Month: January 2017

Perils of being a physician leader

You’ve been pulling long hours at your practice for the past five years, and are finally building a sizable patient following. Your hospital is making record profits in part to your labor.  One day you get a call from the administration.  Will you finally get that raise that you’ve desperately needed?  No such luck, but the administration invites you to attend their exclusive meetings.  You say, “yes” without truly understanding what the job entails.

You would be lucky to have these chairs in your hospital conference room

Guess what? You’ve now become a physician leader. Sometimes your hospital or group may spin the title in euphemistic terminology like “executive team”, “management team”, or “lead provider” (shudder).  No matter how this title is spun, the bottom line is that you’ve just volunteered for more work.  Don’t think that you can cut back on your clinical hours just because you have that fancy new title.  That extra $1,000 every quarter on your paycheck will SURELY cover those extra hours of your life spent in meetings.

Did you just sign away your life?

 

Becoming a healthcare administrator can promote your career.

There are merits to becoming a leader.  Most doctors in every stage of our careers still report to someone else.  As a medical student, you reported to residents, attendings, and even nurses!  As an attending physician, we still report to our chairmen, the insurance companies, and other regulators.  There is always someone who is above you at any point of your career. When you become a physician leader, you start gaining that authority to help make our healthcare system better.

 

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The second you move onto an administrative role, you automatically acquire authority. Authority to make decisions. Authority to change the silly policies that you hated to deal with when you were a peon.  These changes can be as insignificant as replacing the low-grade coffee stirrers in the break room.  How about getting rid of that noontime mandatory team huddle that you always missed because your clinic runs two hours late? Done!

More importantly, you gain the opportunity to grow your career as a healthcare administrator. You get to see the side of the healthcare system outside of direct patient care. You will see how complex, confusing, and inefficient our healthcare system really is.  This is where you can actually shine. What goals can you implement in your hospital to improve healthcare delivery? How does the revenue cycle for an orthopedic clinic work?

You might actually be a whiz at healthcare policy.  That would be a powerful skill to have. Instead of fighting hypertension in the clinic, a strong healthcare policy reform could prevent the same disease in thousands of people without stepping foot into the clinic! There is real opportunity in administration to lift yourself out of direct patient care.

 

Becoming a healthcare administrator can destroy your health.

This picture is more representative of hospital conference room chairs.

Look, being a leader is not all fun and fame. Who knows how many failed administrators never become CEOs, start up their own consulting firms only to fail, or even quit medicine altogether.  Administration is not a sure path to lifelong success.

We all know that being a physician leader involves added work. You have to hustle through your patients and then rush to meetings afterward. The hustle is actually not the hard part. You already know how to hustle.  The problem is that progress with any hustle takes time. You will fail. Many people will hate you for implementing changes.  It may take years before you realize whether you’ve accomplished anything, and that can take a  heavy toll on our psyche. You might burnout.

Related read: How To Identify Physician Burnout — And How To Prevent It

No one is immune to burnout. I get notices almost every month that CEOs or senior staff  members of local hospitals getting replaced. Some take on roles in other organizations. Others vanish. I doubt that every single one of them actually left their prior jobs because they were offered wildly lucrative offers elsewhere. I bet that most of them burned out from their long hours and lack of job satisfaction. Don’t think that you are immune to administrative burnout simply because you are a doctor.

 

Becoming an administration adds tension between your colleagues. 

Once that title of “lead physician” gets appended to your name, your colleagues will view you differently.  That inherent trust that you shared is no longer as apparent.  That is a weird feeling. Whether or not you actually continue to suffer through the pain of clinic, useless meetings, and stupid online compliance training makes no difference. Your colleagues probably think that you actually know something that they don’t. The lack of certainty is a powerful motivator for skepticism.

 

You probably aren’t going to be besties with the administration either.

If you can’t be friends with your fellow doctors, you’ve still got your administrative posse right?

 

Wrong.

