Forget Silicon Valley, It Still Pays More to Be a Doctor in America | Hacker News Reader

Forget Silicon Valley, It Still Pays More to Be a Doctor in America

bloomberg.com

29 pointspseudolus74 comments

These comparisons are too coarse. I make more money as a line level eng in big tech than my wife who is a surgeon at a well respected hospital with a hoity toity pedigree. I have always made more than her, my path has caused me to incur much less debt, and I work about 60% of the hours that she does. In 10 or 15 years, she might make more than me or we might make about the same depending on the career track I decide to take. She is in the top 2% of her field pedigree/track wise and the real benefits accrue after 10 years or so of being an attending. At that point, you can consult, be an expert witness in court cases, direct a medical program etc. If you aren’t in the top echelons then you’re ceiling is going to be 300-400k unless you get a deal at a rural hospital desperate for your services.

It's striking to me how many of the doctors I know envy tech people; maybe it's just a case of "the grass is greener."

There are also many downsides to medicine not being considered by the authors: https://jakeseliger.com/2012/10/20/why-you-should-become-a-n....

working at FAANG and making 300k tc is like 5-10% of engineers even in America, your experience certainly isn't true for the run of the mill engineers. Top 5-10% doctors probably pull in close to a million.

Getting into medicine is heavily gated (getting into med school, graduating, getting into residency, etc), ensuring that only the top N% of people who would like to do so actually can, while the only gate for devs is getting a job, and it seems that nearly everyone who wants to does so. So the top 5-10% of devs is not really comparably to the top 5-10% doctors, because the latter have effectively been allowed to drop the lowest-performing (100-N)% of their peers. I would ballpark that N is well under 50 for doctors, and well over 90 for devs.

I work at a FAANG company and median TC for senior engineers (5+ years exp) is around 350k. If you can make staff (prob 1 in 4 L5 eng make it to staff) then you’re at 400 - 600k TC.

The weird issue with medicine is that the top doctors usually work at university hospitals that get all the difficult cases, but due to the nature of medical billing, the complicated cases pay less and take longer, this these “top docs” usually make the same or less than their counterparts at a private hospital working on more mundane procedures. At that point, the money comes in from the side gigs I listed above (expert witness, consulting, books, speaking, patents on devices/drugs etc). Some university docs also pull in money through small private practices where they do cosmetic procedures etc.

I seem to recall reading a comment on hn a few months ago about over hearing (at the gym) a transplant surgeon trying to recruit his friend saying that he could get several mill per year.

That sounds about right. I sometimes deal with surgeons through work and also through someone close to me and these surgeons seem quite wealthy considering the types of cars and houses they are talking about. Must be way into the millions.

there is also no ageism so they have a secure career for almost as long as they want.

I chatted with a friend of a friend who had just completed his oral surgery residency.

Once you've established your own practice and got a solid number of clientele (no easy feed), it's not unusual to net >$100K per month.

Yes, but there are probably only a thousand or so transplant surgeons in the US. You are looking at a fraction of a fraction of all doctors.

Total compensation for medical doctors can vary hugely. I suspect that the article was done using physician salaries -- that is, those employed by hospitals, clinics and private practices (i.e. the non-partners).

The way physicians make top dollar is private practice. While not as lucrative on average as it used to be, it can still generate outsized incomes. Many medical doctors make well over $500k as a partner in a private practice. Of course, the hours can be insane and the risks are higher as you're running a business and corporate hospital squeeze associated practices.

Finally, as odd as it may seem, smaller hospitals in second tier areas can sometimes pay more than top hospitals in tier one cities. Why? Simple, because few doctors want to go there.

One big advantage that doctors and lawyers have is that their careers easily progress as they get older, they continue to get paid more and have excellent job security. A 50 year old lawyer or doctor is making bank where no one wants to hire a typical 50 year old developer.

I think the difference is that there are so many more software engineers. That is, there is no doctor equivalent of a typical 50 year old developer that no one wants to hire because those doctors were filtered out through med school, residencies, etc. You're left with a few highly skilled set of doctors. While there is no such filtering process for software engineers and you're left with a large number of people of varying skills. A highly skilled 50 year old software engineer is still very hireable.

This is something I think about a lot. I'm doing okay working in UX right now in my mid-20s. But what job security and prestige will I have in 15 years from now, 25 years from now?

I worked with lots of extremely competent SWEs around that age or older. I don’t buy this at all.

