Do Docs Live Below the Poverty Line (and Some Random Thoughts)?
Officially, the poverty line in the US for a family of four is an income of $32,150. But in a Substack post that went viral at the end of 2025, Michael W. Green, chief strategist and portfolio manager of Simplify Asset Management, says that, based on historical estimates, the poverty line should actually be much higher—four times higher at about $140,000.
Considering the median household income in 2024 was $83,730, that means a lot more people than we thought might be living below the Green poverty line. And considering that the average fourth-year resident makes about $70,000, does that mean that single or low-income medical trainees are really living in poverty?
Do Doctors Live Below the Poverty Line?
As noted by Green, the formula for determining the poverty line was created by a Social Security Administration economist named Mollie Orshansky in 1963. Green writes,
“In 1963, he saw that families were spending about one-third of their income on groceries.” Since the price data of many things (e.g. housing), if you can calculate the budget for enough food in the store, you can multiply it three times and establish the poverty line …
In 1963, that premise made sense. Housing was relatively cheap. A family can rent a good place or buy a house for one money, as we have discussed. Health care was provided by employers and was relatively inexpensive (Blue Cross coverage was about $10 per month). Child care wasn’t really a market—mothers stayed at home, family helped, or neighbors (who were likely wealthy) watched each other’s children. Cars were affordable, if prone to breakdowns. With a few simple conveniences, the neighborhood kids in vo-tech can fix a lot of problems if they do. College courses can be covered by a summer job. Retirement means a pension, not a bunch of 401(k) assets you had to fund.
Orshansky’s three-meal formula was absurd, but as a threshold for a critical situation—a measure of “very little”—it was close to true. A family that spends one-third of its income on food will spend another two-thirds on everything else, and those ratios work more or less. Below that line, you were in real trouble. In addition, he had a chance to fight. “
But we don’t live in 1963. In 2026, food costs as a percentage of the family budget are very low.
Response from Green:
“In most families, it is 5%-7% housing now consumes 35%-45% Health care takes 15%-25% Child care, in families with young children, can consume 20%-40%.
These days, you can’t multiply how much you spend on groceries by three to get an accurate representation of the poverty line. According to Green, you would have to multiply your grocery bill by 16. So, his number is $140,000.
Green got a lot of flak for his statistics (one fellow at the American Enterprise Institute called it “the worst poverty analysis I’ve ever seen”), and it made observers wonder what poverty really means (is it a dire emergency, or are you living paycheck to paycheck and just spending?).
While residents making $70,000 or less may not be in that emergency, it’s clear that many of them feel they should be paid more. In a 2024 Medscape report, a fourth-year plastic surgery resident called the salary numbers “disgraceful,” and a third-year psychiatry resident said, “There’s no need to provide slave labor to learn the trade.”
In 2023, a fourth-year medical student in Arkansas named Humam Shahare and some of her peers created a research poster showing that the average PGY-1 salary of $65,000 made by plastic surgery residents left them with more than $23,000 after living expenses.
“It’s not how much money you make, it’s how much money you have at the end of the day,” said Shahare, via AMA. “That’s what will answer, ‘Are your bills taken care of?’
Add in student loan payments, housing costs, and potential child care for a family that may add multiple children a year, and you can see that a citizen who puts in, say, 60-80 hours a week but still gets paid five figures feels shortchanged—regardless of where the poverty line really is. Or as one survey taker in that Medscape resident salary survey put it, “I barely survived.”
Here are some random thoughts that have been floating around in my head lately. In the parlance of old-school sportswriters, we call it putting out a notebook.
Space Patch from WCI Friend, Doc, and Astronaut
As I wrote about seven months ago, Gretchen Green is one of the coolest doctors ever, especially since she went into space as part of the Blue Origin NS-32 mission last year and became the first female commercial astronaut. You can read more about it in his recent WCI guest post called Redefining Risk: Lessons from Medicine, Money, and Spaceflight.
After I told him about my interest in space (especially through my father, who designed several astronauts’ crew pieces during the space shuttle and who designed the first building for the US Astronaut Hall of Fame in the 1990s), he kindly sent me one of his custom-made pieces for his flight into space on May 31, 2025.
Here is all its glory.
A few notes on the episode. A space suit with a chest radiograph was designed to honor his work in radiology, and part of the patch’s color palette is Radiology Green (hex #00A676).
As the famous saying goes, you can take the astronaut out of the doctor but you can’t take the doctor out of the astronaut.
What Do WCI Students Really Learn?
I always find it funny that every year we get tons of traffic to all of our Backdoor Roth IRA posts from December to February, regardless of when those posts were actually written (which is why we always update and republish them every few years). Anyway, I took a look at WCI’s website traffic on January 1st at noon CT, and here’s what I found. The top four most trafficked posts were all related to the Backdoor Roth IRA.
Yes, everyone loves a Backdoor Roth IRA after all the champagne has been popped and the New Year’s balloons have been deflated.
In case you want easy access to all those Backdoor Roth posts, here you go:
Getting into the HOF
Heartfelt congratulations to Dr. Flip Homansky, who is part of the class of 2026 by being inducted into the Universal Music Hall of Fame. Although I have been a HOF voter for almost a decade, I did not vote in the non-participating category, which is where Homansky was elected.
After completing his residency in internal medicine in 1979, Homansky moved to Las Vegas and worked as a general practitioner for twenty years. As noted by the IBHOF, “he was at the forefront of and instrumental in many initiatives to improve the safety of boxers, including reducing championship rounds from 15 to 12 and mandatory HIV and anabolic steroid testing.”
Here’s Homansky playing the Mike Tyson-Orlin Norris fight in 1999.
More info here:
Your Crystal Ball Predictions for 2026
What’s the Worst Financial Advice You’ve Ever Received?
Money Song of the Week
As we say goodbye to Grateful Dead guitarist/vocalist Bob Weir after his long, tumultuous tour, let’s take a look back at the time he and Jerry Garcia were interviewed about the jam band’s wild success from the 1960s onward. Basically, he was asked what it was like to be rich and famous, and Weir, who died last month at the age of 78, responded with an interesting answer about pistachios.
Sometimes, if you have enough money, small worries are not worth considering.
In 1974, the Grateful Dead released the song Money Money, written and sung by Weir, and it tells the story of a man who is hunted by his partner for, you guessed it, money.
As the song goes,
“You say, ‘Money, honey,’ I rob a bank/I just load my gun and mosey to the bank/Take out my savings and a loan/To keep my chiquita in eau de Cologne.”
The song hasn’t aged well, and many fans think the messages are outdated and misogynistic (although some say it was actually a joke). The band apparently only played live three times, so apparently, the members didn’t like it too much either.
But then again, the Dead weren’t known for 4 minute, 24 second deep songs. He was famous for his incredibly long concerts that forced his fans to travel all over the country to hear him live. And giving the band their money’s worth for years and years.
More info here:
Every Money Song of the Week Ever Published
Tweet of the Week
Obviously, it pays to be a pilot.
An American Airlines Boeing 737 captain based in Miami posted his salary statement on reddit, leaving many speechless.
Total pilot year to date compensation was $458K, and hourly pay is $360+ (flight hours only).
Some comments suggest that the pilot… pic.twitter.com/3yH1Z5zB1s
— News and videos Aviation Aviation (@aviationbrk) December 23, 2025
As one Redditor pointed out, however, “From absolutely zero, plan to invest ~$150,000 in your certificates and 10 years of low-paying entry-level jobs before you break even on that investment. Then it’s another 5-10 years before you make this kind of money.”
How much pressure have you felt as a resident? Do you think it is conceivable for a family of four to live on about $32,000? How about $140,000?
