Wednesday, February 13, 2013

On Job Openings the Minimum Wage and Being Middle Class


 I had lunch with a friend, he was bitching and moaning about business. He’s having a very hard time closing deals – and he only gets paid when there are deals.


This fellow is a headhunter. He specializes in supplying people for the medical industry. One of his clients has given him a sweet assignment – they have a dozen job openings that need to be filled – yesterday. The job description is OT – PT (Occupational or Physical Therapist). Some additional details:


Compensation:  $100 per hour.


Location: Metro NY.


Terms: This is Per Diem work. There are no benefits.


Job Requirements: The applicant must have a graduate degree and at least two year of work experience.


Hours per week: Minimum of 40. There will be the opportunity to work more hours, but the $100/hr rate stays the same.


Long Term Prospects: Most of the jobs will be converted into full time positions with an excellent benefit package in less than one-year. The per diem option will remain open. (Full time work with benefits is less than $100/hr)


Micro Economics: There are no benefits and the taxes will be high. One should expect to pay 40% taxes (11% NY State/City and this income will be subject to the new, top Federal bracket). In NY, the out of pocket cost for medical insurance is $1,000 per month ($2k for a family plan). This brings the take home, after tax and after medical insurance to $55/hr. At 45 hrs a week, 50 weeks a year, it means a take home of $123k – call it 10 grand a month of spending money. Not bad at all.


Macro Economics: To get this job you must have six years of education – four years of college, two more for the graduate work. What does that cost? It could cost over $200,000. I’ll assume only $100k. The payback on that is $1,000 per month for ten years. In addition, there is the lost income for the six years that it takes to get an education; I’ll exclude that.  When you factor in the debt, it brings the real disposable income down to $9k a month.



So what’s my friend groaning about? It’s been two weeks, and he hasn’t filled one of the jobs. There is a big shortage of people with these skills.


I checked a few online sites. There are plenty of ads for the jobs I describe. It’s not just in NY; it’s all over (pay varies significantly by location). None of this is either startling or new, but taken together, I thought it was interesting. Some observations:



-       This part of the economy is red hot. It’s not just OT – PT, the shortage of qualified workers is across the hospital industry.


-       In 2014 (10 months) Obamacare will kick in, and millions of people will have medical insurance. What will they do when they finally have benefits? They will go see a doctor. The demand for medical services is going to grow substantially as a result.


-       Supply and demand says that today’s personnel shortage will get worse very soon. My conclusion is that this will translate into an overwhelmed system where patients do not fair well.


-       A substantial portion of the rising demand for medical services is Medicare and the aging population. More Federal debt is the driving force for the high paying jobs.


-       With personnel costs rising this fast, you have to believe that all of those estimates for what Obamacare was going to cost, were just noise. If you thought Medicare was in financial trouble today, wait three years. The costs will be double what what sold to the public in 2010.


-       Want a good job? Get six years of education. I see this as a very big barrier to entry.  The “good life” will remain elusive.


-       If six years and $100k are required to get a good job, doesn’t that mean that the problems with unemployment today are structural? Can ZIRP or QE fix this?


-       Healthcare is a big chunk of the economy. Clearly there is wage inflation in this sector. There are potential monetary policy implications to this. I would not “short” 2014 CPI at 2.5%….I suspect the new boss at the Fed will have to grapple with this.


-       All of the jobs offered are per diem only. This is not new, but the trend is increasing. Hospitals don’t want the burdens of full time employees. It’s easier for them to write a big check, and let the employees deal with paying taxes and obtaining insurance. We will see more and more of this. You’re on your own…


-       These jobs are very much full time. But because they are per diem, they statistically fall in the category of part time or temp workers. I’m not sure there is spin to this as far as the employment numbers we look at. If there were, it would suggest that the economy is a tad hotter then thought.



Now assume that have the skills and you’re willing to move to the Big Apple. Assume you also have two young kids. You need that $100 an hour to pay all those bills. Including:


-       An extra $1,000 a month for insurance for the kids.


