Dear Captain Capitalism-
I also put this on the Before You Become A Doctor posting.
I graduated Med School in the early 1970's. I trained into a subspecialty- 6 years total post med school. During my training I married and my son came along. Then I went into solo private practice. I also joined the US Army Reserve. Two more children arrived. I was always the sole breadwinner. Any solo businessman has good and bad years. The taxes were stupidly high on a sole proprietor. The little bit from the USAR was very handy- I had help paying the social security (and later the added medicare).
I also worked as an independant contractor emergency dept doc when business was slow, plus insurance physicals and other income I could hustle. Note about ED doc- you had better be a gunfighter betting your malpractice you are better than anything that comes in the door- only one doc in ten has the guts for it. I have been in my one town 35 years (more or less- keep reading). The 3 kids turned out good. When they were all in school, my wife oversaw the books. The insurance companies were consistantly shorting me the contractual payment- never over. Forget about getting diligent (or grateful) help. I have owned my house three times. The first working 6 months 2 or 3 nights a week in the ED as well as the office.I walked out of the ED 1 Jan 1980 with my house paid off (and the government).
Then that bastard H Saddam invaded Kuwait in August 1980, I was making a major's pay and the bank had my home (equity loan) to keep the office recurring bills paid. When Kuwait was liberated I went back to my town and started the grind to get my house back. Back to working office, Army, EDs and insurance exams. Got the house back and stopped the EDs and insurance. A few years later my daughter (who had instate scholarships) went out of state to stand on her own two feet and my money. When the Air Force ROTC reneged on her 'promised' scholarship, I was holding the bag for almost 20K. The bank got the house again. Back to EDs and insurance but now I am in my 50's with kids' car insurance plus college. Then 9/11. Sure enough, the USAR two years later promoted me and put me on full time with spending a year or more at various forts. At least I could afford my office overhead on a colonel's pay. I got my house back and so far still have it. Did I mention my 17 month or my 15 month tours in Iraq? Obama was elected when I was over there. When I got back the great recession was in full swing. Solo doctors don't get paid by medicare- who knew? My insurance payments for patients I saw were frozen at the level 15 years before. You know about that 80 year doctor still practicing and getting $10 a vist- yep, you are locked in. Unless a doctor moves states every 3 or 4 years, his insurance reimbursement is frozen.
Women docs don't work the hours of men. They take SABBATICALS. .for years! I went to cash but my accountant told me to expect an audit because the gov is using audits to punish docs on cash. I could go to a hospital group but these are soulless- given to superficial questionnaires, give a smug answer during the meet'em and street'em and limit or 2 or 3 prescriptions- more than that requires another visit. Plus you are never producing enough. My accountant recommended cutting to 10 hours a week (45 hours a month- I get social security, thank you), keeping up my education, and wait for the crash. I was bitching about this to a friend (blown up in Iraq and partially disabled). He told me I would consider these 'the good old days' when I was treating wounded in a barn on the run from government forces. But if you are younger, forget about medicine.