Month: October 2015

One Less Hour of Sleep Each Night Can Make You Richer

It is well known that highly successful people are able to function well on little sleep. It doesn’t matter which profession you are in—the more time you dedicate to your profession, the more likely you will be successful.  One of the principles of becoming a rich doctor is to hustle. If you wake up one hour earlier than everyone else, you will have more time to hustle.

I once knew a surgeon who woke up at 4am every morning to go swimming. He would arrive at the hospital at 6pm and review his patient charts before going into surgery at 7:30am. He did not allow his waist grow with the size of his wallet, and stayed active and healthy. His patients loved him and he took good care of them.  He also retired at age 59 with a healthy chunk of change without ever focusing on hyper-saving his income.

But wait, this guy probably netted over $300,000 a year his entire career! He could have retired 10 years earlier and still be in financial independence! If finance were that easy, why do 41% of all doctors still have less than $500,000 in retirement savings?

DISCIPLINE

The surgeon mentioned above did not have great investment acumen. In fact, he was guilty of the typical situations that chew up one’s net worth: (1) investing in gold and rare metals, (2) divorce, (3) investing in land that could never be converted to any appreciable asset, and (4) investing in properties sold by infomercial pitches.

Despite those shortcomings, he had discipline and he hustled in his career. The 4am mornings allowed him to exercise and prepare for his patients. In return, he remained healthy and was able to maintain his job throughout his career. He also did not have a lavish lifestyle but drove a 20 year-old truck.

What Can You Do With An Extra Hour?

What you choose to do with an extra hour of your day depends on what your immediate and long term goals are. Do you wish to build up endurance for your physically demanding job? Perhaps you can dedicate this time for exercise and improving your health. An hour a day of exercise for an entire year will definitely result in better health.

Perhaps you need to bulk up your financial knowledge or medical knowledge. Maybe you wish to embark on a side business or simply need additional time to clean your house. Make a list of mini-goals that you can hope to accomplish if you are able to dedicate an extra hour to during the day. As long as you aren’t vegetating on the couch watching television, extra time will definitely achieve more and get ahead.

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Your Neighbor’s Wealth Has No Bearing On Your Own

Your Neighbor's Wealth Has No Bearing On YoursI occasionally peruse the Bogleheads online forum for advice and inspiration on my finances. One amazing aspect about online forums is that there is almost always an answer for everything. There are many data-minded people out there to do the calculations and plenty others who are itching to poke out flaws and nitpick.

While I’ve developed a thick skin to comparing my finances to those of others online, it is always humbling to read about some poor soul who is much younger than you with a much higher net worth frantically asking for financial advice.

A few days ago, someone who was 27 years young with an emergency fund of $275,000 and a tax-advantaged account value of over $100,000 (Roth IRA, 401k) asked about where to put $150,000 in a taxable account. By doctor standards, this guy is wealthy. When I was his age, I was well into a negative six-figure net worth. A doctor in her 30’s would have to be somewhat knowledgeable about finances to be in a similar financial situation (A large percentage of doctors have less than $500,000 in savings!).

This scenario does remind me of two lessons:

1. Everyone’s Circumstances Are Different. How someone manages to build a certain net worth at a certain age has little bearing on how you build own net worth. You may have started from scratch while someone else may have had a windfall. It’s not their fault that you spent ten years of your life learning to become a doctor while someone else spent that time making money. Likewise, just because you are a decade behind financially you are not condemned to a lifetime of financial failure.  Psychology is a powerful phenomenon. Use that to your advantage. Let it not hinder but fuel your hunger to succeed.

2. You Can Only Control What Happens To You. It doesn’t matter if your neighbor or the guy on the Internet has a huge amounts of wealth. It’s not like they are going to give it to you. However, you can control how wealthy you can become. If someone from the Internet can do it, so can you. If a random guy can save 70% of his income on a $100,000 annual salary, you can certainly do so on a $200,000 income! You just have to ask yourself how badly you want it and what you need to modify your lifestyle to get there.

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Your Waist Grows Along With The Size Of Your Wallet

Most of us have gone through our lives eating microwaved instant noodles at some point, whether in college or later in our careers. Doing so was an exercise in convenience and frugality—how else can you possibly pack in so much sodium and fat in such an inexpensive package? I remember being able to buy 10-packs of instant noodles for $1 at Big Lots years ago, and boy did I take advantage of those sales.

