That number is probably about right. But those who don’t usually pay a financial price for their indecision. It's a bit like deciding whether to have the military pay for your medical/dental school or not. For Psychiatry, Child and Adolescent tends to pay more by perhaps $25,000 per year, as does Geriatric Psych. With respect to general internal medicine, I am concerned that the entire field will be taken over my lower paid nurse practitioners. Maybe some of those people you saw on the trail were older than you thought. The second was doing an interventional radiology fellowship for 1 year after residency. You can start investing and capture tax-advantaged space the delayed doc will never get back and reap the benefits of an extra year of compound interest. And this is a financial post. If you want to do your own calculations and change the assumptions, knock yourself out. However I’ve had this itch to go back and do a pain fellowship. That’s where the $500K came from. Still a bad financial decision but I’d make it again. WCICON Park City: www.whitecoatinvestor.com/PCsale. Just wanted to point out that there is definitely an arena for a psychiatrist to do all these fellowships and have a coherent career. There was no one on the trail out in the boonies over age 60. Duration, Time & Type of Programs Agree with the decrease in reimbursements and salaries, but even taking this into account I make more in pain than I would have doing anesthesia. If the financial reward for doing a fellowship is higher income later, then truncating the working career would lead to a lower payoff. The financial payoff would be vastly higher, if you could get in to NS. The average doc retires with 2.2 million? Do your own calculations with the numbers you like. http://jaapl.org/content/early/2019/11/21/JAAPL.003889-20.long. What do you think? That has you working at 70-75 years of age. It would not change your point but just enhance it. A decision based on anything else is likely to lead to regret. So yes, half of docs are practicing past 65. They should also consider fellowships. Assuming an anesthesiologist makes $400K a year these days, and a typical one works until 65, he left $400K * 22 = $8.8 Million on the table. Also while in military training you can’t moonlight, which is part of that “I’m willing to work harder for more pay” intraspecialty difference. Why or why not? . This not only makes no sense financially, it makes no sense as a career plan. They start talking about med/peds, and EM/IM and EM/Peds kind of residencies. Some of that is lower student loans, some is a smaller mortgage, some is more home equity, some is retirement contributions etc. I'm thinking cardiology, GI, and critical care. The truth is that the best financial decision you can make with regards to career, specialty, subspecialty, and type of practice is to choose the one that you can do the longest. I’m a bit biased because at least one of my fellowships pretty much got me my job even though I will be signing out general surgical pathology. But only 10% of those in the 50-64 age group have $5M and a lot of doctors retire before at 65. I read that only 19% over 65 have $5M so that is more like one in five. Income usually goes up with a fellowship, but it comes at a price. My work is actually easier than my colleagues as my volume is lower (though I cant predict when it will end). Sinking that much time and you could complete an elite neurosurgery program followed by a spine or vascular fellowship. I picked 25 years because it gets a doc to 60 from age 35. Even in surgery, specializing may mean lower or similar pay. It lasted 11 years and I earned a pension worth 2/3 of the max social security amount. Is your current lifestyle more of an anesthesiologist or a resident? I’m curious if radiology has similar problems. Seems low to me…Are you including the house and the office practice in that? Thanks for posting this timely article! Look at all the subspecialties of pediatrics, internal medicine, and emergency medicine. You state: How much more does she need to invest each year to overcome that $500K ($250K * 2 years) opportunity cost over 23 years?…. I can pretty much attest to the sub specialization not earning much more than a generalist salary. You can refinance your loans and start paying your loans back. Click to learn more! I was considering it but I'm worried about time investment. What is the point of training in a wide variety of fellowships with no overlap? Also available on Audible! What percentage of your portfolio do you reserve for "play money"? Physician Burnout! Clearly avoiding early burnout is pretty important financially. If you assume a high rate of return, then it is harder for the higher income later to catch up. Come to your own conclusions. Both of these cost you an extra year, but seem crucial choices to work out: see young people or see old people. I may be wrong but I think the difference might be more then you calculated. Or Gen Surgery plus trauma plus burn fellowships. And this is a financial post. Register before November 30 to get a $120 discount. I do interventional pain, have an anesthesia training background. I'm done with patients and charting by 430 99% of the time. How much more, after-tax does that subspecialty have to pay in order to be worth it? That said, having the fellowship (and the additional training) is always valuable and gives you the greatest opportunity to call your shots. I chose my sub-specialty (pediatric anesthesia) based on my fascination with the subject matter primarily. I’ve sat through a discussion on this topic at a national meeting, and it seems to be a nationwide issue. Idea is fine, your calculations are needlessly steering to wrong conclusion. In emergency medicine, one can do a 3-year residency or a 4-year residency. Seconding this comment as a radiologist-in-training. Also included is Ortho and OB/Gyn. With current valuations, many would say that 8% is an optimistic return projection. And I can always travel cheaply within the US as well. “…if docs are 30-35…they should have 35-40 years of practice…”. I have a pretty good job and feel like I’m compensated fairly well. Our one-year fellowship is an integrated, multidisciplinary pain management fellowship that includes common and advanced interventional techniques as well as interdisciplinary, acute, chronic and cancer pain management on an inpatient and outpatient basis. Wilderness Medicine. Your email address will not be published. Let’s combine both conversation- doing a fellowship in the military! If I fast-track into child, then I’m looking at 9 years of postgraduate training total! As explained in the post. People come to me to ask. Not the impression one would get from all the shock and awe about someone planning to work a few years past that age. Agree that medical students should think about the financial implications of their specialty choices. If I’m intact and fully functional at that age, I will certainly feel very lucky. Immunology. You didnt explain that in the post, instead you used all of 500K as starting investing hole for the fellowship trained doc which is incorrectly applied. Maybe $100,000 is really just your tax bill. Definitely an interesting read. Unless I misunderstood your assumptions. In my specialty (eyes), lifestyle and work hours generally get worse with more training. To the extent that the financial payoff of a fellowship is higher income, only coming after a delay of 1-3 years, then truncating the working life reduces that payoff. So while this is a fun exercise, just like running the numbers on the military HPSP “Scholarship,” I wouldn't bother. Expires 11/30/2020 Basically, the specialist needs to make $48K a year more after-tax in order to come out ahead. Lower it. The emailer outlines well the effects of a delayed start. Not sure all of those are doing it willingly though, but there are likely some who retired before 65 who didn’t do so willingly either. That’s a good point. Lengthen it. This happens a lot with med students who haven’t figured out what they want to do with their life yet. In the end, I opted out of the pulmonary/ critical care fellowship I had matched into and entered into the practice where I have thrived for 25 years. I am a general internist who did a chief year 26 years ago. Why are the docs illustrated as only practicing 23 years? Do you think this should be a financial decision? https://www.runnersworld.com/trail-running/a21998984/73-year-old-sets-western-states-record/ My colleagues cant. Not me. One thing that I see is that subspecialists (at least in anesthesia) seem to be more in demand. 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