November, 2015 | Smart Money MD

Month: November 2015

If you Want to Succeed, hustle like Taylor Swift

Posted on November 28, 2015November 27, 2015 by SmartMoneyMD

Those who are successful in their careers often are not only talented but also willing to outperform their peers. I’ve written previously that it is hunger that drives our will to succeed. We see that the willingness to sleep less and work harder often translates to more wealth and success.

These exact traits can be seen in politicians, celebrities, and innovators. One celebrity whose image reflects this hunger is Taylor Swift. I am by no means a fangirl/fanboy, but am absolutely an admirer of her drive. I state this as an older professional whose career trajectory was completely opposite of the stardom and fortunate that Taylor has generated in her career. If anything, understanding the progression of her career gives us a model to follow, no matter what profession we are in.

Talent.

To say that Taylor Swift is talented would be an understatement. She is a musical prodigy whose range of skills include songwriting, production, performance, and entertainment on the big stage. Ability to this degree is rare. Geniuses like her only present once every decade, but doctors and medical professionals are a dime a dozen. Think of how many classmates in your medical class went into your specialty, and think about how many medical schools there are that place students in your specialty—a lot.

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If you are fortunate enough to have talent in your profession, consider yourself lucky. You can potentially get very far in life. If you are only blessed with average talent in your profession, you can still succeed. No one is ever condemned for mediocrity, but skill can really get you far.

Drive.

As Malcolm Gladwell describes in his book, “Outliers”, many leaders of their profession not only possessed talent but also lived in the right place at the right time. Bill Gates was skilled in computing, but he also had access to mainframes that allowed him to nurture his talent.

Taylor Swift definitely had the hunger to become a star long before she was known. In her early teens (age 12), she convinced her parents to drive down to Nashville from Pennsylvania so that she could find someone who realized her gift. She would knock on doors of producing studios to find someone who would listen to her mix tapes. Rejections certainly came by the hundreds before her talent was realized. Taylor eventually convinced her parents to move to Nashville to immerse herself with the music scene.

She perfected songwriting from absorbing the experience that others offered her. She spent her early teens writing hundreds of songs in her bedroom. Taylor Swift nurtured her talent by positioning herself among the musicians that she wanted to become.

Appeal.

In order to sustain your success, the service that you are providing has to be what people want. For Taylor Swift, her music delivered a message of common struggle that most teenagers experience. She has kept her public image clean from scandal, which reassures parents to allow their kids to listen to her music and attend her concerts.

As a physician, your delivery of care needs to target your intended audience: patients. You must treat them with care and compassion that you would care for your own family. Specialists need to treat their referrers equally well—the last thing your primary care physician referrer wants is for a specialist to work on their patient without any feedback or updates. Keep them in the loop, and they will continue to treat you well.

Hustle.

The final point to understand is that your success depends on what your goals are, and how long and hard you plan to stick to your game plan, and even a bit a good fortune. Talent, drive, appeal, and hard work—take the wisdom of Taylor Swift into consideration, even if she may be half your age.

(Photo courtesy of Jana Beamer)

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The Fundamental Art of Getting Stuff Done

Posted on November 25, 2015November 24, 2015 by SmartMoneyMD

We are busy. Patients, charting, meetings, business plans, e-mails, and texts flood our daily life whether we are in the office, operating room, or at home on the weekends. By profession, I think doctors are more efficient than the average person. We could still do better. Remember, the sooner and more efficiently you can finish your tasks, the higher your hourly rate becomes.

We all have our methods to get stuff done. No single strategy is going to be better than any other, but I have a few pointers that have gotten me through 50 e-mail days. Below is the Smart Money MD rules for getting stuff done.

Don’t Panic.

One of the administrators at my practice receives over 100 e-mails a day in addition to phone calls. I’ve had several days where my inbox had over 50 e-mails! Sometimes you run late in clinic, have meetings to attend, and then have dozens of tasks to complete or phone calls to return. Realize that our work lives have become so much more complex than it used to be, and so has medical practice. The world will not end if you don’t finish every task.

Prioritize using Buckets.

