that it can be a very difficult task to work tirelessly for years, while bringing home a small salary, but at the same time paying employees who put less effort into the clinic a salary that is 3 or 4 times more than you pay yourself.
On the positive side know this, if you're willing to work for very little or nothing you'll always have job.
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futuredoctor
- Posts: 34
- Joined: Tue Jul 27, 2010 4:03 am
Mo- Thank you very much for both of your replies. I’m very excited to be talking to a doctor on ERE! You’re one of the most well-informed people on this forum that I could possibly talk to.
I am aware that it’s going to be difficult to accumulate 500k before I graduate medical school. In fact, I’m positive that I will get nowhere close. However, I think it’s important for me to keep my goal in mind and have something to work towards. I’m certain that if I scrimp and save whatever money I’m able to make and invest it wisely, I’ll be far better off than most of the other medical students I graduate with.
Thank you for your information about the different ways I could go to medical school for free. It’s very helpful and informative and I’ll need to look into those options some more. My whole plan rides on getting through medical school without too much debt. If I can’t do that then I’ll be forced to work a normal job until it’s gone. I agree with you that I might need to work a few years after becoming a doctor in order to reach my approximate goal of 500k. I don’t have a problem doing that.
It’s important to me that I’m financially stable and have enough for retirement/emergencies before I give my livelihood away.
I am aware that it’s going to be difficult to accumulate 500k before I graduate medical school. In fact, I’m positive that I will get nowhere close. However, I think it’s important for me to keep my goal in mind and have something to work towards. I’m certain that if I scrimp and save whatever money I’m able to make and invest it wisely, I’ll be far better off than most of the other medical students I graduate with.
Thank you for your information about the different ways I could go to medical school for free. It’s very helpful and informative and I’ll need to look into those options some more. My whole plan rides on getting through medical school without too much debt. If I can’t do that then I’ll be forced to work a normal job until it’s gone. I agree with you that I might need to work a few years after becoming a doctor in order to reach my approximate goal of 500k. I don’t have a problem doing that.
It’s important to me that I’m financially stable and have enough for retirement/emergencies before I give my livelihood away.
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futuredoctor
- Posts: 34
- Joined: Tue Jul 27, 2010 4:03 am
Also, this comment made me laugh: “In my opinion, you're likely to have a greater net worth at age 30 by becoming a dental hygienist than by going to medical school.”
I’m pretty sure I could have a greater net worth by working at burger king too. The average medical student graduates 100k in the red, no? ;P
I’m pretty sure I could have a greater net worth by working at burger king too. The average medical student graduates 100k in the red, no? ;P
I'm glad you laughed. Often when I read what I write, I think I sound like a pessimistic, cynical jerk. I don't mean to be. What I'm trying to do is present some of the beneath the surface kind of information that might actually be helpful, rather than cheery, but useless junk. I do a LOT of free work, and even work 2 days a month at my local VA. I believe in having a moral/ethical purpose in my career that extends beyond my own salary.
Based on recent numbers, most medical students come out about $150k in the red-- the diff. b/w BK and dental hygienist is probably at least $50k per year in earnings, or $38k+ per year in savings (depending on state of residence, marital status, expense level, work hours, benefits, etc...). I've thought about this a decent amount, and I don't know too many other occupations that offer better ERE potential than dental hygienist-- you could be earning above $50k by age 22 with minimal (if any) student debt.
I think that about 75% of doctors will complain about their jobs and suggest they should have done something else, but I think that less than 25% truly think they would be financially better by not being doctors, and of them only a small minority are correct. It is still the right job for people who want to know, and share, a lot of information about the human body. One person CAN change the world, and you CAN be that person.
I made the right choice for me by becoming a doctor. Some of it totally sucks, and some of it totally rocks, but if I didn't do this I would have regretted it for my entire life. Probably there is an amount of money that would squash that regret, but I'm unlikely to earn that amount, so I play the odds...
Based on recent numbers, most medical students come out about $150k in the red-- the diff. b/w BK and dental hygienist is probably at least $50k per year in earnings, or $38k+ per year in savings (depending on state of residence, marital status, expense level, work hours, benefits, etc...). I've thought about this a decent amount, and I don't know too many other occupations that offer better ERE potential than dental hygienist-- you could be earning above $50k by age 22 with minimal (if any) student debt.
I think that about 75% of doctors will complain about their jobs and suggest they should have done something else, but I think that less than 25% truly think they would be financially better by not being doctors, and of them only a small minority are correct. It is still the right job for people who want to know, and share, a lot of information about the human body. One person CAN change the world, and you CAN be that person.
I made the right choice for me by becoming a doctor. Some of it totally sucks, and some of it totally rocks, but if I didn't do this I would have regretted it for my entire life. Probably there is an amount of money that would squash that regret, but I'm unlikely to earn that amount, so I play the odds...
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futuredoctor
- Posts: 34
- Joined: Tue Jul 27, 2010 4:03 am
No, I really appreciate your input. You know far more than I do, after all. Thanks for the info about dental assistants-- I'll pass it along to some of my friends =). Since I'm not going down that road though, what do you think about my becoming a paramedic? I've been a volunteer EMT for 3 years. I talked to a medic recently on one of my calls and she said classroom training is 1 year, 2 nights a week and most of Saturday (it's designed for full time workers/students). Then there's about a year of further training in the field. The shifts are 12 hours and I believe you can sign up for however many you want whenever you want, so it's very flexible.
