Daily reminder to do the bare minimum

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Daily reminder to do the bare minimum.
Members don't see this ad.
 
  • Like
Reactions: 1 user
GonnaBeADoc2222 said:
LOL.

Lets work out the math in the example @EctopicFetus presented, assuming 1500 hrs / year:

1) $225/HR for 0.5 pph: 338k, 750 patients; $450/patient

2) $300/HR for 2 pph: 450k; 3,000 patients; $150/patient

Option 1 has less patients, more money per patient, less stress, less work, less documenting, less liability.

The choice is abundantly clear.
Click to expand...
I guess it’s all a matter of how long your employer wants to lose money on you for option 1.
 
GonnaBeADoc2222 said:
LOL.

Lets work out the math in the example @EctopicFetus presented, assuming 1500 hrs / year:

1) $225/HR for 0.5 pph: 338k, 750 patients; $450/patient

2) $300/HR for 2 pph: 450k; 3,000 patients; $150/patient

Option 1 has less patients, more money per patient, less stress, less work, less documenting, less liability.

The choice is abundantly clear.
Click to expand...
JacobMcCandles said:
I guess it’s all a matter of how long your employer wants to lose money on you for option 1.
Click to expand...
It’s all just degrees of what it out there. You can find outlying 1 pph sites near me for 180-200/hr.

The purpose of my examples is to weigh the difficulty of time at work with the actual hours at work. I dont mind working quite hard but i want to be at work for as short a time as Possible.

The second examples i made was more akin to 1pph for 200/hr or 300/hr for 2pph or 3 pph for 400/ hr.

Personally as long as it is safe im taking the 3pph for 400/hr.
 
  • Like
Reactions: 2 users
Members don't see this ad :)
JacobMcCandles said:
I guess it’s all a matter of how long your employer wants to lose money on you for option 1.
Click to expand...
They just lost nearly all the docs at my place and are paying me extra to fill some upcoming shifts. Those seem like great shifts for me to do the bare minimum. I see myself at little risk of being let go. They have no warm bodies. But really, I haven't been seeing very many patients on recent shifts, but the ones I've been seeing are sick as hell and time-consuming.
 
  • Like
Reactions: 1 users
EctopicFetus said:
It’s all just degrees of what it out there. You can find outlying 1 pph sites near me for 180-200/hr.

The purpose of my examples is to weigh the difficulty of time at work with the actual hours at work. I dont mind working quite hard but i want to be at work for as short a time as Possible.

The second examples i made was more akin to 1pph for 200/hr or 300/hr for 2pph or 3 pph for 400/ hr.

Personally as long as it is safe im taking the 3pph for 400/hr.
Click to expand...

I'll totally do 3pph for 400 sign me up.
 
More math.

Average 1,500 hours/year.

Job 1: 2 pph at $300/hour = $450K/year for 3,000 patients at $150/patient

Job 2: 1.5 pph at $225/hour = $337.5K for 2,250 patients at $150/patient

Difference of $112.5K/year ($450K - $337.5K) for 750 more patients.

Extra income marginally taxed at 24-32%, but perhaps an effective tax rate of closer to 24% married filed jointly.

$112.5K x 76% = $85.5K extra post-tax income for post-tax investing.

Place all in S&P500 for 20 years with a conservative, inflation adjusted rate of return at 7% results in an extra $3.5M with compounded growth.

Compounded Growth.png


750 patients extra for 20 years results in 15K more patients seen during that time for an extra $3.5M. Equates to $233/patient ($3.5M/15K patients).

I think we'd all take $233/patient as $150/patient after overhead is the gold standard. Very few places collect >$200/patient.

You essentially get to retire 5 years sooner and have a lot more in post-tax investment accounts at that time. Over those next 5 years from age 50-55 you have a better passive income stream and the gap further widens.

Passive Retirement Growth.png


You end up with close to an extra $5M assuming you don't withdraw from this amount and live off of your traditional retirement that you would have otherwise had in your portfolio. All for just working a little harder and seeing 0.5 pph more.

Retiring 5 years sooner saves you from seeing an additional 11,250 patients (2,250 patients/year x 5 years) during that timeframe. 60,000 patients (3K patients/year x 20 years) versus 56,250 patients (2,250 patients/year x 25 years). 3,750 extra patients over 25 years for $5M.