-       $3,000 for rent. (The Apple is expensive – You will live in Brooklyn, not Manhattan)


-       Pre-School/baby sitters will cost another $2,000 a month. (Forget about private schools, that starts at $20k per child)


Now the monthly take home has fallen from 9k to $3,000. Then there is the cell, cable, Internet and electric. You’re making $225,000 a year and have no 401K. You have kids – and they need an education too. So savings is a question in this. Put a $1,000 a month into the market (minimal for this person) and what’s left falls to $1,500.


Can you put food on the table and buy clothes and all the other stuff kids need on $1,500 a month? Yes, but not by much. It comes to $50 day of spending money. That goes very fast these days. You’re not living the high life, forget about a vacation, there’s no chance for a car. And you’re making a quarter mil a year.



Bottom line? $100 an hour is the minimum wage for a person with a family in NY. The Prez is offering $9.







  1. Bruce — you are forgetting some of the hospital benefits that led me and the Mrs to move away from the city and become “country hicks” (not really, just playing along to an outdated stereotype)

    Anyway, the Mrs happens to be trained as a nurse. Not precisely the same as a PT, but there are many similarities — especially on the financial side.

    You completely overlooked one of the biggest expenses facing anyone in healthcare: malpractice insurance. Include that in your analysis and your hypothetical single PT making $100/hr (lets forget about kids) is losing money. I suspect the premiums for a PT is less than for a nurse, but it is a lot more than you might expect. If you can injure a patient, you can be sued for big bucks. I would guess that a PT has to worry about inappropriate sexual touching lawsuits more than nurses, so their malpractice premiums might be just as high as nurses.

    This is America. Its OK for politicians to lie and bankers to steal … not OK for a doctor or nurse to make an honest mistake. You will be presumed guilty until proven otherwise, and you will be on hospital probation after that. Plan on wasting hours and hours of your life in human resources “training” seminars.

    Second, you are forgetting the treatment that many in healthcare have to deal with — especially in cities. Do you have any clue how many patients spit on, strike (assault), or urinate on nurses? How about the patient with Hep-B who decides to stick you with a needle — either because they are scared or on purpose (you get both)? How about the person who’s meds are not adjusted — and they decide to take it out on you? Verbally if you are lucky, physically more than once per year. Maybe you get lucky and a security guards are nearby, maybe the security guard is on break or got downsized. Roll the dice and risk your own health to find out!!!

    Bonus — if you are a woman of child bearing age, keep in mind that many of the diseases (like hepatitis, HIV, etc) can be passed onto your baby. Doesn’t that make you want to sign up?

    Third … while healthcare spending appears to be increasing with baby boomers and obamaCare and whatever, that only speaks to the total number. It doesn’t say how much gets taken by hospital administrators (who make seven figures, do not get urinated on, and generally do not risk their own safety each day — not to mention these administrators are the source of avalanches of paperwork). Anyway, if you actually look at the cashflows in a typical hospital, the pencil pushers tend to get most of the financial reward. Not the doctors, not the nurses, not pathology, and I am guessing not the PT crowd.

    Fourth, on the subject of financials… city hospital janitors are unionized. They make a lot more than the top nurses on the ICU floor (don’t forget the janitors get massive overtime at 2x, and they milk it big time). Janitors do not have 6 years of college or six figures of college debt. When hospital administrators create a system where janitors make more than highly trained nurses, there is a big problem. The obscene cost of janitors plays into why NY public schools cost too much also — why study to be a teacher when the uneducated janitor makes a lot more?

    That is just of few of the considerations you omitted. That is why the jobs can’t be filled. Its not like your friend (and dozens of his counterparts at other hospitals) haven’t advertised the openings.

    • @Bubba – for God’s sake…you have good information, just present it. Stop with all the personal attacks because it’s unspeakably irritating and you kill your credibility!!

      We are very angry and frustrated by all the bullshit too, so we don’t need to hear yours. Go get your own blog if you want to rage against the world. Or chill and present your case. Please.

  2. Someone must be paying through the nose to enable ludicrous salaries like that. Who? Who is paying the bills? Can they continue to do so?