The ones that left switched jobs or retired (and some came back from retirement).

The title of this article talks about Silicon Valley but then uses national numbers. There are very few software engineers in the Bay Area making only $110,000 a year. If they want to talk about tech that's fine, but this includes programmers working at insurance companies in Tulsa, which isn't exactly the image that comes to mind with "Silicon Valley."

Still though, on a cost-of-living adjusted basis, it works out the same. The other day someone asked me if a $100k offer at WalMart in Bentonville, Arkansas was a good offer. The effective purchasing power is well over $200k in Bay area dollars, not to mention the lower tax burden.

Granted, there is huge opportunity cost living in Arkansas.

Regardless of local cost of living, it's a bad offer becasue Wal-Mart can afford to pay better. That's "company town" pay right there.

Do Tesla’s cost half as much in Bentonville? What about MacBook Pros or student loan payments?

No, but if you are careful with money you can pocket more. For example, Texas and Washington do not levy a state income tax, letting you keep about 10% more (even more true now that you can no longer exclude state tax from federal earnings).

Property taxes and housing tend to be far cheaper in Texas and until recently, were also lower in Washington.

biggest purchase of anyone's (average/above average people) life is always a house. When we say purchasing power, we have to include the "weight" of a house (which is proportionally much much greater than say purchasing a macbook pro.)

No, but food and rent cost far less, meaning you can buy more Teslas and pay off more of your loans.

The math doesn’t add up. Food isn’t uniformly half as expensive and rent is only a limited percentage of your take home. A 1k apartment vs a 4K apartment is a yearly difference of $36k, not $100k.

This. 10 out of 10 discussions I have around this topic with people looking to move out of the Bay Area results in the other party realizing money isn’t going to net out in their favor.

Also, don't forget that need based aid (assuming you are talking about student loans for children) are calculated off your total earnings and assets, irrespective of location.

There are plenty of developers working at startups earning close enough to $110k plus "equity", and even plenty in other more mature businesses. For example, the company I work for has that as the midpoint for our entry level software engineers: we're a mature, public company with over 300 engineers and about 10% of our staff is in that classification. Take a look at angel.co. I haven't run an analysis but there are plenty of Bay Area jobs posted there for sub-$100k salaries: some of those are going to be filled. Then we have a number of older tech giants and tech divisions of companies who haven't caught up with salaries paid elsewhere: IBM, Visa, Raytheon, Oracle, etc.

A doctor in the US is someone who has gone through 4 years of undergraduate college, 4 years of medical school, and 3 years of residency.

In addition, getting into medical school is pretty difficult, so they have to be among the best students in undergrad.

Now let’s compare an somewhat analogous software engineer. Someone who has gotten a bachelors degree from a good college graduating near the top of the class. They now have 7 years of experience in their job. A possible equivalent of the competition for getting into medical school might be landing a job with FAANG.

Looking at levels.fyi, it seems that such a person would be making from 250-350K, which is comparable if not greater than an internal medicine or family practice doctor with a lot less stress and much fewer work hours.

> Looking at levels.fyi, it seems that such a person would be making from 250-350K, which is comparable if not greater than an internal medicine or family practice doctor with a lot less stress and much fewer work hours.

Is that $250k-$350k exclusively in hyperinflated areas of the country? What would a FAANG developer be making in Miami, or Iowa?

I've heard near-FANG companies pay roughly 75% of what the expected value in Silicon Valley would be in places like Denver or Austin. A deep discount for sure but with the added benefit of far lower cost-of-living and tax burden. Facebook and Google are unique in that the majority of their engineers are in high cost-of-living areas, so they pay the same amount for the relatively small numbers of engineers working outside of the major offices.

Three years of residency will make you a GP, on the very low end of the MD salary range. Specialists typically have a 4-5 year residency with 1-2 years of fellowship following.

Not all specialists are created equal. The well-known plastic surgeon in Los Angeles will earn a magnitude more than the same in the midwest who in turn earns more than general surgeon in the midwest. The work hours and culture are hugely variant between specialities too.

But this is only true in SV, where housing prices have inflated to meet, if not exceed, what FAANG pay can support. The economics of a software engineer starting today are very different from one who started five or ten years ago.

On the flip side, the Facebook/Apple/Google engineer would be exposed to intense competition from overseas engineers and/or immigrants, while the doctor has a government-enforced monopoly on his degree.