I'll take job 1. Daily reminder to do the bare maximum.
 
Last edited:
  • Like
Reactions: 4 users
Mount Asclepius said:
More math.

Average 1,500 hours/year.

Job 1: 2 pph at $300/hour = $450K/year for 3,000 patients at $150/patient

Job 2: 1.5 pph at $225/hour = $337.5K for 2,250 patients at $150/patient

Difference of $112.5K/year ($450K - $337.5K) for 750 more patients.

Extra income marginally taxed at 24-32%, but perhaps an effective tax rate of closer to 24% married filed jointly.

$112.5K x 76% = $85.5K extra post-tax income for post-tax investing.

Place all in S&P500 for 20 years with a conservative, inflation adjusted rate of return at 7% results in an extra $3.5M with compounded growth.

View attachment 376257

750 patients extra for 20 years results in 15K more patients seen during that time for an extra $3.5M. Equates to $233/patient ($3.5M/15K patients).

I think we'd all take $233/patient as $150/patient after overhead is the gold standard. Very few places collect >$200/patient.

You essentially get to retire 5 years sooner and have a lot more in post-tax investment accounts at that time. Over those next 5 years from age 50-55 you have a better passive income stream and the gap further widens.

View attachment 376261

You end up with close to an extra $5M assuming you don't withdraw from this amount and live off of your traditional retirement that you would have otherwise had in your portfolio. All for just working a little harder and seeing 0.5 pph more.

Retiring 5 years sooner saves you from seeing an additional 11,250 patients (2,250 patients/year x 5 years) during that timeframe. 60,000 patients (3K patients/year x 20 years) versus 56,250 patients (2,250 patients/year x 25 years). 3,750 extra patients over 25 years for $5M.

I'll take job 1. Daily reminder to do the bare maximum.
Click to expand...

You spent way too much time on this.
 
  • Like
  • Haha
Reactions: 5 users
Also if you have a DB plan you could defer those taxes and that number is much bigger. I think if you are hourly it’s not wrong to do the bare minimum. If you have some RVU portion if it is big enough it makes sense. If the RVU portion is too small which is often the case then you have to weigh it.

For RVUs it’s often something stupid like some flat rate and $8/rvu.. that makes the docs stupid to work hard for that especially if it is wRVUs. Then that extra patient is only worth like $30.. thats nonsense money for the work Imo.
 
  • Like
Reactions: 1 user
Mount Asclepius said:
More math.

Average 1,500 hours/year.

Job 1: 2 pph at $300/hour = $450K/year for 3,000 patients at $150/patient

Job 2: 1.5 pph at $225/hour = $337.5K for 2,250 patients at $150/patient

Difference of $112.5K/year ($450K - $337.5K) for 750 more patients.

Extra income marginally taxed at 24-32%, but perhaps an effective tax rate of closer to 24% married filed jointly.

$112.5K x 76% = $85.5K extra post-tax income for post-tax investing.

Place all in S&P500 for 20 years with a conservative, inflation adjusted rate of return at 7% results in an extra $3.5M with compounded growth.

View attachment 376257

750 patients extra for 20 years results in 15K more patients seen during that time for an extra $3.5M. Equates to $233/patient ($3.5M/15K patients).

I think we'd all take $233/patient as $150/patient after overhead is the gold standard. Very few places collect >$200/patient.

You essentially get to retire 5 years sooner and have a lot more in post-tax investment accounts at that time. Over those next 5 years from age 50-55 you have a better passive income stream and the gap further widens.

View attachment 376261

You end up with close to an extra $5M assuming you don't withdraw from this amount and live off of your traditional retirement that you would have otherwise had in your portfolio. All for just working a little harder and seeing 0.5 pph more.

Retiring 5 years sooner saves you from seeing an additional 11,250 patients (2,250 patients/year x 5 years) during that timeframe. 60,000 patients (3K patients/year x 20 years) versus 56,250 patients (2,250 patients/year x 25 years). 3,750 extra patients over 25 years for $5M.

I'll take job 1. Daily reminder to do the bare maximum.
Click to expand...
We collect more than $200/pt at our worst payer mix site. Where are your numbers from?
 
