[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.

[kevinventullo]

I agree benefits are hard to measure. Honestly, as a tech employee I think I value the free and convenient meals quite a bit more than paid sick days. I suppose one could try to put a dollar amount on it, but it’s really just a nice quality-of-life perk. One less thing I have to think about.

[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.

[mrep]

Each is slightly different but it amounts to $10,250 worth of match if you max it out and then you can hit the $66,000 limit through the mega backdoor roth.

[kevinventullo]

Right, and the mega backdoor you can fund yourself. So there’s not much point in cos juicing the match versus just paying people more, which big tech is not afraid to do.

[mrep]

Sort of. The employee + employer match can go into regular 401k or roth 401k whereas the mega backdoor roth is only roth.

Thus you can put ~33,000-66,000 into roth ones and only 0-33,000 into pre-tax ones whereas if the employer match got you up to the full 66,000, you could fully customize it to pre or post tax however you like.

[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.