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Old 09-16-2007, 12:17 PM   #41
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Both are valuable services, I believe. Still, I have made a good living and had a fulfilling career. But as we face health care reimbursement issues, these discrepancies probably will need to be addressed.
It think the discrepancies have already been addressed by the fact that neither of you has switched jobs.

I know you're just using this as an example, but it's a good opportunity to look at the issues in any career-change debate.

Financial: I understand the reimbursement numbers, but what about take-home pay after equipment, support staff, & malpractice insurance? You can probably practice your craft for decades, what about her? I don't have any idea about the costs but I know that focusing on annual income is a risky approach.

Qualitative: While salary gets a lot of attention, there's also the intangibles like quality of work and quality of life. Even if you accepted the higher reimbursement you might be miserable in some other field... or miserable with work in general.

Rich, it'd be a lot harder to replace you with a robot or outsource you to Bumrungrad... but just about any neophyte can open a LASIK clinic these days and that trend will accelerate. Considering the competitive changes in the last decade, if I was a surgeon I'd be looking for a sideline.

When I learned that I wouldn't be a submarine XO, at 12 years of service with eight more years before retirement vesting, I thought my career had slammed into a brick wall. I spent the next eight years in training commands while exploring just about every alternative the Navy had to offer-- and not realizing that I'd already found it. Despite all the choices, it came down to the fact that I was comfortable with who I was and what I was doing, and I didn't want to leave that behind just for the possibility of finding something better. Although it was better than the alternatives, eight years later I still hadn't found my "Aha!" career so I ER'd...

I've had a lot of "Aha!!" moments during ER.
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Old 09-16-2007, 12:45 PM   #42
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Originally Posted by Nords View Post
It think the discrepancies have already been addressed by the fact that neither of you has switched jobs.

I know you're just using this as an example, but it's a good opportunity to look at the issues in any career-change debate.

Financial: I understand the reimbursement numbers, but what about take-home pay after equipment, support staff, & malpractice insurance? You can probably practice your craft for decades, what about her? I don't have any idea about the costs but I know that focusing on annual income is a risky approach.

Qualitative: While salary gets a lot of attention, there's also the intangibles like quality of work and quality of life. Even if you accepted the higher reimbursement you might be miserable in some other field... or miserable with work in general.
Entry and exit costs are high. It's not that easy to switch jobs. To train to be (for example) a brain surgeon can take 10-12 years (of residency hell) after med school. In comparison, a Family Physician can train in as little as two years. To some extent, the higher reimbursement for procedural specialties reflects that differential investment in skills.

Expenses of doing business vary greatly by private vs. public, how much "stuff" you need (psychiatrists obviously don't need much as much equipment as opthalmic surgeons) and by whether you practice in an academic setting. For example, I am an intensivist practicing in tertiary care hospital settings and do not have an office practice. There is no office overhead and I don't have to buy intensive care equipment. I can predict my earnings and plan accordingly. If I were in private practice I would need a business plan like every other small entrepreneur in the service industry.

Regarding quality of life, that's a personal preference. Many surgeons love what they do and it's right for them. There are probably just as many specialists in less physically demanding fields who are bored, frustrated, burned out, etc, and would like to make a change. No job is perfect!
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Old 09-16-2007, 01:23 PM   #43
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No job is perfect!
Nuff said...
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Old 09-16-2007, 02:38 PM   #44
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Yes the grass is always greener on the other side of the fence.

I still like what I do despite the increasing inefficiencies being built into the system. Unfortunately I see the entire US health care system getting alot more broken before a real attempt at fixing it is made. In the meantime we will continue to make good $, some specialties more then others, and many of us will not save or invest it wisely.

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Old 09-16-2007, 07:42 PM   #45
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Several times I have investigated other lines of work and self employment. I never found anything that paid anywhere close to what I was used to and usually required very long hours. Engineering ain't so bad after all.
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