TooMuchResearch said:
We collect more than $200/pt at our worst payer mix site. Where are your numbers from?
Click to expand...
Personal experience. Anyone please share if you have broader data on collections and are able to share.

I don’t think it’s common to average collecting >$200/patient after overhead. Some do, but you have to have a pretty decent payer mix.
 
  • Like
Reactions: 4 users
Members don't see this ad :)
The older you get, the wiser you become, the more wealth you accumulate. Time start to be more important than Money. Time can buy you money but money can not buy you time. Money>>>>Time when I was a teenager, as time passed, this has flipped where Time>>>>>>Money.

10 yrs ago, I was happy with 250hr working in an efficient community ER. 5 yrs ago doing Locums, I would not step into a shift unless they offered me 500/hr. Now, I would not go back to those locums site even if they offered me 1k/hr. If they offered me 2k/hr, I may do it if I had a cleared personal schedule.
 
  • Like
Reactions: 1 users
TooMuchResearch said:
We collect more than $200/pt at our worst payer mix site. Where are your numbers from?
Click to expand...
I know the data for collections from 6 different EDs in my state, all in very different areas with different demographics. None of them exceed 200/patient on average. I suppose it's possible that my state is simply poorer than yours or that yours is much better insured, but I don't see how your collections is exceeding 200/patient unless your billing is conspicuously high (e.g. adhering to the CMG mentality that every ED visit should be a lvl 5 or CC)
 
BoardingDoc said:
I know the data for collections from 6 different EDs in my state, all in very different areas with different demographics. None of them exceed 200/patient on average. I suppose it's possible that my state is simply poorer than yours or that yours is much better insured, but I don't see how your collections is exceeding 200/patient unless your billing is conspicuously high (e.g. adhering to the CMG mentality that every ED visit should be a lvl 5 or CC)
Click to expand...
$200/pt across all sites is crazy impressive. Agree that it sounds too good to be true. Keep in mind app had $165. Usacs also. Envision likely a bit higher pre nsa.

Groups can have exceptional contracts, minimal self pay etc.

Medicaid expansion also a factor but I think average for sdgs pre covid /nsa was like 130/135. That’s data from multiple rcm companies.
 
I agree with working more for more per hour...for now. Once I hit a good CoastFI number, I'll probably go to a local but rural hospital that sees 4-5 patients per day and pays around $160/hr, with a longer contract/more hours would probably go up to 180/hr. Working on getting locums shifts there currently. If you don't factor in the 6-8 hours of sleep that people pretty routinely get there that I'd be sleeping at home anyway, that rate goes up 20-30% for pretty minimal work. Work one 48 hour shift two times a month and have enough to live off of and still increase savings a bit, and have 12 days off between shifts making it easy to see the kids a lot and travel more. Yes I make close to $300/hr right now, but I'm already pretty burned out just a couple years out of residency, and I'm not going to be able to keep this up forever. I'm keeping at it due to the increased time value of money saved early on but that will diminish more as I keep getting older.
 
EctopicFetus said:
OK. I guess im a big fan of 12s but my group doesnt have them.. I’ll try to make it more of an apples to apples comparison.

I’ll restate my question as such would you rather work all 8s and job one see 2 pph and make 300/hr or job b see 1 pph but make 200/hr. The $/unit of work is higher for the lower paying job.

To make 300k in job 1 I have to work 1000 hours a year but I have to work 1500 hours a year in job B to earn the same.

My opinion is clear and skewed as I would frankly rather see 3pph and make 350/hr if it were sustainable than either of the above examples. For the sake of my example i am aware how i would be getting paid less and less per unit of work.

In reality in most true RVU based systems you should frankly be earning more per patient (which is how my sdg works). Every shift I have a fixed cost I cover. We operate as effectively an independent business unit. My scribe cost is fixed, one could argue my med mal cost is fixed and assuming a flat $/pt my fixed costs become a smaller and smaller % of my expense.

Again, I would be curious how the others on here see things. In my opinion part of doing the bare minimum is being at work as little as possible. Maybe my hospitals aren’t that nice but I dont find my time there terribly relaxing regardless of the number of patients I see. The beds suck, the food is average at best, the TVs small etc. I guess I would much rather be home.

