Reality Check (Ruthlessly Candid)
I am looking for a job.
After three years of residency in Internal Medicine I have decided to forgo fellowship and go into Primary Care/Internist or Hospitalist work. I thought it would be interesting to share with you some of the offers as well as my thought process.
I think this can be interesting because due to my anonymity I can afford to be ruthlessly candid. The other reason is that as some have stated you would like to read about the true experience of being a resident, look no further.
In the past, I have done my share of complaining: about the job, the hours, the pay, the future etc. etc. I’ve stopped all that. Not because I don’t still have those same concerns but because I realize that some of my audience likely make a fraction of what an internist makes these days and so my complaining seems kind of “funny”. So please don't view anything I write here as complaining, just my honest thoughts.
And, since I always believe that two, or two hundred, heads are better than one I would certainly welcome any tips that my readership can provide, maybe something I haven’t thought about.
Before I do, I think I have to be candidly honest about my goals and current situation, so that all of you can give me the best advice:
Overall, this is the plan: My wife and I would like to be able to return to Israel to live there within 5-10 years. Since doctors make roughly $30-40,000 in Israel I do not think that I will be able to pay my medical school loans there, this is the reason why I returned to the U.S. after attending medical school in Haifa. I would also like to be able to purchase the apartment/house I will live in there, since that can be very expensive. The plan is to pay off the private loans before I go back and make enough investments in the U.S. so that I can have income that can pay off the rest of the loans by itself. Currently, we are hoping to finally purchase a home and stop renting. Preferably in a good community with good schools so that Jordan can be safe.
Current financial situation:
1. Private Student Loans: $80,000 at 6.25% variable interest. Current monthly payment can vary but minimum is rough $600.
2. Stafford Student Loans: $96,000 at 3.25% locked, monthly payments $400 over 30 years.
3. Savings: $40,000
4. Currently renting but hell-bent on buying something soon. I currently live in a major urban city and the housing prices here are on the level of prohibitive.
Thus Far: I have been to 5 primary care interviews and 3 Hospitalist interviews here is what I have come up with: I have multiple offers, here they are:
Primary Care Positions:
1. $120,000 a year. No bonus. Partnership, maybe, after two years. Housing reasonably priced.
2. $115,000 a year. Bonus once surpassing three times your income. Partnership after 3 years. Opening Concierge service possible. Housing extremely expensive.
3. $80,000 a year. No bonus. 10% of whatever you bring in. Housing extremely expensive.
Funniest trend: The more expensive housing is in the area the smaller the salary.
1. $110,000 no bonus, known to be a hard hospital to work in with lots of hours of work. Housing in area extremely expensive.
2. $125,000 no bonus. Work hard. Housing expensive.
3. $140,000 with bonus. Two hours away from family and outside current city. Housing cheap. Good community. Work hard.
My current inclination is to take the third Hospitalist position since I will likely be able to save the most there. The wife and I think it is our best chance at achieving our goals even though we will have to leave the family behind.
I had intended to go into clinic based medicine but will likely hold off until I move to Israel. It is an unfortunate truth which I simply have to confront and that is that currently I cannot allow myself to enter primary care and achieve my short term goals. When I listen to my friends who entered other specialties and the offers they are getting I am extremely jealous and if I had to make the same decision again I would have chosen differently.