What this sample user told us
These choices are the inputs for the verdict below.
Stage
Resident
Decision
Compare two subspecialty paths
Life priced
Wealth-Builder / Owner - $243k/yr spend
Wealth target
$8M by 55
Sleep limit
<=2 disrupted nights/mo
Geography
Any major metro
Practice future
Facility/equity
-> everything below is computed from these choices
Run my scenarioBuilding sample decision memo
Required gross
$615k-$785k
Pre-tax, not salary survey
Fit signal
57/100
Heuristic decision support
Midpoint scenario
~$700k
Uses this persona's inputs
Sleep burden
72/100
Call burden varies by group
Salary-only gap in this scenario: ~$0 above a transparent $700k salary-ceiling input.
Target-life cost
$243k/yr
after-tax real spending, before taxes and target investing
Source detail: Target-life pricing - user inputs
57
Lifestyle fit signal
1 / 9 - tap to advance - hold to pause
Executive summary
Your income target is hard to reach on a salary alone. It points toward building, buying into, or partnering in a practice, which means more risk and debt early on.
Required gross
$615k-$785k
pre-tax household · modeled
Lifestyle fit
57/100
feasibility signal
Salary-only gap
$0
ownership must fill
Sleep / call tax
At risk
6 call nights/mo
The hard truth
Your $683k desired life is possible in medicine. Just not through every version of it. The real work now is narrowing down to the exact niches and practice models that actually fit your math.
Career Diagnosis
Path Battle Report
Resident choosing a path · Compare two specific paths head-to-head
Not just a job. A business, with facility and equity upside.
The real decision
Your real decision isn't Spine / MIS / Endoscopic versus Endovascular Neurosurgery. It's elective ownership, schedule control, and device upside versus acute stroke, device innovation, saving brains. Pick the identity first, and the path follows.
Your central conflict
Your income target is hard to reach on a salary alone. It points toward building, buying into, or partnering in a practice, which means more risk and debt early on.
The trade to make on purpose
Trade early-career simplicity for equity and leverage, plus the work of running a business.
What must be true
Most likely to disappoint you
An acute-care specialty. The overnight burden would break your stated sleep limit.
This report answers: Two specific paths, compared head-to-head on the dimensions that actually decide a career.
All modules below use this single sample input set.
Diagnosis archetype & Central Conflict
Your income target is hard to reach on a salary alone. It points toward building, buying into, or partnering in a practice, which means more risk and debt early on.
Use guided questions to understand the model, tradeoffs, and what to verify before acting on this report.
This report recommends Spine / MIS / Endoscopic. ownership-leaning version as the most feasible path based on your constraints.
Fit score 513 from income 90/100, sleep protection 65/100, geography 80/100, ownership 88/100. Your $683k desired life is possible in medicine. Just not through every version of it. The real work now is narrowing down to the exact niches and practice models that actually fit your math.
Generated from this report's modeled estimates, assumptions, and source-labeled data.
The gauge summarizes whether the target life, training stage, geography, sleep limits, and practice model can coexist.
57/100
Lifestyle fit signal
Enough to fund this life and invest the annual amount needed for your wealth target. It's a range because taxes and how you're paid move it.
Controlling debt and location matters more than chasing the highest-paying field.
Public claims and typical practice patterns suggest a higher overnight burden than you want. You would need a highly protected subspecialty or niche job.
Flexibility is leverage. More markets means more jobs, more negotiating power, more ownership options.
You're not forced into ownership to fund this, though it can still speed up wealth.
Best fit / viable / risky / avoid, with the drivers behind each call. The same memo sections a paid report renders for your own inputs.
Ranked verdict
Spine / MIS / Endoscopic-BEST FITclears required income by $149k at income mid.
General Spine / Trauma-VIABLEclears required income by $74k at income mid.
Functional / Neuromodulation-VIABLEmeets required income near the midpoint.
Peripheral Nerve-VIABLEfalls short of required income by $51k at midpoint.
Endovascular Neurosurgery-VIABLEcall and sleep burden exceeds your indicated limit.
Hyper-Competitive: ~1.8 US MD applicants per spot. Top-tier Board scores and extensive sub-internship networking required.
Hyper-Competitive: ~1.8 US MD applicants per spot. Top-tier Board scores and extensive sub-internship networking required.
Hyper-Competitive: ~1.8 US MD applicants per spot. Top-tier Board scores and extensive sub-internship networking required.
Verify your take-home math in the Offer Comparator.
See alternative routes in Fellowship ROI.
See payoff, IDR, and PSLF side-by-side for your training runway.
Explore pay vs. cost-of-living arbitrage geographically.
Rank all states by after-tax pay and BEA cost-adjusted net.
Review the discussion checklist for your stage.
6 call nights/mo with only 2 disrupted nights/mo tolerated.
The persona is flexible across major metros.
Salary-only gap ~$0
Prices target life into $243k after-tax spending.
Taxes and local costs vary
Input scenario
Amortized wealth target
Wealth trajectory
Invested / yr
$220k
Real return
4.5%
Years to target
~23
At $220k/yr invested and a 4.5% real return, investable net worth crosses your $8M target in about 23 years of attending-level saving. That lands about 2 years past your target retirement age of 55; closing the gap needs more savings, a later date, or a higher-ownership path.