 

<insert cynicism> Half of your hospital’s management team aren’t physicians (or providers if you’ve already been brainwashed). Some of them may not have any formal professional degrees other than “B.S.” or some made-up title like “DFO” (Director of Financial Operations). Since this is a financial website, I’ll add that all of these people have salaries higher than your best friend who got a USMLE Step 1 score of 260—this is considered a high score—but decided to go into family medicine.  <end cynicism>

Related read: Is a degree from a prestigious medical school advantageous for doctors? 

This administrative team expects you, the physician leader, to be on board with their recommendations.  Some of these recommendations will be unfavorable. Do you have to be a sycophant and agree with their decisions? Or do you risk your future career as CEO by going against the grain?  Will you always be outvoted since you are the sole physician on the board? What can you actually accomplish if you don’t already agree with the existing administration?

 

Will you be happy as a physician leader?

I’m all about happiness. If you don’t like what you do, you probably aren’t going to be motivated to improve your skills. If you dread the 5 hours a week of additional meetings in addition to your clinical practice, you’re probably not going to be good at your job.  However, if you love spending a few hours every evening planning for your meetings, you might actually be a great administrator.

 

Related read: Why are you a doctor, lawyer, or engineer?

 

“A jack of all trades is a master of none.” There are only 168 hours in a week.  I know a vascular surgeon who works 85 hours a week. Imagine adding on another 8 hours of your weekly life going to meetings.  For most people this is unsustainable.  You will break down.  If you pare down your clinical activities, you might not actually have enough time to maintain your clinical or surgical skills either.

There is a fine line between the clinician and administrator. Plenty of us do both, both are we sacrificing our abilities to perform one for the sake of doing both?

 

Have you considered becoming a physician leader?

(Photo courtesy of Flickr)

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Lifestyle modifications for your wallet

“Your cholesterol might improve if you’re able to lose 40 lbs!”

“Let’s strengthen those quadriceps before we do that knee replacement”

“Let’s cut back on sugar and carbohydrate consumption and see how your blood sugar  responds.”

Modern day medicine is big on lifestyle modification.  What can we do to improve our health without simply throwing chemicals and medication at the problem?  We promote these strategies in our hospitals and clinics with the intention that it could save healthcare dollars long term.  Even bariatric surgeons who offer the ‘fix’ of weight loss focus on improving metabolism, activity, and the psyche to keep that weight off while maintaining good health.  These recommendations extend beyond the exam room–every daytime talk show has had at least one segment on health. Some shows only focus on health, with @Dr. Oz’s talk show being the sine qua non of lifestyle tweaks to improve your health. Does this work for healthcare? You betcha! There’s no silver bullet for every malady, but these changes spark the conversation.

Cutting up your wallet is only a figure of speech…

Is wallet lifestyle modification even applicable to doctors? 

Ten years ago, I would have dismissed the notion of curbing spend as a pertinent strategy of building wealth for doctors.  Look at those commercial real estate developers. Lori Greiner didn’t build a real estate empire by saving money on street parking rather than springing $20 to park in a garage. The Golden State Warriors wins games with their high-powered offense (although the defense helped too).   As a doctor, shouldn’t I be able to go gangbusters, bring in $2 million a year, and not worry about that $5 latte every morning?

Okay, most doctors don’t bring in a 7-figure income annually, but a solid 6-figure income should still be attainable. Isn’t that enough? With a good offense, I wouldn’t have to worry about changing the air filter on my 10-year-old car. I still agree on this principle, and pinching pennies matters less when we become more financially stable.

Related: 41% of doctors have less than $500,000 net worth.

However, most people don’t become financially fit overnight, nor can we reap in a cool 7-figure salary each year straight out of residency (I actually have a friend who actually was able to bring in $1.1 million net his first year, but that is a highly unusual situation). While we are building our net worth, there are strategies to expedite the process without drastically changing your lifestyle.

Five quick lifestyle tips to curb your spending.

