The more I travel and see the world, the more I realize that we are incredibly fortunate to live in the United States. Clean water, bountiful produce, cheap land, and awesome plumbing are just some of the perks that we benefit from in this part of the world.
Most professionals in America have a pretty good life too. Sure, our vacation time pales in comparison to the French, but our earning potential is not bad. As our online financial community has shown, you can really build up a nice chunk of change relatively quickly in life if you play your cards right. Even doctors, who spend at least a decade of our lives training, can build up a nice retirement fund and enjoy the option of retiring “early” (looking at you, PoF and WCI!).
However, the common bond between all of these achievements is that essentially all of our online financial blog gurus have worked in the United States (except for Millennial Revolution). Is America that great? Is it possible for doctors elsewhere to replicate this financial wizardry?
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Could a doctor in Sweden, enjoy 50+ weeks of maternity leave, work for a decade, and still build up adequate savings to meet the 4% rule to enjoy a comparable lifestyle as a U.S. doctor? Or does “socialist” medicine condemn doctors to a life of mediocre earnings and retirement under a governmental pension system?
Let’s walk through the considerations of this thought experiment:
Incubation time to become a real doctor.
If the goal is to earn and save as much as you can, you’d want to spend your time making money. Unfortunately, the 6-figure income that comes from being a doctor has to be bought with time. While some people try to shave off a few years of training through accelerated BA/MD programs, most doctors I know are at least 30 years old before starting their first real jobs. Some of us who took on medicine as a second career are even older when we finish.
In France, whose medical training is considered to be one of the most rigorous in Europe, doctors train for nine to twelve years. Starting at year 7, doctors start getting a stipend, sort of how residency works in the U.S. The difference is that this training starts right after high school. This means that doctors in France can be fully trained by age 26 for a generalist position! They can actually start generating an income by age 23!
From talking to my international colleagues, it takes about the same amount of time to become a doctor no matter what country you train in. However, most countries start medical training right after high school. This means that you can start earning and saving at a younger age, perhaps by four years. At $100,000 a year, you could have made an extra $400,000 by skipping “college” through training in another country.
Medical education isn’t free in America either. Most doctors in the U.S. finish up with at least $200,000 in loans. Most medical training programs elsewhere, are much cheaper. Medical school in France is essentially free (thanks to a 45% tax rate for high income earners).
All in, doctors in the U.S. could be at a $600,000 disadvantage compared to doctors elsewhere by the time they finish training. You could buy a nice Lamborghini for that price. ?
Earning potential of doctors.
We have a general idea of how much U.S. doctors earn. Our work isn’t easy, but you can earn pretty good money. I work about 55 hours a week and am pretty exhausted after every day. I’d say that the 55 hours I put in is as tiring as 120 hours of writing software! I’ve gotten the impression that many doctors in Europe might not work as many hours as those in the U.S., and doctors in Asia put in insane hours. How do physician salaries in other countries compare?
We have to realize that statistics are only numbers. The reported specialist salary of $230,000 for the U.S. looks more in line with university and academic positions. One of my friends from Holland moved to the U.S. explicitly for career opportunities and higher wages. One of my acquaintances from Australia also told me one of the orthopedic surgeons in his medical plaza makes $1,000,000 a year.
If any of the data is to be trusted, I would still conclude that doctor salaries in the U.S. should be among the highest in the world, but any of the countries we’ve listed on the chart should also be conducive to high incomes for doctors.
How do the financials look being a doctor in the Netherlands?
Suppose that you are Dutch and wanted to become an emergency medicine doctor. Let’s look through the education/career process:
Education/Training
You finish high school at age 16, and enter your medical training. This consists of 6 years of medical school (3 years undergrad and 3 years Msc). I’d estimate that the cost of education would be relatively low for the first three years (perhaps 2 000 euros a year), and then ballooning up to 20 000 euros for the last three years.
At age 24, you enter internship and EM residency (totaling 4 years), and finish at age 28. During residency, you earn approximately 40 000 euros as a stipend. Afterward, you get a great job and earn 150,000 euros annually as an attending.
This doesn’t look too much different than being an emergency room physician in the U.S., only that ER physicians might have the opportunity to earn much more in the U.S. long term.
Would I rather be a doctor in the United States?
Let’s face it, Americans still have it good despite having to go to college before becoming a doctor. Sure, I’m biased, but America is cheap. Cheap housing. Cheap food. Cheap cost of living. Big homes. Big cars. I haven’t seen the cost of gas go over $3 a gallon in Minneapolis for years, but the average gas price in Amsterdam is around $6.50/gallon! I doubt that you’d find $0.99 Aldi strawberries in Nijmegen either. I’m sure that toilet paper is more expensive anywhere in Europe and the toilets don’t work as well either.
I might be missing something as an uncultured American. However, with such great savings opportunities, couldn’t I just travel elsewhere to enjoy the cultures that I’m missing out on?
Would you consider working your entire medical career outside of the United States?
Regardless of the accuracy of the salary statistics, ISTM inflation is relentlessly reducing real incomes
I have been working outside the US for the last 20 years. I wouldn’t want to go back and work in the USA now, for sure. When I talk with my US colleagues, I find that they do much more paperwork than I do, pay higher malpractice, and have less freedom of decision-making. I work in Northern Italy, so I see high profile patients in Milano. I live outside Milan in a small town, so I also see a large number of middle class or less-than, in the clinic close to home. My patients in both clinics are almost uniformly grateful, polite, punctual and thoughtful. I see new patients for one hour and followups for approximately 40 minutes, so I really have (take) the time to consider both their health and their illness in our office visits. No one tells me which pharmaceuticals to prescribe or not prescribe, and if a rare patient really needs an opioid prescription, there is no problem. Since I work in private practice, about 50% of my patients pay out-of -pocket and so my rates are pretty elastic. It all seems to work out in the end. I make less than my USA colleagues, but I also have almost no overhead. Also, if I wanted to have the lifestyle I have here, in the USA, it would cost a whole lot more. (food, holidays, culture, even Pilates and yoga cost less here.) So while I think with affection about my previous life and work in the US, I am completely content to not work there.