How Much Do You Earn Dr. Dad … or Dr. Mom?

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Your Children and Your Money

Rick Kahler MS CFPBy Rick Kahler CFP

As a doctor – Do your kids know how much money you make? If not, and they asked, would you feel comfortable telling them?

My hunch is that the most common answer to both these questions is “No.” Talking about money is such a strong taboo that it often keeps us from sharing information about our earnings and net worth even with members of our immediate families.

Yet being honest with children about what we earn and how we spend it is a perfect opportunity to teach them important life lessons about money.

Here are a few suggestions to foster those conversations:

  1. Take advantage of teachable moments. As with many other big questions, like where babies come from or whether cats go to heaven (personally, I doubt it, but that may say more about my prejudices than my theology), the ideal time to answer money questions is when the kids ask.
  2. Provide context for numbers. To a child who gets an allowance of five bucks a week, either $10,000 or $100,000 a year can seem huge. One way to put those numbers into context is with comparisons: “I earn about the same amount as your teachers do,” or, “Most doctors probably earn about twice as much as our family does.”
  3. Talk about expenses as well as income. This is huge. It’s another important way of providing context. Plus it helps open kids’ eyes to the realities of earning and spending. When my kids, at about age 10 and 14, first asked about my income, they were impressed with how high the number was. Then we looked at the family expenses: house payment, health insurance, food, college savings, and everything else. They were even more impressed. Seeing what things cost and where the money goes is a good start to educating kids about spending, saving, and creating healthy money habits.
  4. Share appropriately for kids’ ages and understanding. Seven-year-olds and 13-year-olds aren’t ready for the same information. Don’t underestimate your kids’ comprehension, however; if you encourage them to ask questions and are willing to explain and clarify, they may understand more than you expect.
  5. Tell the truth. If you have financial difficulties that stem from your own money mistakes or other bad choices, being honest with your kids can be a powerful teaching opportunity. If you don’t earn a lot but are managing to take care of the family, that’s something to be proud of. If your kids may inherit substantial amounts, it’s wise to start teaching them early how to deal with wealth. Whether you have a net worth in the millions or are barely getting by from month to month, clean honesty about the family finances is a good policy.
  6. Remember that you’re the adult. Over-sharing about financial challenges can frighten your kids. It’s more useful to be matter-of-fact about problems and focus on what you’re doing to solve them.
  7. Keep in mind that when parents don’t talk about money, kids will make up their own stories. Typically this will be either that you earn and have more than you do, or that the family is on the brink of bankruptcy and homelessness.
  8. Look at your own shame and secrecy about money. If parents never talk about money, kids may never ask money questions. Either the topic is simply not on their radar, or they have internalized the unspoken message that it is off limits. In either case, parents can change the family culture by becoming more open about their finances. Those teachable moments for kids begin to happen when money is no longer a secret.

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Doctor salary

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Most Physician Compensation Plans Still Productivity-Based

By Health Capital Consultants, LLC

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Study: Most Physician Compensation Plans Still Productivity-Based

A study conducted by the RAND Corporation and published in the January 2022 issue of the Journal of the American Medical Association (JAMA) seeking to determine whether health systems primarily incentivize volume or value in their physician compensation models found that almost all physicians are still compensated through a volume-based model that rewards productivity over the value of care provided.

CITE: https://www.r2library.com/Resource/Title/0826102549

These study results are in direct contradiction to the longstanding narrative that the U.S. healthcare delivery system is shifting away from volume-based reimbursement and toward VBR. (Read more…) 

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PODCAST: If You Pay Doctors More, Will They Work More or Less?

Income and Substitution Effects in Healthcare Economics

By Erice Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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The MD SALARY “versus” NET-WORTH CONUNDRUM

A Graphical Power-Point Presentation

Courtesy: https://lnkd.in/eBf-4vY

“Of the 125 medical schools in the USA, only one of them to my knowledge offers a class related to saving or investing money.”
– William C. Roberts, MD

Private Banker Jorge Russe; MBA CMP™ explains in this PPT Presentation on Net Worth; NOT Income.