I am not a fan of “To Do” lists. It works great for groceries and a handful of household tasks/errands that I need to run. But in the workplace, many tasks fall into grey zones and these tasks end up staying on the list for an indefinite amount of time without being dealt with.

The goal of having buckets is to have a means to store your pending tasks without having to think about them while you’re doing something else. We have limited cognitive processing power, and the more we keep in our minds, the more likely we become distracted from the task at hand. Remember, the sooner you finish the task you are working on, the sooner you can move on to the next.

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I recommend keeping two mental “buckets”: one for getting stuff done right away and one for everything else. Every end of the week, the goal is to clear out the everything else bucket and start with a clean slate. Prioritization is key. The right away bucket should have patient tasks, lab follow-ups, and other needs that must be taken care of by the end of the day.

Prioritize the items within the bucket.

Every morning I quickly review the tasks for the day, and reprioritize them during the day as new issues arise. The items that must be performed during business hours take precedence, and tasks that can be taken care of via e-mail are taken care of immediately. Once the e-mails have been sent, the task is done. Get rid of it from your memory.

When your right away bucket has been emptied, review the everything else bucket and move accordingly.

You may never finish.

Remember that even though you are hypomanic, you are still human. Society has forced us to work efficiently whether or not getting tasks done actually create positive value to society. Be aware that you may never finish everything that is thrown at you. Take care of your patients, finish your charts, and work hard. The rest will fall into place.

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You must have a financial goal in mind in order to achieve it

Posted on November 23, 2015November 22, 2015 by SmartMoneyMD

Doctors undergo a regimented course throughout their training. We are used to having clear milestones during the journey to achieve our goals. What do I have to do to get into a residency? Get good grades, crush the USMLE Step 1, and get recommendation letters. Each single step can be broken down into a series of tasks and checklists. If you can sustain it for your entire medical school, residency, and fellowship, you reach your goal of becoming a doctor!

Unfortunately when it comes to securing our financial future, the goals are less defined. We all want to have a good lifestyle, enjoy our hard work, and have enough left over for retirement. That magic number is different for everyone. If you like to vacation every year in the Seychelles and want to continue doing so when you’re not practicing medicine, you might want to beef up your bank account. If you plan to live off the grid, grow your own vegetables, and farm your animals, your stash probably doesn’t need to be as substantial.

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Work with a goal in mind.

The first step in establishing a financial plan is to have a goal in place. The more concrete you can define your goal, the easier you can figure out how to achieve it. From your goal, you then build a financial map. For most people, the answer may not be clear. We all start with a vague notion of what we want. Whittle down the details as we progress in our careers. Our goals may change depending on life changes. You don’t have to figure it out right away, and that is okay. It’s taken me several years to figure out exactly what I want, and my goals are still evolving.

In the meantime, build up your nest egg.

Refine that goal.

Once you have a goal, you can start building your financial map. Is there a certain age that you want to retire from your medical career? Do you love medicine enough to practice until you die? How much are you earning now, and how much do you anticipate earning a decade from now? Map these concepts out in writing. Some people build lists, others have flowcharts. Whatever you do, put it in writing.

New questions will always arise in the process, but the first step is to estimate how much your living expenses are even if you don’t track every single penny that you spend. You have to know how much you spend in order to know how much you should save. Each decision point in your financial map should trigger new ideas, unknowns, and more immediate goals. At each step, you should ask yourself what you can do now to help you reach that step in the future.

Then act upon these mini-goals and tasks.

It is okay to change your mind.

The decision tree in creating our financial map sort of correlates with a working diagnosis in medicine. When a sick patient rolls into the emergency room, we form a series of possible causes based on signs, symptoms, and lab work. The list of possible diseases becomes refined as we establish more data. The same applies to our financial goals. If your daughter wins a full scholarship to Harvard, you can mark off tuition payments on your list and recalculate your financial needs.

Don’t be afraid to learn.

When you first encountered an unknown condition in medicine, you sought out the textbooks, research articles, and papers. In creating your financial map, you will encounter many subjects that you are unfamiliar with. Be resourceful and learn. Figure out how much you spend per year, how many years you will likely need, and calculate how much total wealth you would need to build up by the time you stop bringing in a full working income. Keep evolving as you build your knowledge and understand your financial situation more. You will make mistakes. That is okay.