 

  1. Sell your excess clothing.  We all have clothing that we shove into the back of our closets. I definitely have shirts that I haven’t worn in years. Once we fill up our closets, we buy homes with bigger closets.  Now, this problem may be more gender specific—most male doctors who read financial websites in their free time probably cycle through a fair share of free t-shirts—but we are all guilty of owning clothes that we don’t actually wear.  Get rid of your clothing and make some money! Sell on eBay or Etsy!  It’s not that hard. The goal is not to make a flip on your old clothing (although there are people out there who make a living on eBay), but to purge unwanted items and get some return on the initial purchase. You will feel better with an emptier closet and perhaps a fuller wallet.
  2. Get audiobooks from the library. Look, you’re paying a marginal federal tax of 39% and state, county, and city taxes to boot. You’re paying to get those roads paved and for the public libraries to stay open. You probably also commute a solid 4 hours of your life every week to work. If you listen to audiobooks, save your $10 a week and check out some books through the library. You don’t even have to walk into the library to check out an audiobook! My local library has both Android and iOS audiobook streaming apps (Overdrive) that allows you to check out books. This isn’t going to make you rich, but do it for the principle!
  3. Cut down on housekeeping. Look, our time is valuable. About half of my colleagues, especially those with kids, have opted to have housekeeping. It’s a wonderful process. You pay someone and your home magically gets cleaned. The problem is that housekeeping is expensive. If your net worth is still negative or are within a few years after residency, you don’t need to have regular housekeeping. For hardwood or tile floors, use a microfiber mop. Get the most expensive microfiber cloth in existence. You’ll still save money over a weekly housekeeper.  Get a Roomba (or your favorite robot vacuum cleaner). I run my Roomba twice a week. It doesn’t wipe the counters, but it cleans up some of the dust bunnies on the floors. It’s very helpful if you have pets.
  4. Don’t be a sucker for expensive furniture, appliances, or fixtures. Your first home (or even your second home) won’t be your last. If you have young kids or misbehaving pets, your couch will take a beating. A $2000 sectional is possibly more comfortable than a $1000 sectional, but you have no need for that $10,000 handmade couch from Bali (yes, this does happen!). Likewise, I have seen numerous doctors and one business administrator who spent tens of thousands of dollars renovating and customizing a formal dining room that gets used 2-3 times a year! A friend of mine also has copper faucets and sinks in his bathrooms. Copper may look nice, but guess what? Your sinks will look like the Statue of Liberty in no time with no maintenance!
  5. Be wary of growing into overpriced niche foods. What do you mean overpriced? Take honey, for example. You can buy your standard clover honey at the grocery store, or you can buy Manuka honey from New Zealand. You’ll probably get a 1000% markup from the standard honey. Does this special honey confer health advantages that other honeys do not? The jury is still out, but you’ll surely pay a lot more if you stick it out. Going 100% organic on foods is another sure-fire way to empty out your wallet. There are many ethical and health benefits to consume certain foods ‘organically’, but if financial stability is any priority, temper the high-end grocery purchases.

 

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Related: How Mustachian can a doctor be?

 

The lifestyle modifications for your wallet will evolve throughout your career.

Don’t fret! You don’t have to suffer your entire life! I was guilty of lifestyle inflation during residency, fellowship, and during my first job. I was guilty of eating Manuka honey while having a negative net worth. I learned to align my actions with my immediate and long-term goals. Once I reached a certain financial milestone, I readjusted my trajectory.

You can too.  Lay off the Manuka honey when you’re making $50,000 a year as a resident. Once you get the firepower to generate $2 million a year from your job, you can buy all of the Manuka honey you want.

What wallet modifications have you implemented?

(Photo courtesy of Flickr)

Why every doctor needs a side hustle

Doctors are impressive individuals. This statement is by no means objective, but this is the truth. ? I’m not even referring to the medical miracles that a decade of training allows us to perform.  Some of the most talented and diverse people I know have primary careers in the medical profession, many of whom have tremendous drive outside of medicine.

Take, for example, the following people I know:

  1. I had a classmate who contributed to the scriptwriting on the set of Scrubs prior to entering medical school.
  2. Another friend of mine patented some special brace for treating scoliosis. In grade school.
  3. Another one of my colleagues once conducted the New York Philharmonic. Over ten times!

All of these people are true hustlers in their own league.  But hey, don’t discount your successes!  The rest of us mere mortals who entered the medical profession, too, have that inner drive that has carried us thus far into our careers.  We opted to become “experts” in our respected fields.  At least several gallons of midnight oil were burnt to get us anointed as medical doctors. We’ve all got the grit to hustle if forced to.

