Sunday, October 4, 2009


When someone makes a comment about rich doctors, I want to punch them.

The median med school tuition for last year according to AAMC is about $40,000. That is just tuition, not including room and board, academic expenses (some schools require laptop purchase), health insurance, or gas money. I think it's safe to tack on an extra $15,000. So that brings the grand total to $55,000 per year for four years. Doing the math: that's $220,000 in debt before you earn your MD. And that doesn't even count any debt from college.

You would think that after accumulating that kind of debt, you'd be able to go out an earn some money. Not so. My residency salary right out of medical school was $40,000 per year. Are you sick yet?

Then you do something insane like go and have a baby during residency. You need a bigger apartment and now a nanny or daycare. Once we had a child, my entire salary after taxes went directly to the nanny. But I accepted it, telling myself it was just temporary while I was in training.

I swore to myself that after I finished residency, I wouldn't worry about money anymore. Then I found a fellowship that I wanted so badly, but I knew the salary was nowhere near what I'd make in the private sector. It was a job I knew I'd love (and I really do), but part of me felt sick accepting it, considering the high cost of living around here.

So here I am, in my 9th year of medical training, still pinching pennies, making less than some of my friends made right out of college. Everyone asks me when I'm going to have a second child, but when I do the math, I simply can't afford it without having a negative monthly balance. I'm a doctor and I can only afford to have one child. Something about that seems a little off to me. People look at me weird when I say it.

I think to myself, "Did I do something wrong? Why am I still struggling to make ends meet?" I could moonlight, but that would involve working extra weekends, when I had vowed to spend more time with my daughter when residency finally ended.

I was at the ice cream store yesterday with my daughter. I was staring at the menu, struggling to decide if I wanted to pay an extra dollar to get the medium instead of the small. The small will be enough, I told myself, it's not worth the extra money. The ice cream is such a rip off. And as I contemplate this, I think to myself, "This is crazy, this is ridiculous, I shouldn't be worried about spending an extra dollar on ice cream... I'm a DOCTOR."

And then I get the small ice cream.


  1. "Once we had a child, my entire salary after taxes went directly to the nanny."

    Hi Fizzy,

    Had to comment on the above statement. While I often am tempted to say this myself, a wise friend and colleague reminded me that having a child and paying the related costs are a FAMILY decision. So the money used is FAMILY money, not yours or mine. The child is a member of the FAMILY.

    That helps me a lot. Almost as much as the nanny does!

  2. Well.... I wouldn't say that the *money* was mine specifically... but it was my *salary* that was being paid directly to the nanny. Once we get our own variety TV show on FOX with a single paycheck, I can refer to it as the family's salary, but for now, it's my salary :P

    Anyway, the point was that I was not doing so good financially.

  3. F, I thought Tigermom's comment was pretty sanctimonious frankly. It's not like you resented your daughter for stealing all YOUR precious money or anything. Sheesh. Children are expensive and residents don't make squat.

    I'm glad you're enjoying your fellowship!

  4. I totally get where you're coming from. Now 5 years out of residency, still about 200,000 in educational loans, husband makes much less than me (and sometimes nothing at all). Have 2 kids and struggling to pay the daycare bills and our mortgage (on a very normal house). It's amazing how a large salary can amount to very little take home money.

  5. Having a child is a decision that should be made knowing well that children are expensive and will require a large fraction of your salary. I'm sorry, but I cannot feel sorry for you when you have made this decision for yourself. There are many expenses in life that cannot be helped, but having a child is not one of them. Enjoy your career for what it is, and not for the money you feel that you should be making.

  6. Dear colleagues,

    Let me clarify some of my thoughts. I spoke of my own situation in which I am married to a man who also makes a salary from his job and we have kids together. So, yes, for me, the child care is paid for with money from the family. The child care benefits not only the kids, but also both of us.

    Good, caring, reliable child care enables both of us to work with our hearts and minds focused on work when we are there and know that our kids are well cared for and safe.

    I certainly cannot speak to anyone else's financial situation and if I were the sole breadwinner, yes the money for the child care wold literally be from my job, but still benefit other people in the family. I do not, of course, know others' financial situations.

    Old MD girl, when I first read your comment I paused to think about whether or not my comment sounded sanctimonious. Certainly I did not intend it that way. Feel free to ignore my comment.

    I do notice that often we/I/people do ascribe childcare and related issues - choosing it, paying for it, covering for it when the childcare is not available, getting the kids there and back - inordinately falls upon the mother in a male/female parenting relationship.

    Should the mother have that primary responsibility?

    Why do we often make that assumption?

    I do think that phrase, that I also used, that 'my whole salary goes to the nanny/day care' makes that assumption as well.