ESSAY: https://lnkd.in/eGArJR2

CMP® CURRICULUM: https://lnkd.in/eDTRHex

Assessment: Your comments are appreciated.

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BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:
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2 – https://lnkd.in/ezkQMfR
3 – https://lnkd.in/ewJPTJs
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A Mid-Year Update on Physician Compensation

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Medscape Compensation Report

vicki

By Vicki Rackner MD

A 2015  Medscape Compensation Report sheds light on physicians’ earning potential.

Here are some key findings from a survey of 20,000 physicians in 26 specialties:

  • Orthopedists ($421,000) and cardiologists ($376,000) are still the top earners among physicians.
  • Physicians in private practice earn significantly more ($329,000 for specialists) than do employed physicians ($258,000 for specialists), despite the trend toward employment.
  • Male physicians earn more ($284,000) than their female counterparts ($215,000).
  • North Dakota and Alaska ($330,000) are the top-paying states for physicians, while Rhode Island ($217,000) and Maryland ($237,000) are the lowest-paying.
  • 9% of physicians have concierge or cash-only practices, the same percentage as last year, while ACO participation continues to grow.
Assessment

However, it’s not what you make that’s important; it’s what you keep. Click here to read a blog post about the Myth of the Rich Doctor that addresses the disconnect between income and wealth.

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So, what are your thoughts about physicians’ potential to enjoy financial independence?

ABOUT

Vicki Rackner MD is an author, speaker and consultant who offers a bridge between the world of medicine and the world of business. She helps businesses acquire physician clients, and she helps physicians run more successful practices. Contact her at (425) 451-3777

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Will single-payer really reduce administrative waste?

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There is no other comprehensive book like it to help doctors, nurses, and other medical providers accumulate and preserve the wealth that their years of education and hard work have earned them.
—Dr. Jason Dyken MD MBA

[Dyken Wealth Strategies, Gulf Shores, Alabama]

The 2015 – 18 Physician Pay Check-Up

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Annual Medscape Findings

[By Staff Reporters]

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Medscape2015Report

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iMBA Inc., Historical Review

[By Hope R. Hetico RN MHA CMP™]

[By Dr. David Edward Marcinko MBA CMP™]

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http://www.CertifiedMedicalPlanner.org

SOAR

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Other MEDICAL Professional SALARIES 

Dentists are Different

A 2003 Survey of Dental Practices reported net income from dentistry-related sources. Dentists differ from physicians in that 90% are in private practice.

In 2002, the average practitioner’s net income was $174,350. The average dental specialist’s net was $291,250. These figures represent a 0.7% and a 5.8% increase over 2001, respectively. Net income rose steadily since 1986, when general dentists made an average of $69,920 and specialists an average of $97,920.

But, by 2010, according to PayScale.com, the average general dentist earned $98,276 – $157,437; a decreasing trend allocated as follows.

Salary $92,689 – $147,682
Bonus $1,996 – $19,727
Profit Sharing $1,038 – $27,514
Commissions $480.74 – $32,500

Source: http://www.ada.org/prof/resources/pubs/dbguide/newdent/income.asp#private

Source: http://www.payscale.com/research/US/Job=Dentist/Salary

dental

So Are Chiropractors

According to Salary.com, the median salary for strictly office-based chiropractors was $78,994 in 2005; while Collegegrad.com reported the median annual earnings of a salaried chiropractor as $65,330 in 2002; with the middle 50% earning between $44,140 and $102,400.

The U.S. Bureau of Labor Statistics estimated chiropractors earned an average salary of $84,020 in 2004. A Chiropractic Economics survey in 2005 suggested mean salary at $104,363.

