[haldujai]

Not true, some do (stereotypically the surgeon with 4 ex wives and children that don’t know them) but it really depends on your country/practice pattern.

On one extreme Canadian physicians are (generally) ineligible for pension/retirement benefits. Many US private practice jobs are the same. Academic US jobs usually have some form of retirement support.

Add in the opportunity cost of not earning income until you’re 30+ as well as loans and I don’t think it’s a fair characterization to say “most physicians in the 50-70 age range want to work”, especially full time and considering burnout rates of ~50-60%.

Can’t speak about Europe which has very different compensation structure and debt burden.

[sarchertech]

> Many US private practice jobs are the same.

Where are you getting this from? The vast majority of doctors have access to the same kinds of fixed benefit retirement plans as people in other industries have.

[haldujai]

From my job search as a physician. Literally no private practice job I’ve interviewed at or heard of provides defined-benefit retirement, if you know one let me know. Similarly I don’t know of many non-medicine jobs that still offer this either, but they do offer defined-contribution plans and GlassDoor suggests Google matches 7%.

The super high income (radiology) jobs people are alluding to here (500k-1m) are structured as partnerships that don’t offer employer contributions (depending if you own your own facilities you can potentially exit for a lump-sum at retirement, if you are just part of a hospital based group you don’t have any assets other than the contract so it’s like a 1-200k exit similar to the buy-in).

My surgeon friends in that income bracket are also all fee-for-service/eat what you kill rats that also don’t get employer retirement contributions/benefits or equity. A lot of us don’t even get paid sick days.

The jobs that offer you defined-benefit or employer contributions for retirement are academia or HMOs which is like 250-350k in radiology.

In Canada we’re technically corporations (for tax deferral) and consequently don’t even have RRSP (401k/IRA equivalent) contribution room (unless you pay yourself in salary). But there’s no employer matching/contribution in either case.

[vibrio]

“ The super high income (radiology) jobs people are alluding to here (500k-1m) are structured as partnerships that don’t offer employer contributions”

Am I reading correctly that having no 401k match would be a concern for someone making $500k-$1m annually?

[haldujai]

You’re reading incorrectly and I also wasn’t very clear.

It’s not a concern and I’m not saying we’re not well-compensated but 7% is something to consider when comparing total compensation across industries (and is one of the easiest line-items to objectively discuss).

A larger part of that physician’s income has to go towards planning retirement and inflation (and self managing that) than is being posited here. In addition to health benefits, sick leave and vacation. Someone making 400k at a place matching 7% with a good benefits package isn’t making less than a radiologist at 500k in private practice.

As an example a colleague of mine recently changed jobs and went to ~350k in an academic environment from ~520k PP and after calculating all of the benefits and reduced hours (less evenings/weekends, so assumed he would sign up for extra shifts) came out financially ahead. I haven’t worked an engineering job in over a decade but my gut/recollection is that similar base comp numbers would probably pan out the same especially as there is a significant opportunity cost.

It’s the difference between any independent contractor vs employee, regardless of if that’s medicine, construction or freelance SWE so when comparing the “high income physician” job it should be compared like you would a freelancer to FAANG employee @ 10 years of experience.

FWIW the median in private practice radiology is ~500k. As our compensation is literally per work-unit the only way to go higher is to work more hours, so the equivalent of FAANG engineer doing freelance work on the side.

[kevinventullo]

The defined-contribution matching is not actually that significant. Google and Facebook e.g. match half of what one contributes up to 7%, so they’re paying at most 3.5%. More importantly, employees can only contribute up to the annual 401(k) max; that’s $22,500 in 2023. Thus, the matching is worth at most $11,250, even for execs with a seven-figure base salary.

[haldujai]

Thanks for sharing, I'm still learning how retirement works in the US and was unaware of that detail.

I also wasn't sure how to value benefits (at least health/dental + disability if that's included) and PTO (including sick days and mat/pat leave which are unpaid for this subset of physicians), do you have a ballpark on what that is worth for accounting purposes?

Overall I think the biggest hidden line item in any physician's income is still opportunity cost of 10 years +/- loans but my main point is there are hidden costs behind that 500k which are fairly significant.

[lucaspm98]

Do Google and Facebook really only match half of 401(k) contributions up to 7%?

I thought employers competing on benefits were moving towards dollar for dollar or better matching. This is especially important for high income earners who'd be maxing out, because the 401(k) contribution limit for 2023 is $22,500 for employee contributions but $66,000 for combined employee and employer contributions.

[antisthenes]

> You’re reading incorrectly and I also wasn’t very clear.

There's nothing in your 3-4 posts that is applicable to physicians that also isn't applicable to any other white collar job.

> Someone making 400k at a place matching 7% with a good benefits package isn’t making less than a radiologist at 500k in private practice.

Sure, but what does it have to do with the discussion at hand? People need to do their due diligence about compensation when accepting a position, any position. This isn't unique to 1 profession, 1 field or 1 geographical area.

> It’s the difference between any independent contractor vs employee, regardless of if that’s medicine, construction or freelance SWE so when comparing the “high income physician” job it should be compared like you would a freelancer to FAANG employee @ 10 years of experience.

Sure, but the original point was, people making 400k + 7% or 500k can both easily retire at 50. The rest is pointless bike shedding.

[haldujai]

> There's nothing in your 3-4 posts that is applicable to physicians that also isn't applicable to any other white collar job.

Disagree in that most other white collar jobs don’t treat their employees as independent contractors/self-employed.