Full data utility map
The first row is your report-specific scorecard. Each drawer below explains what a source measures, what it changes in the decision, its caveat, and what to verify with a human.
Your personal data map
Required gross income
$615k-$785k
$243k after-tax life + $220k annual investing, then grossed up for taxes.
Ranked best-fit lane
Spine / MIS / Endoscopic. ownership-leaning version
Fit score 513 from income 90/100, sleep protection 65/100, geography 80/100, ownership 88/100.
Sleep/call signal
At risk
2 disrupted nights/mo and 6 call nights/mo were tested against path call burden.
Geography signal
Feasible
Flexibility is leverage. More markets means more jobs, more negotiating power, more ownership options.
Ownership dependence
Feasible
You're not forced into ownership to fund this, though it can still speed up wealth.
Practice model preference
facility equity
This is used to separate salary-only, partner-track, academic, and ownership-dependent recommendations.
Income model source
Neurosurgery reviewed model - best salary gap +$177k
Still a directional model, not a salary guarantee.
19
Source adapters
6
Implemented connectors
7
Planned connectors
1
Manual / licensed
All specialties with NUCC taxonomy codes; strongest for workforce and geography counts.
Strongest fields
Usable reveals: job-market density · geography flexibility · specialty workforce footprint
https://download.cms.gov/nppes/NPI_Files.html
Strongest for Medicare-heavy procedural fields; weak for pediatrics, psychiatry, cash-pay, and commercial-heavy work.
Strongest fields
Usable reveals: procedure mix · site-of-service exposure · public-data blind spots · ownership-dependence caution
https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners
Strongest for device, drug, and industry-adjacent specialties.
Strongest fields
Usable reveals: innovation/industry adjacency · public-data blind spots · ownership-dependence caution
https://openpaymentsdata.cms.gov
Research-active fields; keyword mapping is specialty-specific and interpretive.
Strongest fields
Usable reveals: innovation/industry adjacency · academic-vs-private tradeoff
https://clinicaltrials.gov/data-api/api
Device-adjacent procedural specialties; product-code mapping is interpretive.
Strongest fields
Usable reveals: innovation/industry adjacency
https://open.fda.gov/apis/device/510k/
All specialties at workforce-supply level once adapter is built.
Strongest fields
Usable reveals: job-market density · specialty workforce footprint
https://www.aamc.org/data-reports/workforce
All ACGME specialties once normalized.
Strongest fields
Usable reveals: training opportunity cost · job-market density · specialty competitiveness
https://www.acgme.org/data-resource-book
Match-participating specialties; fields vary by publication.
Strongest fields
Usable reveals: specialty competitiveness · training opportunity cost
https://www.nrmp.org/match-data
Broad occupation and metro wage baselines; coarse for physician subspecialties.
Strongest fields
Usable reveals: metro cost-of-life · income baseline caution
https://www.bls.gov/oes/
Specialty-agnostic metro/state cost index.
Strongest fields
Usable reveals: metro cost-of-life · geography flexibility
https://www.bea.gov/data/prices-inflation/regional-price-parities-state-and-metro-area
Specialty-agnostic metro/community context.
Strongest fields
Usable reveals: metro cost-of-life · geography flexibility
https://www.census.gov/programs-surveys/acs
ASC-heavy and facility-dependent procedural fields once normalized.
Strongest fields
Usable reveals: ownership/facility upside · site-of-service exposure
https://data.cms.gov/provider-data/topics/ambulatory-surgical-centers
Universal model layer; not specialty-specific.
Strongest fields
Usable reveals: required-income scenario · metro cost-of-life · income-vs-lifestyle
Transparent model layer using federal/state/local tax assumptions; not tax advice.
Neurosurgery reviewed first; additional specialties require review before validated claims.
Strongest fields
Usable reveals: procedure mix · path battle dimensions · ownership/facility upside
Internal reviewed crosswalk; raw/full taxonomy is not shipped publicly.
Specialty compensation benchmarks where licensed.
Strongest fields
Usable reveals: compensation benchmark context · fellowship ROI · ownership-dependence caution
External benchmark reference - verify independently. Not ingested or redistributed.
Group-practice compensation benchmarks where licensed.
Strongest fields
Usable reveals: compensation benchmark context · job-offer due diligence
External benchmark reference - verify independently. Not ingested or redistributed.
Specialty and geography compensation context when available.
Strongest fields
Usable reveals: compensation benchmark context · metro pay context
External benchmark reference - verify independently. Not ingested or redistributed.
Broad specialty compensation and burnout survey context.
Strongest fields
Usable reveals: compensation benchmark context · burnout mismatch
External benchmark reference - verify independently. Not ingested or redistributed.
Recruiting demand and offer context where reported.
Strongest fields
Usable reveals: job-market density · job-offer due diligence
External benchmark reference - verify independently. Not ingested or redistributed.
Spine/MIS and vascular/endovascular are compared on major dimensions.
