If they like their fellowship, great. But never good to let the tax tail wag the dog’s income. (not your kids, but their friends.)
Also, a good example of unintended consequences of Govt policy. Young Doc could be making bank and paying higher income taxes into the Treasury…
Seems like if the frequency of 3-5 year 100-150 mile non-competes was better known, it would be a deterrent against becoming a physician outside of the few states where non-compete employment agreements are largely unenforceable.
How to Know if Non-Compete Terms Are Reasonable | LawDepot - LawDepot.com indicates that 3-5 year durations of non-competes are significantly longer than typical.
I get it that you fundamentally don’t approve of loan forgiveness as a vehicle to incentivize public service. But that’s exactly what Congress, as the representative legislative body, decided to do. In creating PSLF in 2007, Congress made a policy determination that it was worthwhile to provide loan forgiveness to a certain class of borrowers who are willing to commit to working for at least 10 years for a qualifying employer, which includes governmental employers (federal, state, local) as well as 501(c)(3) organizations. The rules focus on what type of loan you have and what broad type of employer you work for.
You’re apparently making a value judgment that it’s better for society for young doc to make bank and pay higher taxes than it is for young doc to work at a non-profit or governmental employer for 10 years and then go out and make bank. Congress in 2007 obviously made a different judgment.
I read a lot of these discussions on other boards. The people who seem to be in best position to pay off massive loans quickly (by continuing to work ridiculous hours in a real job) seem to be ER physicians. The discussion was centered around working 80-100 hours for a couple of years and moving on with their debt free life.
That used to be true. ER docs could do tons of locums (temporary jobs) plus have a regular job on the side. However, the environment has changed since Covid. Hourly reimbursements have gone down significantly as profit driven CMGs have infiltrated the EM job market. ER docs used to make ~$400/hour routinely. Currently the median is around $180-220/hour… The days of $300+/hour are long gone. And…if you don’t meet RVU and productivity goals, your income gets docked.
And quite seriously, in summer 2023 one hospital in Denver advertised and filled EM positions that paid $21/hour. BTW, USACS (which manages the ER at Lutheran Medical Center) is a CMG.
If you can’t pay off loans @ $180/hour you aren’t getting much sympathy from me.
Wow, that’s crazy. And if a doc (or anyone) takes a 1099 gig, that does not qualify for PSLF.
PSLF is not under consideration if they are trying to work hard and pay off the loan quickly?
The discussions I read were quite recent (6-12 months ago) where they were listing specific jobs and working 80-100 hours a week which translates to over 700k even at 180/hr. They were looking at paying off 300k or more in 2 years.
Granted this was all hypothetical discussion amongst ER residents. They are checking with each other about the feasibility and burn out.
Burnout will happen working that many hours.
They’re mostly blowing hot air about paying loans off in 2 years–though it is theoretically possible. But what an awful physical toll it will take. Also w/r/t to patient safety, do you really want the doc treating your elderly mother for stroke to be running on no sleep and Red Bull.
Also they need to “live like a resident” while doing this.
I’ll also bet that most of them are single males with no family members they’re responsible for.
I came across a recent paper from the Dept. of Education titled: “Where Do Borrowers Who Benefit from Public Service Loan Forgiveness Work?” I think this is useful because there is a popular narrative that suggests that PSLF is primarily benefiting “underserving” people such as (1) rich doctors, or (2) slacker baristas with masters in puppetry. This study focusses on the employers of PSLF beneficiaries, and to me these sound like pretty deserving recipients. "We find that K-12 schools are the most common subsector, comprising 28% of all employer occurrences. Institutions of higher education and healthcare nonprofits represent the second and third most common subsectors at 15% and 12%, respectively. . . .Common examples of healthcare nonprofits include hospitals and not-for-profit elder-care facilities as well as community health clinics. . . . One type of employer whose employees commonly benefit from PSLF are U.S. military branches. Employers such as the U.S. Army, Navy, Air Force, and Marines occur nearly 3 times as often as other federal employers in our data, and the U.S. Army and Air Force employers are among the largest single employers for those borrowers who have received forgiveness through PSLF. https://sites.ed.gov/ous/files/2025/01/PSLF-Employers-FINAL-1-16.pdf
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