Point of my comments was to compare the total compensation of the highest income physicians (which we are selecting in this hypothetical) with other high-income white collar professions as the pure dollar amount is misleading.

> Sure, but the original point was, people making 400k + 7% or 500k can both easily retire at 50. The rest is pointless bike shedding.

I mean retirement age in general is mostly a spending calculation.

To the original point, my argument is that if you’ve been making interest only payments on ~300k of debt and are starting to earn $350k at 32+ (a similar lifestyle/benefits job to FAANG, but specialist average income is $382k in 2023) it’s not nearly as easy to retire in your 50s as someone who has been making 100k+ from 22 without the debt and a similar # of earning years at 300+.

In other comments people were quoting 500k+ compensation so I apologize I was off-topic addressing that in this thread but was offering perspective on this very small subset of physicians.

[rs999gti]

> super high income (radiology) jobs

Weren't these replaced by outsourcing imaging reading to third world doctors?

[nradov]

Mostly no. Foreign doctors can't legally practice medicine on US patients. Those third-world doctors are mostly used for things like insurance case review. Some radiologists also perform interventional procedures, which requires being physically present (at least until teleoperated surgical robots become common).

[haldujai]

Aside from procedures:

We have multidisciplinary case conferences every day which can't be outsourced and perhaps most importantly you also want to know who your radiologist is.

Reporting of anything remotely complex (e.g. oncological studies, inflammatory bowel disease, interstitial lung disease) isn't black/white and is adjusted to local practice environments/treatments options with feedback from clinicians continuously adjusting how we report.

Every center I've worked at in US & Canada won't even accept an outside report from another North American academic institution for oncological studies and will request a formal second opinion even if the scan and report came from MGH/Mayo/Hopkins.

Some of this is medicolegal risk but it's apparently backed up by research/quality improvement studies although I'm not familiar with the literature.

The stuff that's outsourced to licensed physicians (within continental US or abroad) is the easy stuff like ER/acute care.

[sarchertech]

Sorry I invented the term fixed benefit to be in opposition to defined benefit. What I meant was defined contribution.

My wife is a physician, as are many of our close friends. They nearly all work for private groups, and they mostly have some kind of employer matched plan. My wife’s group just directly contributes up to 13% of her salary to her retirement plan through profit sharing.

I know a far higher percentage of non physicians without employee contributions to retirement.

My wife doesn’t get paid vacation, but she only needs to work 12 shifts per month to maintain full time status and she makes more than I do (working only 12 shifts) as a principal engineer.

[haldujai]

> My wife is a physician, as are many of our close friends. They nearly all work for private groups, and they mostly have some kind of employer matched plan. My wife’s group just directly contributes up to 13% of her salary to her retirement plan through profit sharing.

Knowing that your wife is in PEM now I expect she's not in the 500k-1M category (if she is kudos again but I definitely made a career mistake) and presumably a large/whole-hospital billing group?

In this setting there tends to be more benefits because the group is so large the costs are diluted and you need to retain certain lower-billing specialties to maintain coverage requirements (peds EM being a good example) but overall compensation tends to be on the lower end, kind of like an academic-lite environment but less non-clinical work hours so comp is better but I really can't imagine the average specialist in a paediatrics or hospital-based group is taking home 500k-1M while providing benefits.

The majority of physicians billing >500k purely for clinical work (especially as you go up) will be 'high income specialties' (proceduralists/surgeons) where the setting is much smaller specialty-based partnerships, or billing as single-individuals, where benefits don't exist as they more directly come out of your pocket and you don't need to 'subsidize' a specialty to keep them employed/eating and your contract in place.

[sarchertech]

I’m not sure where we only started talking about physicians making >500k. Very very few software engineers are making that despite what you’d think from reading HN. The vast majority who are making anywhere near $1M are no longer really ICs, so they aren’t comparable to a physician who only does clinical work.

My wife doesn’t make $500k, but if she decided she wanted to work 40-50 hours a week instead of 25-30 she could get close.

Her group, and from what she says most hospitals in the country, are basically always struggling to find enough PEMs to maintain coverage.

The incentives to work more than 15 shifts and more than 4 overnights are very generous—the alternative is to bring people in from the next city over. And if she really wanted to she could pick up extra responsibilities and work towards becoming a partner.

But virtually no one is making $500k-1M in base compensation in any industry, so percentage based benefits are such a small part of it.

Look at Google for example, you’re at senior staff before your base reaches $250k, so percentage based contributions are based on a much smaller chunk of your total compensation.

[mistrial9]

private office physicians, and General Practitioner physicians, effectively were eliminated in rounds of consolidation and changes in insurance practices, by the early 2000s here in California. Second, large areas of low population density have zero local MDs.

[moneywoes]

Just curious are aware how little CPP pays? Why is that even a consideration,I don’t understand.

The vast majority of tech jobs offer no RRSP match as well

Also consider how few faang jobs exist ( especially now) vs physician

[sokoloff]

Very few people in private industry have access to fixed benefit plans (other than social security). Most everyone has fixed contribution plans: 401(k) [or 403(b) for education/non-profit].

[sarchertech]

Sorry I invented the term fixed benefit to be in opposition to defined benefit. What I meant was defined contribution.

Which was my point physicians generally have access to the same plans as other industries.

[sokoloff]

"Fixed" and "defined" would be roughly synonyms in this usage, which is why no one understood you.

Defined contribution everyone would have understood to be in opposition of defined benefit.