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Steve Austin
- Posts: 177
- Joined: Thu Jul 22, 2010 12:17 am
Mo, I may have read something over the past several years claiming that a pharmacist as a career choice has a strong, quick ROI.
futuredoc, 11 years is not a trivial amount of time -- is your approximate goal of USD500k given in real or nominal USD? Significant inflation (or some deflation) are plausible outcomes. Consider the US in the 1940s, the 1970s (especially), or the 1980s for inflation scenarios; 1930s for a deflation scenario.
Thought you may wish to factor this into your 11-year plan: assume some average, like 3% annual inflation. Are you saying that you'd want 500k in today's USD, in which case you'd need close to 700k 11 years from now? Or are you saying that you'd want 500k in nominal USD 11 years from now, in which case it would "feel" like around 360k does today?
And note that these calculations are based upon a mean historical inflation rate in the US; a mean is just a statistic, the real world doesn't always cooperate with our ex post measurements of it. You may wish to tinker around with a higher inflation rate, as well as some protracted deflation, just to see how such outcomes might inform your approach.
futuredoc, 11 years is not a trivial amount of time -- is your approximate goal of USD500k given in real or nominal USD? Significant inflation (or some deflation) are plausible outcomes. Consider the US in the 1940s, the 1970s (especially), or the 1980s for inflation scenarios; 1930s for a deflation scenario.
Thought you may wish to factor this into your 11-year plan: assume some average, like 3% annual inflation. Are you saying that you'd want 500k in today's USD, in which case you'd need close to 700k 11 years from now? Or are you saying that you'd want 500k in nominal USD 11 years from now, in which case it would "feel" like around 360k does today?
And note that these calculations are based upon a mean historical inflation rate in the US; a mean is just a statistic, the real world doesn't always cooperate with our ex post measurements of it. You may wish to tinker around with a higher inflation rate, as well as some protracted deflation, just to see how such outcomes might inform your approach.
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ScottfromMenominee
- Posts: 42
- Joined: Thu Jul 22, 2010 3:00 am
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futuredoctor
- Posts: 34
- Joined: Tue Jul 27, 2010 4:03 am
@Steve, becoming a pharmacist used to be a fantastic way to build net worth. It's still pretty good now. It used to be that you could become a pharmacist by doing a 4 year college program-- kinda like majoring in pharmacy, and in 4 years you were out earning. Where/when I went to medical school, folks in the pharm school did a 4 year undergrad degree in pharmacy, meaning that their undergrad scholarships could cover the costs, so a lot of them were going for free.
Now, it's a 6 year program, and a portion of it is considered a graduate program, thus the scholarships are not as plentiful. Still not a bad deal, though-- be out and earning a good salary in 6 years (age 23-25 for the traditional student), similar to a masters program in many fields, but generally with better pay. Compared to a doctor, where it generally takes 11 years to earn a significant salary, 6 years is pretty short. I don't know the numbers, but I imagine the average pharm student debt is higher now that it's a 6 year program.
Now, it's a 6 year program, and a portion of it is considered a graduate program, thus the scholarships are not as plentiful. Still not a bad deal, though-- be out and earning a good salary in 6 years (age 23-25 for the traditional student), similar to a masters program in many fields, but generally with better pay. Compared to a doctor, where it generally takes 11 years to earn a significant salary, 6 years is pretty short. I don't know the numbers, but I imagine the average pharm student debt is higher now that it's a 6 year program.
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futuredoctor
- Posts: 34
- Joined: Tue Jul 27, 2010 4:03 am
Mo- what's your specialty? I'm also interested to know what your interest in ERE is.
@ Steve Austin- My boyfriend's brother is doing exactly what you both mentioned. He's in his 5th year of pharmacy school. His interest in pharmacy is the large income/low hours.
The 500k in 10 years is an estimate of how much I would need to have 15k every year for the rest of my life (60+ years). 15/0.03=495. Jacob calculated it for me. I believe that factors in inflation as well. Of course, my time limit is not set in stone and I might decide I want more money/year.
@ Steve Austin- My boyfriend's brother is doing exactly what you both mentioned. He's in his 5th year of pharmacy school. His interest in pharmacy is the large income/low hours.
The 500k in 10 years is an estimate of how much I would need to have 15k every year for the rest of my life (60+ years). 15/0.03=495. Jacob calculated it for me. I believe that factors in inflation as well. Of course, my time limit is not set in stone and I might decide I want more money/year.
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Steve Austin
- Posts: 177
- Joined: Thu Jul 22, 2010 12:17 am
futuredoc, yes I believe that rule of thumb does factor in the mean/historical annual inflation. I still find it useful to explicitly calculate inflation against my assumptions and approximations from time to time. E.g. 15k in current USD is pretty close to my current annual after-tax expense (for now, living on the expensive east coast as well). It's somewhat easier for an individual to control the effects of inflation (i.e. adapt as price inflation affects one's environment more broadly), but we should recognize that in 11 years, mean/historical annual inflation says that it will "only feel" like ~11k does today.
I haven't reviewed ERE blog posts on inflation recently, so I could be afoul on this point.
I haven't reviewed ERE blog posts on inflation recently, so I could be afoul on this point.
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Robert Muir
- Posts: 280
- Joined: Thu Jul 22, 2010 10:15 pm
You may want to look into what Jay Parkinson is doing ( http://jayparkinsonmd.com/ ) if you haven't already. He wanted to offer house calls and eliminate a lot of the overhead and bureaucracy, and "just did it" using ordinary Web 2.0 tools like Google Calendar and Paypal.