You work so hard. You burned the proverbial midnight oil in the library to get through the first 2 years of medical school. You woke up before the break of dawn to get through the next 2 years of medical school. You killed yourself physically and socially to get through residency.
And now, you’re a doctor … practicing medicine on his own.
Life should be good now. You sacrificed and slaved away for a better life. You’re now ready to receive your long-deferred reward. But after just 3 months into your new job, you realized that you have been fooled. The pot of gold at the end of the rainbow is really a pot of fool’s gold. To the outside world, your life seems grand. But you know the truth.
Sure, life is a little bit better than before. You make a lot more money now than during residency. But some things just never change. You still have work coming out the wazoo. You still have calls that interrupt your precious sleep. And your salary doesn’t look so good after Uncle Sam and his cronies claim half of it for themselves.
And if you just joined a practice, you’re the new guy — at the bottom of the totem pole. Someone else is still calling the shots and controlling your life.
Welcome to the Matrix. After more than 10 years of trying to become a doctor, you are finally a doctor — only to find that you’re an interchangeable cog in the big business of medicine. A mass-produced product of the medical education system. There are lots more where you came from.
Don’t get me wrong. You can do quite well for yourself, but don’t expect to get rich. If being an average, run-of-the-mill doctor is what you want out of life, stop reading now. You’re already heading in that direction. But if you want something more, keep on reading …
‘Cuz I’m going to teach you the secret to being irreplaceable, in control, and rich.
Let me begin the lesson with a story about Walmart paying an absurdly high salary for an entry-level position.
At one recent point in history, Walmart paid $21 / hour for an entry-level, no-skill-required job. Yes, this is the very same Walmart that pays its workers barely enough to live, if it can get away with it. Under normal circumstances, the wages for an entry-level job are so low, it’s minimum-wage workers gotta get welfare to make ends meet.
So where and when does Walmart pay its workers such a generous salary?
It all started in a little town in the middle of nowhere: Williston, North Dakota …
A couple days after I landed in Williston, I was heading back to my pad when I met one of the new arrivals, a black guy from Seattle. There are a lot of Washingtonians out here for some reason.
“Hey man, this city is great!” he exclaimed.
“I was down at the temp office today. They had me sweeping the floor at John Deere. I made $90 just sweeping. And when I got there, they actually said, ‘Thank you for coming to Williston!’” He grinned.
“Yeah man, this is probably the only place in America where we call the shots,” I said. “They need us workers more than we need them.”
That might be an exaggeration, but it’s not a big one. North Dakota is the state with the lowest unemployment rate, at a mere 3% (versus 8% for the country at large); Williston’s unemployment rate is less than 1%. Even with all the press the town gets and the dismal state of the economy, local business are still screaming for workers, forcing wages ever higher. Applebee’s is the only employer I know of that pays less than $12/hr, and that’s only because their employees get tips. Not only do workers get paid big, they work considerable overtime (80-100 hours is the average for roustabouts), further upping their paychecks.
Even the temp agencies, ordinarily the province of the desperate and downtrodden, have good-paying work available. Roll into the office each morning and you’ll have your pick of unskilled labor jobs paying around $13-17 an hour, flagging being the most notable. Flaggers are the folks at road construction sites responsible for directing traffic with stop/slow signs, and with all the expansion in the Bakken, they’re in huge demand during the warm months. To become a flagger, all you have to do is head down to Job Service North Dakota, watch a 15-minute video, take a multiple choice test, and if you pass (and if you have an IQ above room temperature, you will pass), take your freshly printed certification down to the temp office.
That’s right: you can make $16-17 an hour just standing around holding a stop sign.
Workers are so scarce in Williston that employers are resorting to increasingly desperate measures to lure them in. For example, Walmart is now paying for its employees’ hotel rooms, at least through the Christmas shopping season. This is on top of their starting pay rate of $17/hr ($21/hr for overnight stockers). A Pilot Travel Center north of the city is also offering housing in hopes of rounding up enough employees ahead of their grand opening in a few weeks.
Basically, Williston is perhaps the last city where the American Dream is still a reality.
Williston looks like what you’d expect a middle-of-nowhere burg suddenly invaded by thousands of jobless men to be. The city is over two hours north of the nearest Interstate; the closest major cities, Minneapolis and Calgary, are over a dozen hours’ drive away. It’s as close as you can get to pure isolation in the lower 48.
Downtown looks like it was trapped in a time warp back in the 70’s. There’s a J.C. Penney’s, a movie theater, a cafe and bars, and that’s it. The roads leading in and out of the city are a confusing patchwork of half-finished McMansions, freshly paved cul-de-sacs, and hastily erected gas stations. There are no malls, no art museums, and no nightclubs. There is, however, a Walmart. And a Hardee’s. And a Dairy Queen.
Working 80-100 hours a week doesn’t seem so bad when you realize there’s nothing else to do in this town, aside from sit around at home and stare at the walls.
The Census Bureau says that Williston’s population is 16,000, but don’t believe it. With all the out-of-staters looking for work, I’d estimate the real population is around 30,000-35,000 right now, and 40,000-50,000 during the summer months. The city’s as much of a madhouse as you’d expect.