  7. Here in Ontario, it's more like 60k...but that includes living expenses, if you can live off of 25k a year with a child. It's expensive, especially if youre a single mom.

  8. "I'm sorry, but I cannot feel sorry for you when you have made this decision for yourself."

    To anonymous:
    Are you kidding me!?!? If you are going to be critical you might as well tell us who you are. I don't think Fizzy was looking for any pity here, just some understanding.

    P.S. All the husband-fathers around here get the kid to and from daycare. Doctors appts. Etc.

  9. Also, our decision to have our next child will definitely not be based purely on economics. My parents did it with a heck of a lot less than I have... and I spent the entire afternoon with having fun with my adult siblings. Not every family is like that. Just makes me realize, some things are more important the money you had (or didn't have) in your late 20s/early 30s.

  10. Please read this:

    I'm not asking anyone to feel sorry for me. Everybody is reading this post as being about the high cost of having a child. It isn't! Rather, it's about the low payoff of being a physician. When you start out a quarter of a million dollars in debt, your options are kind of limited.

    I'm not upset that my child is draining my financial resources... I just feel that after working so much harder than many of my college friends for SO many years, I ought to have more financial resources so that I could afford more children. There are people in much less humanitarian fields who are so much more financially secure than physicians.

  11. Thanks for defending me, TR. My decision to wait on a second child isn't entirely economic. Despite the fact that I can't afford another child, if I wanted one right now, I'm sure we'd figure out a way. But right now, I'm enjoying spending more time with my daughter without the exhaustion fo pregnancy or a new baby.

  12. I'm a second-year medical student, and semantics/gender roles/etc aside I really appreciated this post. It also almost made me start hyperventilating, but only because it confirmed what I've already realized.
    My husband and I would like to have children while I'm in residency--it's the natural progression for our marriage, I've/we've felt ready to have a baby for a few years now, and I don't want "AMA" stamped all over my chart if I can help it :). And, assuming that everything goes as planned, it's going to be logistical/financial chaos.
    This post didn't make me feel any better, but I do appreciate knowing that other people have gone through these things. It means a lot.

  13. I had the same experience. After a 5 year residency/fellowship, during which my salary went solely for rent (high rent, to be sure, so that the kids could go to a relatively safe public school), I'm now in my first "real job". I'm working with an underserved population, and although my salary is better than before, I still choose the small ice cream. I don't think that will ever change!

    Hang in there. It's a good job in so many ways.

  14. Fizzy

    How much will you make after fellowship working 40 hr\weeks atleast 200k for next 25 years if you retire before 60. Thats a lot of money!

  15. Average debt for medical school graduates is currently about $140,000. That's comparable to average debt for veterinary school graduates, currently about $130,000. The difference is that ten years after finishing school, the average physician will make about twice the salary of the average veterinarian. Consider that nowadays, about half of all veterinarians go on to internships and residencies (though we don't have to in order to practice). If your debt is much higher, take a look at your decisions in selecting a medical school and college and your spending habits. Then take responsibility and trim where you can.

    As a practicing veterinarian, I still order the small ice cream cone for myself! I don't have children and it's probably a good thing I don't want any, either, because I have no idea how I'd afford them. Never mind time off for maternity leave, which would almost certainly be unpaid, because I work for a small business rather than a hospital or physicians' group.

    So I'm not disturbed at all by the fact that many young physicians must be careful with their money. Rather, I'm baffled that some physicians feel exempt from worries common to, well, the common folk. Why do physicians feel they're somehow, dare-I-say, entitled? Why should the non-physician feel any sympathy for those who chose their profession freely?

    Laughable, except it isn't funny.

  16. Might be interesting to look at some of the underlying assumptions about money here. Fizzy compares herself with people fresh out of college who made more than she does now after her long training, and appears to feel that she should not be making less than them. Does that make her feel "entitled"? Or is it just that she wants what's fair? Can you ask for such a thing as fairness, as far as salaries are concerned? And, since we're on MIM, would the same assumptions rule if Fizzy were a guy? Women make 10-30 % less than men in all industrialized countries FOR THE SAME JOB. Different assumptions about what is ok to ask for oneself as a woman is at the root of that disparity.

  17. Actually, you've made your own point: what is fairness, where salaries are concerned?

    My point is that I've had similar, long, expensive training Fizzy had, BY CHOICE, and I certainly don't feel entitled to a pile of money simply because I'm a veterinarian. Sure, some of my high school classmates who never attended college make more money than I do. So what? Becoming a veterinarian was my choice, just as becoming a physician was Fizzy's choice. I could have attended medical school, or, even better, dental or law school, but elected to attend veterinary school. My choice.