  3. Um, there are a lot of people in the New York metropolitan area who make less than $100/hr, Bruce. Please.

  4. In 1980 all medical spending was about $50 billion. 30 years later it’s $850 billion. About 9.5% per year. In another 30 years that’s $15 trillion, today’s GDP. How likely is that to happen?

    Short the medical industry long term it’s going to crash hard.

  5. thank you for useful information, we have some job opening for financial sector.

  6. I read your article and it’s very useful.we have some doubts about finance, we providing payday loans so i want to how to manage it. if you want payday loan so visit on

  7. As usual BK great info.My daughter has 4 year degree from UNCC in the sciences not liberal arts.She is working at grocery store!Seems all employers want more education.She is looking at her options now.Thanks to regular commenter Bubba joe for the additional info.

  8. How about the other end of the spectrum. You get a guy who gets a job and makes $15/hr. his wife works 40 hours, and makes $10. he gets a part time job at say $10 (if he is lucky to find one). Together they put 100 hours into the system and can barely support a family of 4. You figure what they take home. Something is radically wrong with our system when 100 hours can barely support a family. This goes back several presidents but started with our trickle down theory. You tell me what is wrong.because I don’t know.

    • @David – I don’t have all the answer but can offer some.

      1) People have got to stop being sheep and be BETTER consumers. The notion that self-purchased health insurance always comes with high premiums is patently UNTRUE. Stop, folks….please stop.
      People are not shopping hard enough! I’m 54 and have bought my own for years. Currently — Aetna, it *includes with no co-pay* both annual physical and gyno, mammogram, eye exam… all for the whopping monthly premium of $200 per. Actually it just went down to $182! (A 5K deductible if I start needing big tests for an issue or hospitalization). I hear self-employed people complain about premiums going up every year, etc and I’ll ask, “when is the last time you shopped it?” The answer always seems to be, “oh 7,8 – 10 years ago”. Well, hello? Newbies to a plan always get the lowest rates. So, switch.

      2) My Dad nailed this one 25 – 30 years ago. He observed that a great many had allowed themselves to become very brand-driven and it was costing them a bundle. As was the need for LOTS of stuff. How many TV’s does one household really need? Hey, it’s a free country…do as you like. But, it is simply breathtaking the amount of stuff in American homes. And lower income families too! People would have a lot more savings/disposable money if they quit their addiction to shopping and detached their sense of self-worth from waving around the latest/greatest whatever thingy. (Yeah, Bubba I’m torqued too)

      But, David, I think the reality of your hypothetical couple is that you’re really not supposed to make a career of low wage jobs. They’re intended to be starter jobs. To do better in the world you have to motivate, train, learn and push on to the next level.

      • I’m looking for self insurance as well. I currently live in NYC. A hospital only plan runs about ~$180/month through Empire (this is Emergency Room Only service) while a high deductible regular health plan is about $300 month. Would love to see where your getting the 180/month as I will soon be required to get my own insurance!!

        • NN – Some of the factors in a premium quote are: gender, age, geography (NYC = more $$) and health history, etc. As I mentioned, I’m currently using Aetna.

          Give a look on: http://www.ehealthinsurance.com
          It will make your head spin how many options there are. And plenty of detail to sort thru but, hey, at least there are a lot of choices. Website has good navigation and quick page loads.

  9. Kreditanstalt stop by The Hive and say hi. We’d all love to hear from you.

    Bruce, I think the entire system is broken if 100.00/hr can be whittled down like that. Most cities in the US are not paying wages like this, but it is supply and demand. How many Americans do you suppose want to be healthcare workers? We don’t even have the education systems in place to train them if they wanted to. Who wants to make clothing, shoes or manufacture anything? Over the last 30 year we became a nation of paper pushers. We offshored almost all our manufacturing and even the soul sucking call centers. Now all we have left are Banks, Home Builders, insurance, retail and real estate. We are the FIRE economy and now as we get older we want to have good wages and low priced healthcare, but god forbid we increase taxes to have a healthcare system similar to what Canada. We want it all and we want it now. America is so broken that it is like Humpty Dumpty. Obama (being the empty suit that he is) cannot put it back together again. You are right the healthcare industry will be overrun when 40 million people walk into the system. I wish I had an answer other than we are screwed. You have Payday loaners spamming your blog that is how bad it is. BTW you are on my blog list and many of my readers comment on your astute observations.