If you are astute (which most likely are, as a doctor), you’ll see why a common overnight stocker could make a middle class salary, while his peers in other parts of the country are barely scraping by. It is because of …
Scarcity is what allows you to be irreplaceable, in control, and rich.
It is simple economics really. If you reduce supply (by being one of the few people who can fulfill the demand), the price (your salary) would go up.
As a medical provider, there are two ways to be scarce:
There is something about doctors all congregating at the same place. A lot of them practice near their residencies. If they move, they move to a major city or a suburb of a major city (where tons of doctors already work).
Thus, if you just wanna be an average, primary care doctor while making an above-average salary, you better move to the middle of nowhere. Towns desperate for doctors will pay you quite well. In a state like Montana, you can make $450,000 a year. That’s not shabby at all.
If you decide to stay in a place already overcrowded with doctors, like New York City, do not expect to make a killing. Why pay you $450,000 when other doctors will accept $150,000?
This is precisely why an average overnight stocker in Williston could make $21 / hour. There are so few stockers in a middle-of-nowhere town, they can command 3x the salary.
If you’re the only doctor in town, you’re pretty much a monopoly. It doesn’t matter if you’re subpar, mediocre, or superb. Without you, no one can get their treatments. Therefore, it is feasible that you make 3x the salary of a family medicine doctor in New York City.
But what if you don’t be a country doctor? What if you need to be close to the city? Or at lease close to civilization?
Then you gotta specialize. You gotta get unique, in-demand skills that few doctors have.
Why do you think so few medical students go into primary care? Why do most students want to specialize? As much as they say that enjoy the training and the specialty, the predominant factor is money. Specialists make more money than generalists.
Those who specialize usually complete a fellowship, which could be challenging to get into. But that’s not all. Once you get in, you’ll still have to pay your dues. Think of fellowship as a second residency. You still gotta work a lotta hours for a low pay.
What if you did not complete a fellowship and have no plans of doing so in the future (like me)? Does it mean you’re destined to remain a generalist? No, you can still specialize.
Lemme explain …
As an allopathic or osteopathic doctor, you have an unrestricted medical license. Your license allows you to practice any kind of medicine. You can become a dermatologist and treat only skin diseases, even if you didn’t go to a dermatology residency. (You just can’t be board-certified. But if you don’t want to work in the hospital or accept insurance, it doesn’t matter.) You can do surgery without going to a surgical residency. Heck, you can even be a chiropractor, optometrist, massage therapist, naturopathic doctor, or whatever other doctor you can think of.
Now here’s an insane, but brilliant idea. What if you learn a specialty on your own? Instead of completing another residency or fellowship, you hack your own post-graduate training. Read books. Go to conferences. Apprentice under other doctors.
(For doctors who are sick of the whole medical system, this is an excellent way for you to rebel.)
You get all the benefits of a fellowship without all the opportunity costs. No loss of time, no loss of money, and no loss of control. Imagine if you spent 5 years after medical school to become a radiologist … only to find that the majority of the work is outsourced to India. What then?
Stick a fork in you. You’re done. As you can see, following the well-traversed road could be very, very risky.
Although “hacking” your own post-graduate training could work for any specialty, it is especially useful for a field that does not have a residency or fellowship. Think complementary and alternative medicine (CAM). Osteopathic omedicine. (This is where osteopathic doctors have an advantage over allopathic doctors.) Acupuncture. Medical spa treatments. Weight management.
The possibilities are endless.
(Do you want more details about uncommon, but insanely profitable, specialties? Including how much you can potentially make — backed by real data? If so … you do not want to miss this!)
According to the Centers for Disease Control and Prevention’s (CDC) …
In 2007, approximately 38 percent of U.S. adults aged 18 years and over and approximately 12 percent of children used some form of complementary and alternative medicine (CAM).
In 2007, U.S. adults spent $33.9 billion out-of-pocket on visits to CAM practitioners and purchases of CAM products, classes, and materials.
As conventional medicine becomes more and more expensive …
As conventional medicine fails to treat chronic conditions …
More and more people will turn to other options — CAM. Trust me, alternative medicine is not going away anytime soon.
(But remember … No matter what you choose, getting trained formally through fellowship or “hacking” your own specialization by yourself, the most important criterion is not the money. Rather, it is loving what you do.)
Choose a job you love, and you will never have to work a day in your life.
The Immutable Law of Supply and Demand
Whatever you choose, you cannot escape from the laws of supply and demand. If you wanna be a lemming — an ordinary doctor practicing ordinary medicine, surrounded by a sea of competition — don’t be surprised when you’re doing no better than your peers.
You will keep on losing control over how you practice medicine.
You will keep on working more for less money.
But at least you’ll feel comfortable knowing that you’re just like everyone else.
If you dare soar above the crowd and position yourself as a scarce prize, you will be irreplaceable, in control, and rich.
Attention! Do you want to make more money as a doctor? Do you want more freedom? Are you sick of all the useless, time-wasting paperwork? Do you wanna learn how to set up and run a profitable practice that only takes cash, from someone who has “been there and done that?” If yes, check out My Cash-Based Practice: Essential Knowledge for Creating a Successful Private-Pay Physical Therapy Practice — the best book I have found on starting and running a cash practice.
At the very least, check out the book review.
This article is part of the Money in Medicine series. Click on the link if you want all the money-making secrets available to doctors.