Another survey, for 2007, in Chiropractic Economics is available here: http://www.chiroeco.com/article/2007/Issue8/images/CES&ESurvey2007.pdf

And, a range of $44,511 – $82,826 was reported in 2010 by PayScale.com, allocated as follows:

Salary $42,106 – $78,129
Bonus $1,008 – $10,205
Profit Sharing $973 – $8,139
Commission $750 – $10,113
Total PayXTotal Pay combines base annual salary or hourly wage, bonuses, profit sharing, tips, commissions, overtime pay and other forms of cash earnings, as applicable for this job. It does not include equity (stock) compensation, cash value of retirement benefits, or the value of other non-cash benefits (e.g. healthcare). $44,511 – $82,826

Source: http://www.payscale.com/research/US/Job=Chiropractor/Salary

Future Doc!

Podiatrist’s Potential Rising

The salary range for a podiatrist, or Doctor of Podiatric Medicine, in 2006 was reported as $128,000 to $292,000 according to http://www.allied-physicians.com/salary_surveys/physician-salaries.htm.

This robust growth was likely due to expanded education, training, and general allopathic and osteopathic acceptance by the medical community, as well as by insurance companies, employers, patients and various governmental agencies and third party payers.

Increased surgical sub-specialization, in-patient hospital and ambulatory out-patient surgical center activity were also positive compensation factors.

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Ankle-Leg Trauma

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Conclusion

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Taxing the Rich … and Doctors?

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The Effect of Taxing America’s Wealthy

By blog.turbotax.intuit.com.

The wealth difference between states demonstrates that certain states had much stronger increases in affluent taxpayers.

For example, Warren Buffett recently called to raise tax rates on taxpayers making more than $1 million and proposed an additional increase on taxpayers whose income exceeds $10 million.

So, where do the “super-rich live and what would it look like if they were given additional taxes?”

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rich

[Click to Enlarge]

Assessment

But, what about the “rich” doctors? Are they even rich, merely affluent or new members of the holloi polloi working class? Do tell.

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What’s Your Net-Worth – Doctor?

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How Would You Respond … if Asked?

By Rick Kahler MS CFP® http://www.KahlerFinancial.com

Rick Kahler CFPFinancial professionals like me think nothing of asking clients this question.

But, if the tables were turned, though, and clients or prospective clients asked the same question of us, how would we respond?

The “Talk”

Every now and then this issue comes up in conversations among financial planners. Some advisors think their net worth is none of their clients’ business, any more than doctors’ cholesterol levels are any business of their patients.

Others are concerned that a single number like net worth is incomplete information and can even be misleading. Knowing a financial professional has a net worth of, say, five million dollars doesn’t necessarily mean the person is trustworthy or a capable financial planner. Net worth tells prospective clients nothing about where the money came from. The planner may have inherited it, won the lottery, earned it through a business other than financial planning, earned it from commissions on poor investments, or even obtained it illegally.

Wither the “Number”

Nor does net worth reveal anything useful about the understanding of money or knowledge of financial planning. I’ve worked with plenty of multi-millionaires who were skilled at making money but were horrible money managers and inept at investing. Even more, there are many brilliant young planners who haven’t had the time to accumulate a large net worth.

I suspect that most clients who want to know about their planners’ net worth actually have several deeper questions in mind. Some may be asking if the professional actually follows his or her own advice. Imagine how troubling it might be to find out your financial planner doesn’t have a retirement plan, is a habitual over-spender, or hasn’t gotten around to making a will.

Other Reasons Why

Another reason for the question may be a concern whether the planner is financially stable and will be around in the future. During the Great Recession, many financial professionals saw their revenues fall by 30% to 40%. Some who did not have a business emergency reserve had to resort to laying off staff, cutting services, or in some cases closing their doors.

Still another concern may be whether the planner is familiar with a potential client’s particular financial issues. This is especially true of high net worth clients. They need to know a planner can relate to the complexities, responsibilities, and emotional challenges of managing wealth.