  10. Sorry didn’t mean to post that comment as anon. I was having problems with the CAPTCHA Code

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  12. But What Do I Know? says:

    Given that as a 1099 employee you’re going to need to pay 15.5% payroll tax (I know there are some funky deductions from that and you don’t need to pay SS over $110K–let’s just call it 10%). $100 per hour full time is $200,000 per year–your average income tax rate on that is going to be somewhere around 25%, and I assume NY state/NYC will be more than 5%, so it seems that your take home pay will be a bit less than the $10K per month you suggest. Throw in health insurance and you get to keep less than half of that headline number–sucks to be a working man (woman) in this country. . .

    Just out of curiosity, what does your headhunter friend make–seems like he might be better off taking on of his own offerings. . .

    • My friend has been in the hospital biz for quite a few years. But he knows nothing about medicine, he wishes he had a job that offered him 200k.

      He works for a company. The actual per diem rate is $125 (example – I don’t have the actual number). If he fills the job, his company gets the $25 for a year. He takes a share of that.

      • But What Do I Know? says:

        Almost seems like it would be worth it for the customer to train their own workers at that rate–you wouldn’t need to buy six years of school and pay a middleman 20%. Seems like both employer and employee would make out better with some kind of apprentice program–stop pretending that all these jobs need a bachelors/graduate degree. . .

        • No doubt. You can’t tell me a PT/OT needs 6 years of education. Come on.

          • In my view, a BA/BS is broadly required mainly to keep the lower half of high school graduates away, without diversity hassles.

            • Exactly. It’s a way to naturally cap upward mobility to those who were raised in households that could afford to pay for that level of education. There is no earthly reason why a PT worker needs 6 years of education. That’s probably more than the guy who signs his checks has.

  13. I shared this VERY RELEVANT observation on this blog a few months ago but it deserves repeating because I don’t hear other people talk about it. I believe it is a CRITICAL component to the total amount of dollars spent on healthcare in the USA.

    Ready? Doctors rountinely oversell tests, treatments, operations, drugs and on. Everyday, nationwide many millions of dollars are racked up for UNNECESSARY things. Why? Well, follow the money. Much, probably most, of this uneeded stuff provides direct $$ into that Doc’s pocket. They’ve become hustlers.
    Medicare and end of life scenarios are rife with this fraud. A friend of my Mom’s was diagnosed several months ago with both liver and lung cancer (beyond stage 4, no curing that) and yet, they still offered her chemo!? REALLY? And she did it because she trusted them. What a lousy way for her to spend the last few months of her life…dealing with that horridness. It’s morally corrupt.

    No doubt, BILLIONS get spent every year in the USA on needless medicine. Time to start questioning your Doc’s about tests, drugs you take, do you really need that operation? 60 Minutes has an espisode about this stuff a couple months back. Finally, some are waking up.

  14. utilization of medical services is not higher in the u.s. it’s just that everything costs twice as much here as in other oecd companies. 25% of healthcare dollars goes to insurance company overheads, profits and red tape. that’s a start.

  15. M. Thatcher,
    A final thought. I live in MA and only know what I see. Health care insurance is expensive and many people go without. They end up going into the out patient. We have virtually no GP’s today. I would love to know how much an OP visit costs vs a GP.

  16. I feel really sorry for doctors who have to bear this bunch of crappy people every day. Being a doctor at a developed country really sucks.