 

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Physicians are at high risk of burnout.

Imagine signing charts and refilling prescriptions every day for 2 hours after clinic!

Hustling for no good reason but to hustle, unfortunately, can be unhealthy.  You can’t run at 110% all the time.  And medical practice can drive you to go 110% all the time.  Our actions can determine whether someone will be alive or dead, walking or wheelchair bound, blind or sighted. Even the results of cosmetic surgery will impact someone’s physical appearance, self esteem, and livelihood. We deal with high stress situations daily. These actions wear on us. Over time, this can lead to burnout.

Interesting, the term “burnout” was coined by a psychologist in the 1970’s named Herbert Freudenberger.  He was a workaholic who burned out himself.  Stress, fatigue, and irritability…these are the common symptoms of burnout.  We’ve all seen it.  We’ve all had those days, the days where we want to call it quits.

You might also like: How to identify physician burnout: and how to prevent it.

Burnout is prevalent in medicine. Recent studies from the Mayo Clinic and @Medscape have burnout rates for physicians in the 50% range. One study reported that Emergency Room physicians, Internists, and Urologists have a burnout rate of 55%!  Another study reported that Critical Care physicians had the highest burnout rate.  It’s also not just the stress of medicine or long hours that contribute to the burnout; survey respondents report that the increasing amount of bureaucracy and computerization of the healthcare system that are the top offenders. Essentially, many of the tasks that cause burnout are things that we don’t like doing.

 

You need to have a hobby to avoid burnout.

Just as how the scriptwriter or conductor-turned doctor has diverse interests, we all should have hobbies to fall back to outside of the workplace. These are activities that we can enjoy without the demand of outside influences. Doctors are artists, musicians, athletes, and photographers. These are hobbies and outside interests that got us into medical school, and these are the same solutions to combat burnout.  You don’t have to be as good as Lebron to play basketball either.  Your interests don’t even have to be productive either.  Hell, you can just go read @Corporette or @RealitySteve in your free time and have a blast…I know I do.

The lack of external pressure magically reduces the stress and anxiety of an activity.  I see this behavior with one of the doctors at my hospital. When the administrators mandate us to see additional patients, this doctor refuses, stating that he doesn’t want to see more patients. However, he volunteers on the weekends and in mission trips to care for patients on his own time. Without pay. The truth is that he DOES like caring for patients.  The irony is that he just doesn’t like to get told what to do.  It makes little logical sense, but that is human behavior.

Hobbies can turn into side hustles.

Many of our hobbies are actually full-time occupations for some people. I know several computer programmers who dabble in photography in their free time. Some of them actually are transitioning to full-time photographers, starting with small-time events through Craigslist and then eventually larger venues through word of mouth.

One of the plastic surgeons in my area dabbles in woodworking and produces craftsman-style furniture. Could he dive into this full-time? Absolutely, but I’m sure that he wouldn’t be happy if his livelihood depended on it. However, it is conceivable that he could turn this skill into a side-hustle. Will he do that? Probably not, because he is busy enough correcting ptosis or making people beautiful.

Then there are doctors who really kick themselves into overdrive and basically find ways to make a name for themselves outside of clinical medicine. Some of the more popular routes include becoming a CEO of a hospital, joining an advisory board of a company, and or even becoming a writer.

 

You just need to do something that makes you happy.

Not everyone dreams of becoming the next @JohnChow or @FinancialSamurai who works on their own time while money rolls in his bank account.  Most of us actually like practicing medicine or law. We just need a break from it sometimes.

You don’t have to be the next Dr. Oz, but finding a way to maintain your sanity will carry you a long way in your career.

What have you all done to find a good balance between work and life?

(Photo courtesy of Flickr)

Stealth Wealth Revisited – This applies to doctors too!

I went to buy groceries mid week and realized how simple the process was compared to the typical weekend or weeknight days that I typically go. The aisles weren’t crowded, I had my own space to pick through the avocados, and there was no line at checkout!