7 years into your career you could easily be making $500-600K in total compensation at a FAANG while a doctor has yet to graduate.

If that were the case, then those numbers would appear in various compensation tables shown in various websites.

They are on levels.fyi, take a look around the 6 level. Many of these articles compare base pay of a doctor with base pay of an engineer at a FAANG, but at a FAANG, your salary is often 30-50% of your total compensation with annual refresh grants stacking up over your tenure.

Wouldn't "fixing" healthcare cause a big reduction in not just doctors salaries but the amount of profits doctors offices make

Not sure how much they ding my health insurance company for when I got in for a ten minute visit and see the doctor for maybe 5.

> Wouldn't "fixing" healthcare cause a big reduction in not just doctors salaries but the amount of profits doctors offices make

Possibly, though there are a lot of other total cost drivers besides provider profits. Also, part of the profit requirement for providers is, in effect, risk premium for payment uncertainty caused by our multipayer, far from universal coverage, different policy rules system.

Yeah, and that's okay. Nobody's owed compensation at a specific level, and moving forward, medical professionals would be more public servants than rock stars. That's not to say they'd be paid badly, Canadian doctors under the single-payer model make $250-500K CAD and have much lower expenses as malpractice insurance is socialized too.

I vote we go after software engineers next! We won't earn as much, but hey, we will be able to feel good about being public servants. Its always easy to throw others under the bus... Look at what happened to the education profession. It used to be good, but its slowly been getting worse and worse. Now its generally the C students that go into education.

> That's not to say they'd be paid badly, Canadian doctors under the single-payer model make $250-500K CAD

Only because if they got paid less, they could move 50 miles south and get paid 2x.

If you can make a good case for socializing software engineering, then I'm all ears, but I've yet to hear a good one. The difference is that a software engineer doesn't control directly the life or death of another, and doesn't provide a service we all need to maintain basic function and that of society. Health care should be a human right, some letters on a screen less so.

> Only because if they got paid less, they could move 50 miles south and get paid 2x.

That sounds like a market would exist regardless, does it not? Canadian physicians have little interest in working in the US because they want to serve people based on their needs and not sentencing them to death based on their inability to pay. There are serious moral issues doctors in America are payed handsomely to ignore.

The interesting thing is you're arguing against your own interests here.

Basically yes. In theory you can reduce costs by going after the chunk of healthcare funding that ends up going to lawyers, insurance companies, medical billing experts, etc.

But trying to claw back funding from the first two never seems to work out.

Those salary numbers are nation wide. In silicon valley alone, software engineers will make much more on average than doctors.

This seems like a very click baity article.

I've only skimmed the article, but it seems it's looking at median salary. I'd guess that Silicon Valley salaries are on the high end of the income distribution for the positions so likely to be higher than GPs

That’s the problem with wanting “typical” numbers. Amazon range TC numbers are common.

I'm a little confused on the goal of this 'analysis'. It appear that time spent in school/school cost isn't even considered. I'm not that familiar with bloomberg articles so I can't speak to their normal quality, but this seems like a filler article

Now that I noticed that this is aimed at young professionals in an effort to guide their career choice, this article seems even more disingenuous.

I'm a sophomore in college right now. A couple of my friends chose to do Pre-med, and I'm majoring in CS. Nearly everyone in my CS classes will graduate with the degree, and get offers as software engineers. However, the people doing Pre-med are stressing like crazy, taking nearly double the amount of classes I am, and still might not get into medical school. And don't forget residency after that. Obviously the debt from 8 years of school is going to be much more, not to mention the emotional impact of all that stress and school.

I noticed something when I graduated a few years ago that only became more true as I started looking at hiring new graduates. People that would have normally gone the PreMed/PreLaw/Investment Banking route are changing majors half-way to CS. The students changed from easygoing hacker types to hyper-competitive types.

Yea but after they become a doctor, their license essentially acts as a gatekeeper for the rest of their life. Anyone can be a "Software Engineer", and this is not counting the ageism in software and the continual need to update your skill set for the rest of your life.

My GP is leaving medicine. She doesnt make that much and the hospital is dictating her hours like a fast food employee. GPs make in the mid 100K range. I have several relatives that are physicians and they still work long hours, maybe 60+ hours a week, are on call some holidays, weekends, nights etc. They do love their work.