Unfortunately our experience with compromising health with convenience with frugality puts us at a disadvantage. The fact that we were ever willing to consume something that is undoubtedly unhealthy suggests that we are likely to do so again in the future. Wait a second, how is that argument valid you ask? It is human nature that we fall back onto our habits, especially if we are at times of stress. I’ve done it. I see plenty of Hospitalists, Surgeons, and Radiologists do it. The dozen or so of my colleagues who I’ve inquired about eating “junk food” admit that they did it in their younger years. The few that don’t interestingly did not ever do so in childhood either. They all actually had either private chefs growing up or ate organic foods even twenty years ago.

Your Likelihood of Eating Unhealthy Foods Will Go Up

Doctor lifestyles are notorious for allowing us to consume garbage. Many of our clinic days are packed to the rim and encroach into our lunchtime. By the time the morning clinic ends, we are starting our afternoon clinics. What do we do for sustenance? How about the bag of chips that came with the sandwich we ordered from the deli? Hell, it’s questionable whether that turkey-avocado wrap at the deli is even healthy (read: high salt and low fiber).

Do we eat healthier at home then? That’s debatable as well. In a two-person working household with two kids, there is little time to take care of anything in the house, let alone meals. How about take out pizza, fast-food, or fried chicken? These are filling to you stomach as well as your arteries. 

Do you think that you’d eat healthier when you are at a conference, meeting, or even family vacation? I don’t know about you, but I’ve never seen a conference dinner meeting held at a salad bar. Think steakhouses, Italian pasta houses, and seafood. Guess what? You can actually afford to eat at these places!

You Are The Only One Who Can Direct Your Health

At this point in your career, you have all of the reasons to get out of shape: long work hours limiting exercise, plentiful conferences with opportunities to expand your waist, and busy work days conducive to unhealthy eating.  

As difficult as it sounds to the patient when his doctor tells him to lose weight and cut back on sweets, it is equally challenging for us to do the same. It is easy for us to come up with excuses not to stay healthy, but it is the best thing that we can do for our patients. Ironically what I have found to work for me is what many of the self-proclaimed “help gurus” suggest: gradual lifestyle modification.

Try it out yourself. Can you go to sleep 30 minutes earlier every evening to get more rest? How about allocating 10 minutes of your day to walking? After you achieve your mini-victories, move on to bigger goals. Stay persistent, and stay hungry.

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Be Careful What You Wish For In Your Job

be careful what you wish forI previously wrote about compromising career options for family reasons. There are often scenarios where you do find your so-called “dream job” only to realize that it’s really not what you expect it to be. If you are looking to start your first job or simply to find greener pastures, buyer beware.

Private Practice Dream Jobs

For instance, the buzzwords in private practice include “high income potential”, “real estate opportunities”, “busy on day one”, and other phrases along the lines that suggest that the new physician will be wildly successful financially and have a great lifestyle. Can that be possible? Sure, but those opportunities may be more uncommon than you realize. As doctors, we are paid on productivity. We’ve discussed how doctors are paid, and how they can earn more money. An opportunity that has “high income potential” can mean a handful of things: (1) You will work your tail off seeing tons of patients a day or doing a ton of surgeries (2) You do that while building ancillary income opportunities through real estate or hospital contracts or (3) something that the practice is doing is either unethical or illegal. We all hope that we never end up in the third scenario, but these instances exist. You sometimes hear about docs who have homes abroad, private airplanes, and an 10-car garage. Some of them are even being investigated for insurance fraud. If a potential employer tells you that’s their lifestyle, beware. Most doctors under our healthcare system can become rich, but not likely real estate mogul rich.  Grand riches in medicine always come with a catch.

University Based Dream Jobs 

The appeal of working at a university include working with like-minded peers in your field in a cutting edge setting. You have the potential to run clinical or laboratory research to mold the way we practice medicine. You also have the opportunity to educate the future of medicine. Monetarily, you will still do fine, but you will likely have additional income through speaker or consulting fees. Beware, even the best university-based medical jobs will NOT be perfect. One lesson that I’ve learned is that you must love your career in order to succeed at the university, because you will likely be BUSY. While you may only have one to two days of clinical work, you will likely spend a lot of time working on lectures, presentations, teaching, and paper writing. This time can extend into your personal life at home. There were plenty of nights I spent during my training preparing abstract and paper submissions into the early morning hours and still received prompt e-mail responses from my attending mentors. If you wish to succeed in an academic environment, you will have to spend more time in your career than you would otherwise. This isn’t necessarily negative, but a dream job at a university is really one that allows you to focus your energy toward your career.

Your Dream Job May Be One That Affords Your Time Away From Work

Ironically, an ideal medical career for you may be one that allows you to have time off from the daily routine. I have seen job offerings in remote areas of the country (or the world) that allow up to 3 months of time off! For unmarried doctors with the travel bug or an interest in adventure, three months of time off would be a dream job. Even at a lower base pay, you can sustain a healthy life outside of medicine. Being a doctor will hopefully provide you with career stability, but time is a precious resource that we gave up during our training. It would be nice to have control of our time to enjoy our hard earned dollars.