  17. Bruce,

    Markups for independent contractors range from 40% as a bare minimum assuming no marketing and minimal overhead costs to over 200% (3X salary) for consultants who have marketing costs, overhead, uncertainty in utilization, etc. A 100% markup would be pretty reasonable to use for the OT/PT who would have to move to an expensive location, could have their hours cut any time for any reason, and has to cover all their own benefits. Bubba brought up malpractice insurance, which could kick that up even more. This would put the OT/PT’s equivalent net earnings at $50/hr, or about $100K per year if all goes well. Still a good amount, but maybe not all that attractive to someone who has a good OT/PT job somewhere else. I would bet the hospital’s total loaded costs including all management, insurance, and overhead to actually hire a full time OT/PT would be over 3X multiplier on salary.

    • This country has gone pill crazy, how did the human race ever survive. I see these elderly with a pill container and each one is filled for the week…Hello no wonder they have two stores on every corner. I’ll bet they make more selling prescriptions than the whole rest of the store.
      Now for my story. I take Trileptal. I tried the generic but the just don’t work. I tried writing to the drug mfg co but I make to much $. I get a statement from my Ins company and they pay about $200 per mo. I figured I could pay that. My I C pays about 2k per year an runs out about Aug. Aug I went to pick them up and when I went to pay they wanted $450. WTF
      Another time last year my doc wanted me to take a new type of the same, it was newly developed and the first mo was free. Wow, quite a deal and I have to say it was much better. The next mo I went to buy some myself and when I went to pay…..$950. I got out of there pretty quick. At $950 for 60 pills by my calcs . $15/ pill, better not drop one. $15 for a pill most likely made in China and costs at most $1 to make and ship…hello. I’ll let you take it from there.

      • David – check this out: http://www.planetdrugsdirect.com/Drugs/Trileptal/101000/

        SO FAR, cheaper pharma is often available from Canadian sources (until our charming Govt shuts down that choice). I’ve used that company for years and never had an issue.

        Elderly people with lots of pills? Like I said above, Medicare is rife with fraud….over-prescribing, testing, operating….you name it! Your tax dollars at work. Clue your parents into the nonsense.

        • M. Thatcher
          I find that things to good to be true usually are. Actually I take 1-1/2 per day (600mg). My co-pay is $75./mo or by my calcs $1.67/tablet. According to your to your Canadian Company they are $89. per 100 tablets or $.89/ tablet………..They want a a prescription from my doctor. You bet I am going to be on the phone to my to my doc. tomorrow. Are they making $ on my co-pay……… Now you are really making me sick…will I need a new tablet for that. Thank you, David
          ps I’ll keep you posted

          • David – Glad to help. No, it’s not that your Doc or insurance co. is skimming off your co-pay somehow. It has more to do with the way big pharma prices their drugs to individual countries. It would be very interesting to see a worldwide spreadsheet of that.

            Anyhow, they sell to Canada cheaper (I presume b/c it’s a socialized system). I’ve used that company for a couple of different meds for several years and had no problems. Personally, I don’t see why your Doc needs to know where you obtain your drugs. I would just call the Doc’s office, tell them you want to switch pharmacies and would they send you a paper prescription in the mail? (mine have done so) Then scan it to your computer to upload when you order (or you can fax it). Easy peasy. **Btw, I assume it’s obvious that you purchase this way outside of your insurance company, yes? It’s direct purchase.

            Good luck, I hope it’s helpful to you. P.S. Might take up to 3 weeks to receive the meds in the mail. Cherrio!

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  20. Thanks Atlantan. M. Thatcher has saved me quite a lot of money. I guess you never know what’s around the corner.
    I will do as you recommend and keep my doctor and ins co out of this. I’d hate to be a peg in the possibly of ruining this for myself and others.
    By the way, any idea of what Vigbx and Bali…… are saying or am I missing something.

    • David – Well gee, look there……I busted myself. In fact, M.Thatcher and I are one in the same. I use 2 computers and they auto-populate with the name I started with on each. I didn’t notice on the last response or I would have changed it.

      No matter. I think there are a few others on here who use multiple names. But, I may now stick just with Ms. Thatcher……as I’m liking her viewpoints/assistance lately. :>)

      VigRx and others are spamsters who got thru even with the Captcha gauntlet. Click their names…takes you to websites selling stuff. In that case, drugs for guys.

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