u/Round_Trust2814

The Physician shortage, why it's happening

I've seen this blamed on various entities Reddit hates such as "corporations" or "private equity".

More accurately, the US has a maldistribution due to ironically Doctors being paid **too much** money. A Cardiologist can easily make $400-500k in Austin, Chicago, Atlanta, Charlotte etc.

Who in their right mind will move to rural Idaho for another $200k? Or Mississippi, or Alaska. What are you even going to do with the extra money there? You're in a frozen hellhole or Mississippi. You get a massive lifestyle downgrade for... essentially not much in the grand scheme of things.

It's the same thing you see that past a certain income, a lot of people choose to work less. Why bother?

Furthermore, a lot of these areas absolutely cannot afford to pay you that much more such as a million dollars a year or many millions due to terrible payor ratios (which would likely be needed to get an orthopedic surgeon or some other highly compensated specialist to give up their lifestyle). Doctors capture **all and sometimes more** of their "surplus value". Hospitalists are paid out of the facility fee in the vast majority of cases.

There isn't infinite money and as the system stands unless supply increases or compensation falls everywhere else. Or the government steps in and drastically increases reimbursement for these areas. These areas will continue to be underserved. Mississippi has 3x less cardiologists per capita as Massachusetts, it isn't Doctors fault. It's the free market working itself out.

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u/Round_Trust2814 — 1 day ago

23M, electrical engineer just got a big break and will be making ~$210K at a tech company (Austin, TX so MCOL)

I plan to spend ~$5,500/mo on housing (15y mortgage 10% down ~$600,000 purchase price. Austin property taxes are brutal). Got the offer yesterday so nothing is set in stone. Just checked zillow and looked at mortgage rates.

Assuming I get a mortgage with property taxes @ 2% I should be able to itemize around $50k (including sales tax deduction)

Company provides 50% dollar-for-dollar 401k match so obviously we max that. I plan to do a Roth contribution since I'll be in the 24% bracket after the deductions. I also plan to do a mega backdoor Roth IRA.

After I max my retirement options and pay for housing I should be left with around ~$40k. I've got no student loans or other debt. Plus, I feel like I can inflate my lifestyle with subsequent promotions.

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u/Round_Trust2814 — 21 days ago