What type of medical practice do you work at?

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Why Doctors Need To Care About Money—And So Should You

doctors need to care about money“I’m not in it for the money!”

That is a common statement that I used to hear in medical school. Those who say it are truly lost souls who make that blanket statement mistakenly attacking his peers. You’d be better off saying that to your college roommate who went into investment banking making $200,000 a year while you’re still eating microwave ramen.  Frankly, I could probably count on one hand the number of people I knew in school and training who were blatantly in it for the money. Half of my peers probably wished they had gone into a career for the money before sinking a decade of their lives into it.

Why Doctors Need To Care About Money

Money pays the bills, your rent, your debt, and your kids’ educations. It would be a shame to spend a decade of your youth busting your ass to obtain the prestige of a doctor yet still not having enough money to put your kid through college. Retirement certainly sounds pretty good by the time you’re in your seventies still trying to do an appendectomy.  Ironically, according to the late Thomas Stanley, wealth doesn’t even necessarily correlate with education. That doesn’t mean that education SHOULDN’T correlate with wealth. It’s up to you to make it happen.

Life isn’t fair either. How much you earn as a physician is often dictated by insurance companies. If you join a hospital system or a healthcare practice, your revenue will be siphoned off by the administration and your employer. Being more knowledgeable in finance will help you get a reasonable compensation package. Know how you bring in money, and how you’re paid. It all starts with a financial education.

One of the problems I’ve seen with doctors and money is that it’s taboo to discuss the two together, especially in a university setting. Why should we care how much it takes to cure someone? The interesting aspect of healthcare for most of us is the science. In contrast, the tech, financial, and corporate industry has not qualms about including cold hard cash in discussions: Series A, Series B funding, IPOs, options, going short.  On occasion we hear about a few bad eggs in healthcare who swindled millions from Medicare (and make our industry look pathetic), but this occurs much more frequently in finance with little repercussion to its industry.

Just remember, you can build wealth in healthcare and STILL be an ethical, caring, physician.

All Doctors Are Capable Of Learning About Money

We don’t all need to be financial advisors in our spare time or become as knowledgeable as Bill Bernstein in finance, but it really is not that difficult building a basic comprehension of financial vocabulary. You also want to be knowledgeable enough to say “no” to your cousin’s pitch for universal life insurance he sells through his firm.

Remember that you spent weeks studying for USMLE Step 1. You probably didn’t even like studying that. Imagine spending an hour of your week reading on finance. You don’t have to like that either. Even after 6 months, you’ll likely be more well-versed than the majority of your healthcare peers.

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The Daily Life of A Dermatologist

The Daily Life of A Dermatologist

Dermatologists are busyThe television perception of doctors is often skewed toward drama, sex, and a rockstar lifestyle. Take Grey’s Anatomy, Mistresses (plastic surgeon character), Scrubs, or Dr. 90201. Even reality medicine shows like NY Med or Boston Med portray a more sensational view of a doctor’s life. Our lives are both exciting and boring at the same time. Exciting in that most specialties involve troubleshooting symptoms and boring in that there is quite a bit of repetition.

To help the general layperson get a broad sense of an average doctor’s routine, I will detail the daily life of a dermatologist. Note: I am not a Dermatologist, but have spent considerable time working with them and have colleagues in the field.

Clinical Lifesyle

The average workday of a Dermatologist is not easy by any stretch of the imagination, but it is also a very manageable day. A typical day runs about 8-10 hours including some amount of time to use the restroom and eat lunch (10 minutes – 1 hour). Most of the workday for a clinician dermatologist involves patient care. An average Dermatology office will have its doctor see about 40-50 patients a day, although I have seen numbers up to 100 a day! What this means is that you haul ass, as a Dermatologist! Minimal chit-chatting, and a lot of spot diagnoses and treatments. Our reimbursements have dwindled over the years, and many offices are often forces to pile on our patients. Nonetheless, the brief time the Dermatologist spends with her patients is quite sufficient for accurate diagnosis.

Rinse and repeat for each of the days the doctor is in clinic. Some Dermatologists may have certain half days dedicated to biopsies or particular skin treatments in order to operate more efficiently. Most doctors will also have administrative duties like business meetings that often add on 5-10 hours a month to the work schedule.

There’s no loitering around. On an average 20-day month, a Dermatologist seeing 50 patients per day will see 1000 people!