Just remember, you have a lifetime to get the details right.

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How much money do doctors make?

Posted on November 21, 2015November 22, 2015 by SmartMoneyMD

Doctor salaries span a wide range depending on the specialty, work hours, and ancillary sources of income generated. It is unfortunate that many of us in the lower end of the income spectrum command less than many other professions with less involved training and risk. Many doctors actually make their career decision from limited financial knowledge or an adequate understanding of the financial consequences of their decisions. While you probably shouldn’t choose your career or specialty based on money alone, it is good to understand where the ranges are. Furthermore, realize that choosing a medical specialty isn’t as easy as picking an ice cream flavor either. Becoming a neurosurgeon is MUCH more difficult than becoming a family practitioner, no matter how you spin the argument. If you know of someone who ended up choosing family medicine over neurosurgery, please let me know.

Below is a list of various levels of physician income, with running commentary:

<$100,000

Many physicians in this income range are in the charity field, some of whom are working at nonprofit centers or abroad in international hospitals. Those doctors who I’ve known in this income level working at nonprofits full time all have a compassion for helping others at a different degree than most of us mere mortals. A few that I know are also crazily independently wealthy (think private jets, boarding schools during childhood, multiple generations of wealth).

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Most other physicians in this income range are likely working part-time. They may have spouses who are the primary breadwinners and are working to maintain their clinical skills. I once met an ophthalmologist working 3 days a week earning less than $100,000. Ouch.

$100,001 – $200,000

A large portion of all physicians have belonged and are in this salary range. Many internists and specialists within their first five years of practice also fall in this range. The unfortunate aspect of doctors who remain in this income level their entire careers is that other jobs that required much less education and stress command a similar salary. Think physician assistants, dentists, optometrists, financial advisors…etc.

$200,001 – $300,000

You are now entering an upper tier of income compared to the general professional population. The majority of doctors are in this salary range. You make good money, but you do work hard. There is no free lunch in this world. You also fall into a high income tax bracket and get hit by taxes at higher levels. This is also a generous income level to have a relatively luxurious doctor lifestyle if you are single, and nearing that if you have a family.

$300,001 – $450,000

I would expect doctors in this income range to be busy. Think ER doctors, ENTs, cardiologists, dermatologists and surgeons to be in this range. These are typically procedural specialties that can generate relatively high RVUs. This is a good income for anybody, and as long as you don’t go crazy with your expenditures, you should be able to live comfortably.

$450,001 – $600,000

You are in the upper echelon of earning potential. Trauma surgeons, cardiothoracic surgeons, orthopedic surgeons, neurosurgeons, and vascular surgeons typically fall into this range. Other specialists who have vested options in real estate or ancillary income streams (read: medical supplies) will also fall into this income range.

>$600,000

Any of the aforementioned specialties can have income in this range as well, depending on how fortunate and busy your referral stream is. Doctors I know in this income range tend to forget to pay their bills because they are so busy. I’ve seen doctors whose nonworking spouses and kids are the ones that end up enjoying their earnings. If you are okay with working 80+ hour weeks bringing in $1 million a year but only enjoy it through your fancy car and two weeks of vacation in an exotic place, good for you. Just remember that as long as you’re doing something you enjoy, that is what counts.

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Fancy Clothes Will Ruin Your Future

Posted on November 19, 2015 by SmartMoneyMD

Saving money on your clothing purchases may not make you rich, but unrestrained clothing expenditures can certainly destroy your financial future. I frequently see colleagues who wear outfits that retail upwards in the $2000 range! As a doctor, you have to appear financially fit and suited for the job, right?

Take, for instance, an outfit suitable for a business meeting:

Tory Burch Flats – $235
Kate Spade Crossbody – $325
Salvatore Ferragamo watch – $1200
Tory Burch Belt – $150
Budget Burberry Jacket: $800
BOSS power suit: $400

Perhaps your other wardrobe is slightly more modest, at $400 per day of wear. Let’s say you have 10 days worth of outerwear that costs $400 per outfit. That’s $4000 of professional attire plus maybe two sets of meeting/conference clothing at $3000 per set. That’s $10,000 of professional clothing, not including any additional shoes, cost of hair products, or underwear!