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Net Worth MDs

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The Questions

All of these are legitimate concerns. Knowing a financial planner’s net worth, however, doesn’t address those concerns. To discover whether a planner is a good fit for you, it would be more useful to ask questions like the following:

  • Do you follow the same advice you give clients? Give me some examples.
  • Do you have six months’ living expenses in an emergency account?
  • Do you invest your money in the same manner you will invest mine?
  • If I were to run a credit report on you, what would it tell me?
  • What are some of the things you have learned from your financial mistakes?
  • Tell me what your company has in place for emergency planning and succession planning.
  • Tell me why you can relate to someone with my net worth and the issues I am facing.

Assessment

If a planner is offended by these questions or dances around answering them, that may be a red flag. If a planner offers answers freely and transparently, you may have found someone who provides exceptional service. Planners who share some of their own financial information are clearly committed to building the trust that is so essential between planner and client.

As a prospective client, you may hesitate to ask these questions even though you want to know the answers. Don’t be shy; ask.

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On Physician Pay Rising

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A New Medscape Report

[By Staff Reporters]

Doctor salary

Physicians working in office-based solo practices and single-specialty practices saw a modest increase in their paychecks from 2012 to 2013, according to the lastest installment of Medscape’s annual Physician Compensation Report.

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2013 Physician Compensation Report

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Salary Update

By MedScape

Doc Comp

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Are Doctors NOW Members of the Middle Class?

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In OR Out?

  • By Dr. David Edward Marcinko MBA CMP®
  • By Rick Kahler MS CFP® ChFC CCIM

Rick Kahler CFPThe middle class Marketers target it. Politicians champion it. Economists talk about it. Most of us consider ourselves part of it. FAs want to serve it.

Yet, when I’ve asked for a clear definition, I have not found anybody yet that really can tell me what “middle class” is.

Definition

I recently posted on Twitter that $90,000 was a middle-class household income and that it would take a nest egg of $3 million to generate that income in retirement.

A couple of my colleagues responded that my figures were way too high and accused me of being out of touch. As a lifelong South Dakotan, I’m used to being seen as “out of touch,” but the idea that $90,000 was beyond a middle-class income intrigued me.

I figured a few minutes with Google would point me to a definition of “middle class.” It wasn’t that simple. I soon discovered that neither politicians, nor economists, sociologists, nor financial advisors can agree on what makes someone middle class. It is a little easier to define a middle class income.

USA Today

I did find an excellent article in USA Today by Dan Horn of the Cincinnati Inquirer. He cited three surveys that attempted to define the middle class by income. The Pew Charitable Trust describes it as the middle 20%, an income range from $32,900 to $64,000. The U.S. Census Bureau disagrees.

They say a middle class income is the middle 60%, an income range of $20,600 to $102,000. The U.S. Department of Commerce begs to differ with both and says an income between $50,800 and $122,000 puts you in the middle class. Combining the income range of the three studies ($20,600 to $122,000) puts two-thirds of all income earners in the middle class.

My Personal POV

For me, defining middle class with such a broad income range just raises more questions than it answers.

First of all, the same income that will provide a comfortable middle-class lifestyle in a place like the Black Hills of South Dakota won’t necessarily do the same in San Francisco or Boston.

Second, if you want to assure yourself of a middle-class income throughout your lifetime, you apparently have to get rich.

Concept of expensive education - dollars and diploma

Case Model

Let’s assume a young couple, both allied healthcare professionals, earn $45,000 each for a household income of $90,000. Let’s assume they want to save enough to provide a similar income in retirement without counting on Social Security. To generate that income, with a 99% certainty they will never run out of money, how much will they need to save?

While financial advisors’ responses will vary, most will agree this couple would need between $2 million and $4 million in today’s dollars. Let’s settle on $3 million. If they each saved $1,000 monthly to 401k’s (about 25% of their salaries), our young couple could save $6,600,000 million ($3 million in today’s dollars adjusted for inflation) by the time they reached age 65.

However, while a couple needs $3 million to produce a middle-class income, someone with a net worth of $3 million is in the financial top 2% of Americans. That’s hardly middle class.

And to complicate things further, Gallup polls have shown that most Americans think anyone with a net worth of $1 million is rich. Yet having $1 million when you retire will generate a secure lifetime income of $30,000. So the net worth that we define as wealthy provides an income that we define as barely middle class.