Easiest to sprint to the FI line in my mind. As a parent maximizing my time with my kids matters. Whatever your financial goals are I think it is easiest for me to hit my desired income in the fewest hours possible. For those mentioning its a marathon i dont think im terribly special but ive been an attending for 10+ years. My first job out of residency we did a mix of 8,9,12s and I worked like a b*tch. I averaged 160 hours a month or so. Seeing 2pph. I tried to avoid the shorter shifts. Now I see more than 2pph, shifts are 8s and I average 100 hours a month clinically. My only complaint is I wish I could do 8 12s and not 12 8s.
Click to expand...
Yes agree with you, specifically as a function eat what you kill with significant "Fixed" cost (mal practice, lots of the benefits). Adding 1-2 patient per shift is "profit". I want my shifts to mostly be very busy, with just enough downtime to shove calories in my mouth.

Now, I have moonlit places where I am a fixed hourly person. My two favorite of those:
--Moderate sized, moderate acuity hospital-- well staffed w/ PA, MD. Run hard for the first 2-4hr, then slow up and have a snack and go easier the second half of the shift (grab more low acuity). Culture was HIGHLY encouraging of getting out on time. I felt like I did good work for them, but also wasn't sprinting and staying two hours late like my P&L gig (where, granted, I could make more $ if I did that)
--Little freestanding place. Totally didn't mind seeing 1/hr low acuity there. Once you hit a threshold of "i'm just here to hold the fort down" and bring a book, an iPad, a switch deck, and your income taxes to work on... I'm cool with that mode of work. However doing it 14x12hr every month would likely make me crazy. 1-2x/mo? lovely.
 
Mount Asclepius said:
Personal experience. Anyone please share if you have broader data on collections and are able to share.

I don’t think it’s common to average collecting >$200/patient after overhead. Some do, but you have to have a pretty decent payer mix.
Click to expand...
After overhead? That's different. I'd have to dig into the books a bit to know our actual overhead.
 
BoardingDoc said:
I know the data for collections from 6 different EDs in my state, all in very different areas with different demographics. None of them exceed 200/patient on average. I suppose it's possible that my state is simply poorer than yours or that yours is much better insured, but I don't see how your collections is exceeding 200/patient unless your billing is conspicuously high (e.g. adhering to the CMG mentality that every ED visit should be a lvl 5 or CC)
Click to expand...
We're not a CMG. I think our billing is fair. We use a major EM billing company. Our patient population is old and sick so we tend to be pretty level 5 heavy. Another of our EDs averages about 25% more per patient with a much better payer mix. Maybe it's state dependent, but I don't think we're outside the norm here.
 
TooMuchResearch said:
Our patient population is old and sick so we tend to be pretty level 5 heavy. Another of our EDs averages about 25% more per patient with a much better payer mix.
Click to expand...
If you're averaging above 200/patient, that means that your other site is pulling in ON AVERAGE over $250/patient? If true, that is utterly bananas. You must live in an area solely populated by young, well employed people with good insurance. Anyone on medicare/medicaid/self pay is going to bring that average down.

Old+sick as the explanation for this level of reimbursement doesn't track. Even if you bill ONLY lvl 5 charts for those sick old people, medicare pays 5.21 RVU for a 99285. That's $176.57 based on the current RVU conversion factor, which is below your low end 200/pt. Obviously, any patient who bills a lvl 3 or 4 brings the average down further.

Maybe your number is a pre NSA implementation? Or maybe I'm just missing something that changes the fundamental numbers.
 
  • Like
Reactions: 2 users
TooMuchResearch said:
We're not a CMG. I think our billing is fair. We use a major EM billing company. Our patient population is old and sick so we tend to be pretty level 5 heavy. Another of our EDs averages about 25% more per patient with a much better payer mix. Maybe it's state dependent, but I don't think we're outside the norm here.
Click to expand...
Food for thought. A level 5 Medicare patient is paying ~$180 before med mal billing and coding and paying for your medical director/admin scheduler. Average your critical care+obs with level 4 and you end up in a similar spot. Hard to imagine your level 5/cc/obs is at 70% total. Level 4s pay about 130. Weighted averaged would be like 160 (at best).