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Those of you who are not in a business/professional type career that requires formal clothing may be shocked at the seemingly frivolous scenario, but this indeed happens. I’ve seen medical residents with a similar degree of retail addiction (both women and men). The desire for fancy attire makes no concessions on your income level. In fact, the higher spending power from a high salary will only fuel consumption.

True Cost of $10,000 worth of clothing on a $200,000 salary.

Suppose you are an allergist who commands a $200,000 annually salary. You are single and unfortunately just made it into the 33% federal tax bracket for 2015. You live in New York City, and have to pay an additional 6.65% in state income tax plus $1,706 and 3.64% of you income over $50,000. Basically, you have to earn 33%+6.65%+3.64% more than what you spend at a marginal tax level. In order to buy $10,000 worth of clothing for a NYC resident, you’d have to earn at least $17,633.57 from a $200,000 salary!

That amount of pretax dollars can fund an entire year’s worth of 401k! For most people, that is serious money.

Your Behavior Towards Money Impacts Your Financial Future.

The problem with spending $10,000 in post-tax dollars every year isn’t because you can’t afford it. You can. The problem is that because you can afford it, you can also afford to purchase many other goods and services that you might not need. A $200 blow-out? Sure! A lease on the newest Mercedes C-Class is only another $500 a month! After all, you have to look the part like a doctor.

We all have our splurges. We didn’t work so hard during our younger days to keep depriving ourselves either. But as a whole, doctors don’t really have much financial sense. One of my good friends leased a 7-series BMW on his first job as a cardiologist. I’m sure it felt good. I’m sure it also is digging into his retirement fund. Is it worth spending your daily 1 hour commute in a luxury vehicle at the expense of saving one whole year of retirement in a thirty year career? If your answer is yes, then by all means, do it.

Compare Your Expenses As a Cost To Your Retirement Dreams.

Think about what your daily routine would be if you were independently wealthy. Don’t consider what you’d do for social reasons or to make yourself look good to the world. Would it be to practice medicine? Or hanging out on the golf range, or even buying clothes? Consider a realistic age to be enjoying your retirement, and then assess every big expenditure’s impact on your retirement goals. Consider whether buying those FENDI sunglasses is worth taking an extra weekend of call. Is that annual vacation to Maldives worth it to work an extra 3 years? If your retirement dreams include unrestricted clothing purchases, perhaps you could consider an alternative career in clothing testing?

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How to become good at everything without knowing everything

Posted on November 9, 2015November 8, 2015 by SmartMoneyMD

There is a reason why interventional cardiologists require 7 years of training—the specialty is complex enough that we not only need the time to learn the nuances of the skill set required in the field but also to encounter enough situations to apply those skills. Despite such long training to become an interventional cardiologist, you (unfortunately) still have limited knowledge of other fields like general surgery.

That is okay, since you can get by in your career without knowing a whole lot outside of it. The truth is that it would be nice to be an expert at everything, but most of us don’t have the time, energy, or interest to master everything. Most people I know who know more than the average person are incredibly intelligent and likely hypomanic.

The Key To Knowing Everything is to Knowing When to Outsource Your Knowledge.

For everyone else, the key to knowing everything is learning to direct your time and energy to high-yield tasks to help you outsource your tasks. There is no universal template to follow—each one of us has different strengths, different time constraints, and different interests. For instance, you may choose replace your own car headlights to save yourself the time and money from outsourcing it to a mechanic. However, perhaps you have a screaming 3 year-old at home that you need to tend to instead. In this case, you might consider going to the mechanic anyway since your time with your kid is more valuable. In order to follow through this decision tree with the most information, you’d have to consider the following:

Changing the headlight bulb on your car is easy for you, and low risk.
Cost savings for doing this by yourself is huge; for minimal risk a 10 minute job for yourself can potentially save you $50 of post-tax income.
You actually have some interest in tinkering with the car.
You do not have more pressing matters to attend to if you were to embark on this task.