I went to an MD PHD program for 5 years before dropping out (for the dot com boom). My dream was to develop systems that would create custom cures for infectious diseases. Take a sample of the virus/bacteria, drop it into the machine, and custom antibodies are created for the particular strain. I realized that medicine changes so slowly and you are essentially a mechanic for the human body. As a physician you have a specialty and will likely be doing the exact same thing for the rest of your life.

As a physician you are servicing people as a developer you are building things. Tech is rapidly changing and for me is way more fun. You can reinvent yourself to a totally different technology or field every 5 years. You can start a company in just about any field with a development background to make much more than a physician can make.

I started my own consulting practice and overall I believe was a much easier and interesting path than medicine would have been.

She should start an urgent care clinic in an underserved, but not totally economically depressed region. She will almost certainly earn multiples more than she made on salary.

From the same article, the median CEO makes $190k, which is considerably less than what I think most people assume -- slightly more than 3x the median household income. Note that for the purposes of government statistics a CEO is running a thousand person company, it is not the "CEO" of a 20-person startup. That pay seems low for the amount of stress and responsibility that job entails.

It is good to be a software engineer.

No shit the average doctor makes more than the average programmer (though a Silicon Valley programmer is going to have a higher compensation than average - which makes this article even more stupid, because it uses national numbers on salary to make a generalization about Silicon Valley salary).

But becoming a doctor is a lot more difficult, expensive, and takes much, much longer. Its much riskier. Getting into med school after the sunk cost of an undergrad is far from guaranteed. Passing your boards and getting into residency is not guaranteed and you may have to go into a different specialty than you were planning on. By this time you've already given up 8 years of earnings and have probably taken out loans in the six figures.

And if you graduate med school and don't like the work? Too bad!

Seeing a few friends go through the stress of the process, I wouldn't want to do it myself. None of my friends got a residency right out of med school. The other one of my friend decided to not go into med school at all after getting a pre-med degree and instead go to nursing school.

My family is full of people in the medical field.

They generally make more than I do. I work remotely on a beach at 30. They cannot, or aspire to once they retire.

For my values and life goals, I prefer my compensation: freedom. Though they get to wake up everyday to help people.

And work twice as many hours a week.

And have massive personal liability that could much more easily leave you unemployable and emotionally scarred.

And start your career $300-500k in debt with the only option you possibly have for paying it off is working as a doctor, even if you decide you don't like it 8 years into the program. You are now 100% handcuffed to the profession and have 20 years of servitude ahead of you.[0]

[0] True story of family friend

There's also the opportunity cost of the years of additional schooling. Their tech counterparts in the Bay Area are making six figures a year for several years while doctors are racking up additional debt.

And an astounding amount of educational debt, with boundaries on where you can practice.

I make quite a bit of money without a degree and I work 30 hours a week as an engineer. Doctor salaries are not much more than what I get already so I'm failing to see how it pays more to be a doctor. I guess if all we're looking at is total compensation then sure they make more than me, but I put in way less effort to formal education and work way less.

Why are all of these articles on comp so wrong?

Can you elaborate on what is wrong about them?

They always just seem meaningless, for example:

What is a Computer and Information Systems Manager? What jobs does that cover?

Let's say maybe it's software engineers, why are we comparing doctors, who's comp is all salary, to engineers, who can have 50%+ bonuses?

Law is a well known bimodal distribution. BigLaw pays $190k salary + bonus straight out of law school.

Where are bankers and consultants? Post-MBA comp is $150k - $165k salary + bonus.

The articles just never seem to align with what I've heard by word of mouth.

Almost half of doctors in the USA are not on salary, they are partners in their own practice.

Didn't know that - great point

Maybe a better source for physician salaries: https://www.medscape.com/slideshow/2019-compensation-overvie...

That link redirects to a login page.

if you study your ass off and work as many hours like doctors do, then i'm sure you can make just as much money in big cities with tech jobs.

They also have the distinct disadvantage of always being in the position of making decisions that may kill someone.

Doctors make more because they have a government-enforced cartel preventing competition for their jobs from other US citizens and also preventing immigrants from coming to the US and claiming to be "doctors" without any qualifications.

Yes, please tell this to the next doctor you see who saves your life or cures your disease. /s

You are implying that they would be insulted. If they were insulted by the implication, why do they accept government interference in doctor licensing?

But its still easier to break into tech.

Did not read. Assumed article did not deduct malpractice insurance premiums and student debt payments to reach conclusion.

Reply on news.ycombinator.com