    As for Fizzy's argument about debt - I'd be surprised to hear that debt is significantly higher for women vs. men. And debt vs. salary seems to be a major issue.

    I still don't think physicians (or veterinarians) should make more money simply because school is expensive. There are cheaper medical and veterinary schools; it isn't necessary to attend Harvard (or Tufts, on the veterinary side). These are all choices.

    Oh, and I am a woman, too, as were 80% of my veterinary school classmates.

  18. Actually, I wasn't trying to make a point other than that people (including women) appear to be less accepting of women wanting financial rewards.
    I think it would be impossible to say what's fair or not for salary for anyone.

  19. Well, I think Anonymous made a good point, but then again, so did Anonymous. And I totally disagree with what Anonymous said.

    Come on, people, man up and at least come up with a name for yourself! Just to avoid confusion of the war of the Anonymous.

    In response to veterinarian Anonymous, I'd be equally pissed off if I went into some other career that required a long expensive training, then was making less money than my classmates right out of high school.

    Someone mentioned (I believe it was Anonymous) that I'd be making $200,000 for the next 25 years after fellowship. That's a big assumption. What if I don't want to take the kind of private sector job that pays that kind of money? It's a big problem among physicians that we tend to shy away from lower paying but more needed and/or fulfilling jobs just because we're completely crushed by loans.

    And as for choosing a more expensive school... all private medical schools are equally expensive, whether Harvard or Bumfuck University. There are public schools but those can actually be harder to get into due to their lower tuition. The UC schools are incredibly competitive to get into.

  20. For what it's worth, I am the second-year-medical-student-Anonymous, and I actually attend a UC. And it's still $50k/year with living costs. And that was the smart choice.

  21. Fizzy is correct that the low payoff in becoming a physician is a problem. One of the big issues in this discussion is physician income relative to length of training, responsibility, long hours worked, rewarding but often unpleasant work. I have no objection to low income IF I'm serving a poor population and decide to be do humanitarian work. I did some of this type work early in my career and some day, after retirement, may do it again. The resentment is that physicians are devalued, both men and women, and the "fruit of our labor" is being ripped of by the middle man -the insurance companies. Why should we sacrifice so much in our personal lives so that the CEO of Aetna can make $30 million+ per year?
    Every one needs their own solution; mine was to go into my own practice that doesn't accept insurance. Outcome is happy patients, happy physician.

  22. Why waste energy being "pissed off" because your high school classmate the plumber makes more money than you, the physician (or me, the veterinarian, or my college housemate, the PhD in English)? At least now I see where you're coming from, though I don't understand you at all.

    You had a choice. We all did. Live with it.

    I have no sympathy re: competition for admission to a state school. So what? Take a few years off to improve your application by working in a related field (research, clinical, whatever).

    Oh, and I have no problem with women making a lot of money. I am comfortable. One of my friends chose the Army, then Wall Street. Good for her. Another chose medical school and now works part time because she's had two children - somehow, she can afford to do so, even on a part time salary. But she attended a state school. Hmm.

  23. I repeat, I don't want sympathy. I'm just sharing my frustration. You can see why this is frustrating, right?

    Let's be civil and drop the sarcasm, huh?

  24. I understand the frustration, Fizzy. Life is a series of choices. Even when you're happy, you're not exempt from the "what if" game.

  25. Vet Anonymous and all others,

    A fair salary is one that adequately rewards the training, skills, risks and sacrifices involved in the job. Therefore, an aerospace engineer should be paid significantly more than a plumber. That's not to belittle the plumber, it's just fair.

    From an economic and social standpoint, any career has to offer a salary high enough to attract workers capable of doing the job competently. If the salary gets lowered across the board, the workforce will be poorer quality. This is a problem we face in health care. Bright, capable students are not going to go into medicine if they can't anticipate a appropriate reward for their work. That's just basic economics, and it's reality.

    Fizzy should certainly make more money than someone with a high school degree. She should make LOTS more money. Would you buy an investment if you didn't expect a good return on it? Fizzy should not feel guilty about expecting a return on her investment of time, training, and hard work.

    She should also make more money than a vet, since the risk of taking care of humans is higher than that of taking care of animals, and since she probably takes a lot more call and spends a lot longer hours. That's not to say vets don't deserve to make more than house painters. They should.

    So, Fizzy, I agree you should feel frustrated. I hope things improve as your career progresses. Hang in there! Don't listen to anybody that tries to make you feel guilty for wanting financial success commensurate with your position.

    Anonymous, get off your high horse. We don't want or need your sympathy or your condescension.

  26. You articulated my feelings perfectly, gcs15. I have nothing else to add.