In general Medicaid while very state dependent is 70% of that but way fewer level 5s.

Your commercial could be way high. That’s the only way to get to $200/chart. Lots of commercial or insanely great commercial contracts (or both).

I’m not doubting you. I worked at a site before where we collected 250/pt+.
 
TooMuchResearch said:
If I saw 3 pph at our big site, I'd make somewhere between 600-650/hr, but it's impossible due to acuity, inefficiency, etc
Click to expand...
Word of advice.
1. Keep this site quiet, b/c if you are getting paid 650/hr @ 3ppd or $215/pp, you must be collecting min $250/pp. Someone will come after this site.
2. Stop hiring docs, suck it up, 3pph and puts you at 1M/yr doing 32hrs/wk. Do this for 10 yrs, FIRE, and do whatever you want
3. Hire some APCs if you want and if they can see 2pph will pull in $500/hr for the group pushing your pay to $800/hr.

Point is to suck this place dry b/c it won't last. From my experience $250/pp can only be achieved if you have almost zero medicare/medicaid/uninsured.
 
  • Like
Reactions: 1 users
Mount Asclepius said:
More math.

Average 1,500 hours/year.

Job 1: 2 pph at $300/hour = $450K/year for 3,000 patients at $150/patient

Job 2: 1.5 pph at $225/hour = $337.5K for 2,250 patients at $150/patient

Difference of $112.5K/year ($450K - $337.5K) for 750 more patients.

Extra income marginally taxed at 24-32%, but perhaps an effective tax rate of closer to 24% married filed jointly.

$112.5K x 76% = $85.5K extra post-tax income for post-tax investing.

Place all in S&P500 for 20 years with a conservative, inflation adjusted rate of return at 7% results in an extra $3.5M with compounded growth.

View attachment 376257

750 patients extra for 20 years results in 15K more patients seen during that time for an extra $3.5M. Equates to $233/patient ($3.5M/15K patients).

I think we'd all take $233/patient as $150/patient after overhead is the gold standard. Very few places collect >$200/patient.

You essentially get to retire 5 years sooner and have a lot more in post-tax investment accounts at that time. Over those next 5 years from age 50-55 you have a better passive income stream and the gap further widens.

View attachment 376261

You end up with close to an extra $5M assuming you don't withdraw from this amount and live off of your traditional retirement that you would have otherwise had in your portfolio. All for just working a little harder and seeing 0.5 pph more.

Retiring 5 years sooner saves you from seeing an additional 11,250 patients (2,250 patients/year x 5 years) during that timeframe. 60,000 patients (3K patients/year x 20 years) versus 56,250 patients (2,250 patients/year x 25 years). 3,750 extra patients over 25 years for $5M.

I'll take job 1. Daily reminder to do the bare maximum.
Click to expand...
Younger me takes Job #1. Older me would not take either job, find me a $175/hr and daily volume of 3 pts would be a good job.
 
sylvanthus said:
Think starfield will work on a couple year old alienware laptop? Whens download time?
Click to expand...
Off thread topic but somewhat related to this, any good recs for games running off of steamdeck for a long 8+ hour flight coming up? I like RPGs, RTS, factorio-type games, lots of random indie games, not so much into FPS genre unless they're real solid (like bioshock or HL). Starfield will have to wait for my return...
 
gruemd said:
Off thread topic but somewhat related to this, any good recs for games running off of steamdeck for a long 8+ hour flight coming up? I like RPGs, RTS, factorio-type games, lots of random indie games, not so much into FPS genre unless they're real solid (like bioshock or HL). Starfield will have to wait for my return...
Click to expand...

My recent plays have been Hollow Knight, Resident Evil 4 remake, Vampire Survivors. Celeste is a great indie platformer. Octopath Traveler is a great JRPG. If you haven't played Portal 1 and 2 I highly recommend.
 
Daily reminder to do the bare minimum.

GonnaBeADoc2222 said:
My recent plays have been Hollow Knight, Resident Evil 4 remake, Vampire Survivors. Celeste is a great indie platformer. Octopath Traveler is a great JRPG. If you haven't played Portal 1 and 2 I highly recommend.
Click to expand...

Blasphemous 2 just got released. Blasphemous 1 was such an amazingly good metroidvania that a sequel was basically mandatory.