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Assessment

Confused yet? I certainly am. There’s just one thing I’m still sure of. If you want a middle-class lifestyle after you retire, what you’d better do now is live a modest middle-class lifestyle so you can save enough to qualify as rich.

Conclusion

And so, are doctors members of the middle class – in potential retirement income under this model? Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Anatomy of a Doctor

Risks versus Rewards [A Changing Calculus]

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Some laymen enjoy helping others, but don’t seriously consider medical school. Hard work does pay off, but only if you’re good at biology in this case. One problem has always been the crazy amount of names to learn.

The thought of SAT exams, medical school and MCAT tests already raise stress levels. It’s no surprise that a large percent of doctors feel stressed. Today, only half of them recommend their career to others. It seemed like a fun career once all the classes and training was done. And, many doctors seemed to be happy by the way they carried themselves.

Not so today! The higher than average salaries probably helped to boost their attitude before the ACA. But, perhaps not so much, today!

So; not everyone is cut out to be a doctor. Although it sounds really cool and we can dream about it as a child, becoming a doctor is not always practical. It is a high-intensity job but with decreasing stature and pay, likely going forward.

Assessment

But, the joys of helping others and saving lives are always worth it; aren’t they?

Conclusion 

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The Effects of Healthcare Reform Legislation on Physician Compensation

Is a Future Look Predicated on the Past?

By Dr. Brian J. Knabe; CFP® CMP™

By Dr. David Edward Marcinko; MBA CMP™

By Prof. Hope Rachel Hetico; RN, MHA CPHQ CMP™

www.BusinessofMedicalPractice.com

With the passage of healthcare reform legislation, officially known as the Patient Protection and Affordable Care Act of 2010, many questions remain regarding its effect upon physicians’ livelihood.

Undoubtedly this bill moves the healthcare system several steps closer to a socialized model, but the effects on physicians’ salaries and compensation models are far from clear.

Other Countries

One way to see the effect that this shift may have on compensation is to look to other countries, many of which already have a more socialized system in place.

According to the CRS Report for Congress, US Health Care Spending:  Comparison with Other OECD Countries http://assets.opencrs.com/rpts/RL34175_20070917.pdf) US specialists rank near the top in compensation compared to these other countries, trailing the Netherlands and Australia.  The average specialist in the US made $230,000 in this survey.  The comparable salary in Canada is $161,000, $150,000 in the UK, and $253,000 in the Netherlands.  Generalists in the US are at the top in terms of compensation with an average of $161,000.  This compares to $107,000 in Canada, $118,000 in the UK, and $117,000 in the Netherlands.

Inflation Adjustments

Another indicator of physician salary trends is the change in compensation adjusted for inflation.  According to the American Medical Association, the inflation-adjusted income for the average patient care physician declined from $180,930 to $168,122 from 1995 to 2003, a 7% decrease. And, the inflation adjusted decrease is more substantial given the low interest rate environment thru 2010, and going forward.

Physician Net Income Chart

  Average net income
  1995 2003 Decrease
All patient care physicians $180,930 $168,122 7%
Primary care physicians $135,036 $121,262 10%
Medical specialists $178,840 $175,011 2%
Surgical specialists $245,162 $224,998 8%

Source: http://www.ama-assn.org/amednews/site/free/prsc0724.htm

Given these trends, as well as the fact that an increasing percentage of healthcare payments are coming from dwindling government sources, it is likely that physician salaries will decline as “healthcare reform” legislation is implemented.  In fact, it is likely that this trend will accelerate.  A 15% to 25% inflation-adjusted decline in salaries over the next decade is a reasonable prediction.

Assessment

It is also important to note that the level of student debt in the US continues to rise, while college and medical education are usually subsidized in other countries.  Many foreign physicians graduate with no student loan debt.  The ratio of debt level to salary in the US continues to become more onerous for new physicians.

Conclusion

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