Academic Lifestyle

An academic Dermatologist will have more dedicated time to research, teaching, administration, or writing. Many university-based doctors will have perhaps two half-day clinics of patient care with perhaps two days a week of research time. One day of the week may even be dedicated to administrative duties. Revenue generated by the academic Dermatologist is minimal and likely insufficient to even cover the doctor’s salary. Income thus comes from donations (appointed chairs), state/governmental funding, and grants to perform research. The perks of academic medicine include the fact that you can be removed from the financial considerations of medical practice. You involve yourself with interesting technology and are given the opportunity to work with thought leaders (and become one) of your field. You can’t really put a price on fame. And what you do daily really shouldn’t be boring. You can immerse yourself in the cutting edge of medicine. Most academic physicians I know bring their paper-writing home and spend a lot of their free time on their careers. Not necessarily a bad thing to do, but it really shows that you love your career.

One of the downsides of the academic lifestyle is that you are removed from many of the practical matters of medical practice (read: finances). Most doctors I know in academia are quite ignorant of finances and actually think that their one-day a week clinic actually covers their salary. There is no free lunch. You really aren’t generating your worth in cold, hard, cash but rather intrinsically through your research, teaching, and innovations to the field.

Dermatologists Are Busy 

You can basically substitute in any medical specialty in the sentence above (except for maybe rehab medicine—j/k). Dermatologists are no different. The clinician routine is quite repetitive. Imagine spending your entire 20’s training to see thousands of patients a month for your entire career! It is not an easy task. Maybe that’s why we often seen doctors with those fancy cars, homes, and yachts….

Do you have any comments to add regarding the lifestyle of a Dermatologist? Sound out below!

Those of you who are interested about the life of a Moh’s surgeon, see our post on this specialty.

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Step by Step Rules To Become A Successful Doctor

Hard WorkBeing a successful doctor isn’t hard, but it also takes effort. And when I say it’s not hard, I mean that it’s easier than what we all went through to become a doctor (testing, rotations, testing, long nights, and more testing). That being said, we aren’t necessarily blessed with the ability to become successful nor are we even taught how to become successful. I’ve collated a few key pointers that my mentors have recommended throughout the years.

The Three A’s

The fundamentals of building your reputation are the three A’s: Affability, Availability, and Ability. No matter how stressed out we are with our lives, practices, and patients, we have to be nice. Remember, we are a service industry. With quality performance measures and ratings, affability is even more critical. Word of mouth still drives our referrals, so we have to present ourselves accordingly. In order to generate business, we have to be available. People do not like to wait, and if they do have to wait several weeks in order to see a doctor, they might as well see someone else. This translates to same-day emergency walk-ins, or same week appointments. The only way you can capture reimbursement revenue is to see the patient AND treat them well. Make sure that the referring doctor is kept in the loop regarding the treatment. Lastly, you have to know what you’re doing. This is the “ability”. Keep in touch with the latest changes and innovations in your field, especially if you are a clinic-based physician. Patients are savvy and are capable of discovering the newest fads, whether or not they are based on science. Treat people well, get your patients into the clinic promptly, and know what you’re doing. That’s it. You don’t have to accomplish all of them the second you open up shop, but strive to improve throughout your career.

Hustle and Work Hard

Money doesn’t grow on trees. Your insurance claims aren’t going to mail themselves. Likewise, physician reimbursements have become so disgustingly low that we no longer are able to hang your shingles and watch the money roll in. Work on the three A’s. If you are in a private group setting, find ways to build your referral network. Meet other doctors and make it known that you deliver good care. If you are a university-based physician, continue to do good work. You have to make it known in the medical and pharmaceutical community that you are a thought leader in your field. Carve out a niche for yourself. That is how you develop your alternative revenue streams through lectureships and invited speaker roles.

If you are in an HMO setting, you are screwed. Okay, I’m joking (almost). Your income level is capped and even though you might receive a productivity bonus, the formulas tend to be subjective (because the administration profits from your hard work). The only practical approach is to work hard and take care of your patients. Meet your RVU requirements and get the hell out of the clinic/hospital when you finish your work. Don’t spend unnecessary time in the office when you could be home playing with your kids.

Keep Improving

Write down a list of your strengths and weaknesses. Figure out how each one plays a role in your work life. Make it known (subtly) at work what your strengths are. Figure out what you can do to turn your weaknesses into strengths or at least improve your skills in the process.

Think about making a one, five, and even ten year plan. It’s good to set some goals. Do you want to be a multi-millionaire? Can it actually be done given your salary and expenses? Do you want to retire early? Do you want to be the next Dr. Oz?

What other strategies have you used to become successful?

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