Sea of Stars (spiritual successor to Chrono Trigger) just got released.

Octopath Traveler 1 was gold. I put down Octopath 2 after a few hours because it's so woke and contains all of the annoying parts of a JRPG with almost none of the fun of the first one.
 
  • Like
Reactions: 1 user
gruemd said:
Off thread topic but somewhat related to this, any good recs for games running off of steamdeck for a long 8+ hour flight coming up? I like RPGs, RTS, factorio-type games, lots of random indie games, not so much into FPS genre unless they're real solid (like bioshock or HL). Starfield will have to wait for my return...
Click to expand...
BG3 if you can plug your deck in as it will decimate your battery.
Disco Elysium is (I think) very interesting.
Vampire Survivors is on the other end of the spectrum vis-a-vis plot/text, but also super fun.
I actually enjoy Civ6 (smaller maps) quite a bit on the deck as well.
 
  • Like
Reactions: 1 user
RustedFox said:
Daily reminder to do the bare minimum.



Blasphemous 2 just got released. Blasphemous 1 was such an amazingly good metroidvania that a sequel was basically mandatory.

Sea of Stars (spiritual successor to Chrono Trigger) just got released.

Octopath Traveler 1 was gold. I put down Octopath 2 after a few hours because it's so woke and contains all of the annoying parts of a JRPG with almost none of the fun of the first one.
Click to expand...

Didn't even bother with Octopath 2 because of the reviews.

I never got to play Chrono Trigger, so I got the Steam port...and I found it...boring
 
Last edited:
GonnaBeADoc2222 said:
Didn't even bother with Octopath 2 because of the reviews.

I never got to play Chrono Trigger, so I got the Steam port...and I found it...boring
Click to expand...

Octop.2 is such trash.
Did they really make a "furry catgirl" character?
They really made a "furry catgirl" character. And yes, you have to "collect all the beasts." Eff that. This isn't Pokemon and I'm not 25.

Don't get me started on the other cast members. There are 2, maybe 3 that I can stand to have on the screen.
 
EctopicFetus said:
I’ll restate my question as such would you rather work all 8s and job one see 2 pph and make 300/hr or job b see 1 pph but make 200/hr. The $/unit of work is higher for the lower paying job.
Click to expand...

$200/hr for 1 pph all day everyday. That’s literally the choice i made 2 years ago.

Can someone please tell me what the difference in quality of life is between 450k and 350k? After taxes you’re basically looking at a difference of 65k.

There sure is a difference in job happiness levels between 2 pph vs 1 pph.

If you’re just coming out of residency, have no net worth, then sure, grind away. But once you have a net worth, your investments are paying off and cash flowing then the extra 60-70k post taxes isn’t going to make any significant quality of life difference, while having a chill job will have a quality of life difference.
 
sylvanthus said:
Think starfield will work on a couple year old alienware laptop? Whens download time?
Click to expand...

Its in early access now and releases in 4 days.

Early reports say is playable albeit not awesome on the Deck. They seem to be actively patching issues however.
 
Mount Asclepius said:
More math.

Average 1,500 hours/year.

Job 1: 2 pph at $300/hour = $450K/year for 3,000 patients at $150/patient

Job 2: 1.5 pph at $225/hour = $337.5K for 2,250 patients at $150/patient

Difference of $112.5K/year ($450K - $337.5K) for 750 more patients.

Extra income marginally taxed at 24-32%, but perhaps an effective tax rate of closer to 24% married filed jointly.

$112.5K x 76% = $85.5K extra post-tax income for post-tax investing.

Place all in S&P500 for 20 years with a conservative, inflation adjusted rate of return at 7% results in an extra $3.5M with compounded growth.

View attachment 376257

750 patients extra for 20 years results in 15K more patients seen during that time for an extra $3.5M. Equates to $233/patient ($3.5M/15K patients).

I think we'd all take $233/patient as $150/patient after overhead is the gold standard. Very few places collect >$200/patient.

You essentially get to retire 5 years sooner and have a lot more in post-tax investment accounts at that time. Over those next 5 years from age 50-55 you have a better passive income stream and the gap further widens.