Neurosurgery
Really about: elective ownership, schedule control, and device upside
moderate confidenceNeurosurgery
Really about: acute stroke, device innovation, saving brains
moderate confidenceSpine is definitively the highest-ceiling, most ownership-leveraged lane in neurosurgery.
The reality: Top-decile wealth is almost entirely driven by ownership in the facility (ASC) and ancillary services.
The signal: This lane features massive, concentrated device and implant adjacency, often resulting in lucrative royalty streams.
The catch: Because much of this income (royalties, facility equity) is opaque, Medicare professional fee data massively understates true earnings.
The verdict: Provides a highly reliable pathway to top-decile, seven-figure physician wealth.
High absolute income, but capped by a complete lack of ownership.
The reality: Stroke call stipends are incredibly lucrative, providing a massive financial floor.
The signal: However, hospital employment is overwhelmingly dominant in this space.
The catch: Your income is strictly capped by the physical hours you can stay awake taking call.
The verdict: A very high floor, but a definitively lower ceiling than owner-operator spine surgery.
A heavily elective-weighted spine practice is surprisingly schedule-controllable.
The reality: You have immense power over your week, allowing you to compress massive volume into 2-3 highly efficient OR days.
The signal: The strictly elective case mix means you can schedule your volume months in advance.
The catch: However, hospital-employed trauma spine models can be punishing; you must actively build the elective side.
The verdict: Choosing an elective-focused group is the key to maintaining sanity and schedule control.
The entire job is organized around unpredictable, acute stroke.
The reality: Your control over your nights and weekends is virtually nonexistent when on call.
The signal: The emergent nature of thrombectomy dictates your entire calendar.
The catch: Large call pools (1-in-4 or better) are the only way to mitigate this.
The verdict: This career fights your desire for a predictable schedule every single day.
Unlock full battle card
See exactly who wins on sleep, call burden, equity upside, and 5 more vectors.
Unlock premiumModeled Base Range
$550k - $750k
Includes baseline ER call stipend and baseline productivity.
Production Upside
$800k - $1.2M+
Highly dependent on elective volume, payer mix, and efficiency.
Ownership/Equity
High
ASC, real estate, and implant/device royalties are the primary wealth drivers.
Required Collections (50% OH)
$1.5M+
Modeled Base Range
$650k - $850k+
Production Upside
$900k - $1.2M+
Ownership/Equity
Low
Evidence & reveals
Spine offers strongest ownership levers.
Why: Ownership funds wealth.
Signal: Device/ASC adjacency.
Caveat: Royalty opaque.
Impact: Push for ownership.
Elective spine is controllable.
Why: Pairs income with sleep.
Signal: Reduces emergencies.
Caveat: Trauma carries heavy call.
Impact: Inspect the job's real call.
Endovascular neurosurgery trades ownership upside for acute stroke call.
Why: The decision is not just income; it is whether the 24/7 stroke identity fits your household.
Signal: Stroke-network employment, comprehensive stroke center dependence, and device adjacency shape this path.
Caveat: Local call pools and hospital stroke volume can radically change the lived burden.
Impact: Verify call frequency, post-call recovery, and device/clinical-trial expectations before ranking this path.
Scores are relative, directional signals, not dollars and never a salary claim. Each carries its own why, supporting signal, limitation, and decision impact, and the confidence badge shows how validated each path is.
Plot and filter every path within the specialty across the decision dimensions.
Path battle visual
Practice model
A: Private group, ASC-oriented
B: Stroke-network employed, Academic
Professional identity
A: elective ownership, schedule control, and device upside
B: acute stroke, device innovation, saving brains
What to verify
A: What share of a high-earning spine practice's income here comes from ASC/implant ownership versus professional fees?
B: How large is the stroke-call pool?
Geography and cost pressure
Higher-cost metros increase the gross income required to fund the same home, family support, savings, and travel assumptions. That makes salary-only roles less forgiving and increases the value of spouse income, ownership, or geographic flexibility.
What would change this recommendation
A lower home target than $1.2M or a lower-cost metro would reduce the required gross range fastest.
Reliable household income outside clinical work can make salary-only paths more viable.
More protected nights can move an acute-care-heavy path back into contention.
If buy-in, facility economics, or partnership timing are weak, ownership-dependent paths lose much of their advantage.
Sensitivity tornado
Income vs sleep quadrant
Bring these to your mentors, recruiters, and spouse.
To a recruiter:
"If I hit the median RVU target, what is the exact gross compensation? How long until I am eligible for partnership/equity, and what is the typical buy-in?"
To a mentor:
"Are the senior partners in this subspecialty actually protecting their sleep, or are they still taking heavy acute call to maintain their compensation?"
To your spouse:
"If we live in our target metro, this path requires a higher volume of nights away. Are we willing to trade geography for schedule predictability?"
The report separates public-data proxies, user-input modeling, directional assumptions, and user-entered constraints.
No evidence card available.
Source type and limitation travel with the claim.
Decision memo, not dashboard
The sample is intentionally narrow: one stage, one specialty, one path battle, one target life. The real report changes the persona, constraints, and assumptions to yours.