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If any of the criteria above is not applicable to you, you might be better off outsourcing the task. Furthermore, if it takes you an unreasonable amount of time to obtain enough information to make that decision, you’d be better off outsourcing it.

You Are Better Off Learning Some Tasks.

Finance is a key topic where you are likely better off investing some time to acquire a baseline knowledge first. No one cares more about your money and future than you. This includes taxes, asset protection, and investing. If you decided to outsource your finances to an advisor, your spare time would be still be well-spent to educate yourself on the basics.

Other fundamental tasks that you could manage yourself and delegate as your time becomes more valuable include cooking, cleaning, home repairs, or vehicle maintenance. I know doctors who enjoy working in the kitchen, and treat their time cooking meals as a therapeutic escape. Likewise, I know some people who would rather exercise on the treadmill instead of mowing their lawns for exercise. To each his own right?

Your Skills Will Build Over Time.

You have a lifetime to acquire your skills and knowledge. That is the excitement of life. Chip away at the needed skills one at a time. Sooner or later, you will have either mastered that skill set or at least acquired enough knowledge to delegate.

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Why Doctors Are Underpaid

Posted on November 6, 2015November 6, 2015 by SmartMoneyMD

Society often portrays medical doctors as elite professionals who drive fancy cars, live in nice homes, and vacation in exotic locales. We are highly educated folks who work hard and have the luxury of a high paycheck.

The converse is true. Yes, most doctors have higher earning power than most of general society but we also paid the price in time. By the time we do achieve earning potential, we get hit by unreasonable regulations, denied by insurance companies, and short changed by decreasing reimbursements. As a profession, we are being short changed by our society. Why? Here are the top reasons:

Most Doctors Don’t Even Know How Much They Are Worth.

Most of us don’t understand billing, RVU generation, or the claims collections process. How we are paid is quite a convoluted process, but it’s certainly easier to figure out than even the fundamentals of diabetic ketoacidosis. Imagine how much hospitals actually take out of your salary or how much overhead your practice has and you start realizing that perhaps you should be commanding a higher income.

We Are Grossly Underpaid During Training.

During residency and fellowship, we go above are expected duties to deliver high quality medical care at the expense of our sanity. After our shifts finish, we prepare for presentations, study our field, and organize for the next day. Yes, we are still training, but getting a $40,000-$60,000 salary is absurd. Most physician’s assistants and nurses command a much higher rate than that.

Once we leave the sacred grounds of a university hospital, our income increases by a three to four fold. That is a serious salary hike for doing the same amount of work we did in residency. We are joyous that we even survived the lost decade in our lives and are happy to get a “good” salary.

The problem with this sudden jump in salary is that the transition distorts our perception of what our incomes should be. Sure, it’s great to go from $50,000 a year to $200,000 a year. It would be shameful if you actually should be getting $350,000 instead of $200,000.

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Discussion About Income Is Taboo.

Money is important but we don’t talk about it. Companies like the one that publicizes how much each employee makes is unheard of. Even my closest medical colleagues are apprehensive when we discuss physician incomes. I typically get answers like, “I am paid great,” or “I make really good money now.” Bullshit. These statements are meaningless without quantification. The problem with income is that we’ve associated a number toward self worth. Perhaps it is a sense of humility that we don’t talk about money. I certainly can’t help you if you tell me that you are making really good money but actually aren’t.

We Actually Think That We Are Being Compensated Fairly.

This would be an ideal situation. We actually are earning our worth and there is no need to fight the good fight. Most people I know actually aren’t getting paid enough but have no idea. Imagine this, all throughout your training, you aimed for your best.

As long as you think that you are doing fine at your current earning potential, you will not have a desire to earn more.

Ultimately, We Do What Is Necessary In Order To Be Happy.

Likewise, it makes no difference if you make $1 million a year but are unhappy. I would say the goal is to strike a balance. If your realize that your dream is to live off the grid practicing rural medicine in Botswana, by all mean do it.

Just make sure that you’ve paid off your student loans first.

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