View attachment 376261

You end up with close to an extra $5M assuming you don't withdraw from this amount and live off of your traditional retirement that you would have otherwise had in your portfolio. All for just working a little harder and seeing 0.5 pph more.

Retiring 5 years sooner saves you from seeing an additional 11,250 patients (2,250 patients/year x 5 years) during that timeframe. 60,000 patients (3K patients/year x 20 years) versus 56,250 patients (2,250 patients/year x 25 years). 3,750 extra patients over 25 years for $5M.

I'll take job 1. Daily reminder to do the bare maximum.
Click to expand...

Technically wrong analysis.

First of all, you shouldn’t be applying the effective tax rate, the last extra dollar is taxed at the marginal tax rate - and for most of us that’s somewhere between 32-35 percent. If someone has a physician wife, that may even be up to 37 percent. And this is just federal. The average state income tax rate is then 5 ish percent. Plus throw in an extra 1.45 percent Medicare tax paid for each extra dollar. Throw in another extra 2 percent for the average city tax too.

All in all, at high income levels of 450k and higher, your marginal tax rate after ALL taxes is easily 40 ish percent. Assuming w2 income.

So if you make an extra 112k, you’re taking home around 68k in after tax income.

So let’s say the person making 337k, saves about 100k per year including retirement accounts. This person does this for 30 years.

And the person making 450k saves 168k. This person does this for 30 years.

Let’s say both get an average 7 percent return.

In 30 years, the person making 337k ends with 10.2M while the other person ends up with 17.1M.

So the difference Is actually more like 7M.

Pretty huge amount. But…not a huge quality of life difference if you are worth 10M vs 17M.
 
  • Like
Reactions: 1 user
cyanide12345678 said:
$200/hr for 1 pph all day everyday. That’s literally the choice i made 2 years ago.

Can someone please tell me what the difference in quality of life is between 450k and 350k? After taxes you’re basically looking at a difference of 65k.

There sure is a difference in job happiness levels between 2 pph vs 1 pph.

If you’re just coming out of residency, have no net worth, then sure, grind away. But once you have a net worth, your investments are paying off and cash flowing then the extra 60-70k post taxes isn’t going to make any significant quality of life difference, while having a chill job will have a quality of life difference.
Click to expand...
That 60-70k adds up quick if you save it and invest it and you could retire much sooner. Alternatively if you prefer it’s fewer shifts, nicer vacations, private school. I wouldn’t minimize it. Just depends on what you value.

I’m not saying my way is right but it all adds up.

You could open up a defined benefit plan in which case it’s all saved pretax.

The counter is you are financially better off working extra years at the tail end of your career so your money can bloat in the stock market.

I imagine most people start our grinding hard and then pull back. It’s what I did.
 
  • Like
Reactions: 1 users
EctopicFetus said:
That 60-70k adds up quick if you save it and invest it and you could retire much sooner. Alternatively if you prefer it’s fewer shifts, nicer vacations, private school. I wouldn’t minimize it. Just depends on what you value.

I’m not saying my way is right but it all adds up.

You could open up a defined benefit plan in which case it’s all saved pretax.

The counter is you are financially better off working extra years at the tail end of your career so your money can bloat in the stock market.

I imagine most people start our grinding hard and then pull back. It’s what I did.
Click to expand...

Yeah i grinded for two years too. I think 2-3 years ago i would have absolutely taken the 300/hr 2-2.5 pph job.

Now my dream job is a < 10 patients per day ER and doing 4 24 hour shifts per month even if it means getting $150/hr. Unfortunately, the closest ER with <10 patients per month is 3 hours away, so I’m settling for a 27 patients per day ER.

What’s the point of grinding for 30 years though? Or even 20 years. That sounds like a miserable life. I certainly can’t do it anymore. But im also hitting my FI number in 3 years too so i have a very different mindset now.
 
cyanide12345678 said:
$200/hr for 1 pph all day everyday. That’s literally the choice i made 2 years ago.

Can someone please tell me what the difference in quality of life is between 450k and 350k? After taxes you’re basically looking at a difference of 65k.

There sure is a difference in job happiness levels between 2 pph vs 1 pph.

If you’re just coming out of residency, have no net worth, then sure, grind away. But once you have a net worth, your investments are paying off and cash flowing then the extra 60-70k post taxes isn’t going to make any significant quality of life difference, while having a chill job will have a quality of life difference.w
Click to expand...
cyanide12345678 said:
Technically wrong analysis.

First of all, you shouldn’t be applying the effective tax rate, the last extra dollar is taxed at the marginal tax rate - and for most of us that’s somewhere between 32-35 percent. If someone has a physician wife, that may even be up to 37 percent. And this is just federal. The average state income tax rate is then 5 ish percent. Plus throw in an extra 1.45 percent Medicare tax paid for each extra dollar. Throw in another extra 2 percent for the average city tax too.

All in all, at high income levels of 450k and higher, your marginal tax rate after ALL taxes is easily 40 ish percent. Assuming w2 income.

So if you make an extra 112k, you’re taking home around 68k in after tax income.

So let’s say the person making 337k, saves about 100k per year including retirement accounts. This person does this for 30 years.

And the person making 450k saves 168k. This person does this for 30 years.

Let’s say both get an average 7 percent return.

In 30 years, the person making 337k ends with 10.2M while the other person ends up with 17.1M.

So the difference Is actually more like 7M.

Pretty huge amount. But…not a huge quality of life difference if you are worth 10M vs 17M.
Click to expand...
Don’t forget the 0.9% Additional Medicare Tax ;)

You’re getting slightly bogged down in the weeds. Also with some incorrect analysis as state/local taxes vary widely with some having no income tax and some a flat rate, an overestimation of the average EM career length, and an assumption regarding savings rate.

Yes, extra income is taxed at a higher marginal rate. I tried to keep it simple using an effective tax rate as the marginal rate between 24-37% is going to vary from EP to EP depending on other factors including single/married filing jointly and total income including spousal income. I'm aware it possibly results in an overestimated amount.

@EctopicFetus made a good point. You start a DB/DC plan and you defer all those taxes anyways eventually possibly paying at an even lower marginal rate.

Paying a higher marginal rate is not a great reason to work less. You could make the same argument to not make more than the roughly average income of $60K/year as you'll get taxed at higher rates the more you make. Extra income now goes a lot further with compounding than extra income later. The time value of money.

I do appreciate you though taking more in taxes away, but ending up with even a greater difference (even if what we were examining is apples and oranges). I solely wanted to demonstrate how hourly rate and corresponding patients/hour turns out in the long run in a way that many of us don't necessarily think about.

I tried to help makes things easy with graphs and simple final numbers. Don't ruin it for me! Let’s make it even simpler. You work harder and save more, then you have more.

I otherwise agree that it might not represent a quality of life difference in the end. Sure does though if it allows for the freedom to walk away a little earlier if you want to.

Most do want to slow down end-of-career either with a path out of the pit, a slower paced job or part time work. The point is to push it harder early on and make that push last for at least a little while. You won't regret that choice. It's hard to speed back up once you start slowing down.

Do the bare maximum and don't save the bare minimum. You'll end up with more choices.
 
  • Like
Reactions: 1 users
I work at my main 2-2.5/h place and then our FSED where we are more like 1.6/h and much lower acuity and I just feel like the time drags when I’m at the FSED. I get I could watch tv or whatever, but I’d rather work less hours and work harder when I am at work.
 
  • Like
Reactions: 2 users
sylvanthus said:
Think starfield will work on a couple year old alienware laptop? Whens download time?
Click to expand...

Looks like Starfield getting murdered in reviews.

7/10 from IGN...ouch!

IGN hands out 10s like candy so this reall says something.
 
You must log in or register to reply here.
Next unread thread

Similar threads

P
  • Locked
What do you think of these "minimum requirements" to get into the Baylor EM Residency?
2
Replies
86
Views
7K
southerndoc
southerndoc
D
How do i progress from middle 1/3rd to top 1/3rd in my daily student evaluations?
Replies
4
Views
1K
gamerEMdoc
gamerEMdoc
Q
Minimum volume for a residency program
Replies
12
Views
3K
ORL10
O
M
Gentle reminder to SLOR writer?
Replies
6
Views
2K
migm
M
Red Beard
Minimum work hours to keep skills up
Replies
6
Views
2K
deleted65604
D
Top