I wondered what the typical demographic of people are able to conveniently run errands on a weekday morning. Wouldn’t it be nice to be able to hold a job that would allow for flex time? It would even be nicer if I worked on my own time.

You might also like: FIRE for doctors

Most of the customers appeared to be mothers with young children. It wasn’t clear where everyone else fell in the spectrum. Entrepreneurs? Funemployed? People like me who took a sick day off? Better yet, perhaps some of these guys are financially independent!

 

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As I was deciding whether to buy the apple fritter or crueller in the bakery aisle, I recognized one of the emergency room doctors at the local hospital. He was sporting a beaten up t-shirt with a logo sponsoring a local 5k race, jeans, and stained shoes. Had I not known he was a doctor in the high dollar range, I would have assumed that he was one of those funemployed individuals.

In reality, he was practicing stealth wealth whether or not he was aware of it.

You might also like: How Mustachian can a Doctor be?

The premise of stealth wealth is simply not looking the part of having a bunch of zeros in your bank account.  This applies whether you’re taking the F train in Brooklyn at 2am or walking into a car dealership with the preying eyes of hungry salesmen tracking your every move. Is it simply a survival strategy? Perhaps, but I can say that I’ve saved a lot of headaches by blending into the crowd.

Sometimes attracting attention is bad for your health (read on).

As doctors, we can’t really hide from anyone. If you are a licensed physician, your credentials are public information. Ever since I obtained my first medical license, I started getting phone calls and mailings from asset management companies, random insurance companies, and ‘wealth accumulators’.

I think these companies knew that most of my colleagues were busy trying to pass our boards too—they invited us to a nice steak dinner while one of their professional advisors gave a talk.

Guess what? I’m guilty of going to these talks too. I still remember that at the last talk I went to, I didn’t understand a darn thing the advisor was talking about. What’s more embarrassing was that I had already gone to a similar talk six months ago.  It felt like one of those Embryology lectures back during first year medical school where you try to follow along but are totally lost when you talk about germ cell layers. He talked about having some “secret” but legal way to fund money into a Roth IRA after I start making real money. I still remember that I was so happy after that talk that I had leftovers to eat another day. I ended up getting GI upset the following day, didn’t associate it with the meal (because what can go wrong with free steak?), ate my leftovers several days later, and got GI upset again and a fever for two days!

I developed a Pavlovian response to these lectures and never attended any more. Sure, I was probably short-sighted to disregard my future earnings.  I also did not have any children at the time who needed to rely on my income.

Had I not gotten the attention of a wealth accumulator service, my future may have been very different. Fortunately, I think that I am able to manage my finances with the help of fellow strangers on the Internet. ?

Stealth wealth as a rebellion against materialism.

One can argue that life is more fulfilling by spending money on experiences rather than objects. It would seem that memories from experiences would sustain happiness much longer than an object like a fancy coffee table.  With memories, we can always look back these experiences and recreate happy thoughts.

I can easily see this corollary in my six-year-old nephew.  He is able to throw the most vicious tantrums in order to get an overpriced model car racetrack. He then becomes the most angelic child after an adult succumbs to his demands but soon requires the expansion pack after several brief days of enjoyment (Hopefully he will outgrow these habits).

 

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Fortunately for car dealerships, clothing stores, and electronics companies, the majority of the world does not buy into the experiences alone either. I honestly don’t either—I wouldn’t mind having a new Tesla parked in my garage any day of the week.

But buying into the concept of stealth wealth can help us reduce our materialistic tendencies. If you don’t want to be flashy making a grocery run in your Tesla, you keep your ten-year-old Subaru running as long as possible. Likewise, if you opt to wear $20 Timex watch in lieu of a giant Hublot, you’ve effectively saved a perfectly good watch from going to the trash or shoved in a drawer with no hope of future use.

Reduction of material substance will help build your wealth.

Gee, if you have a constrained outward appearance of money (stealth wealth) you actually help your bank account grow by keeping more of it in the bank.  I see many high-income professionals practicing this strategy in various degrees. I see some multi-millionaire construction company owners who put their money in their homes and the $80,000 V12 trucks. However, their clothing consists of budgetary jeans and t-shirts. Their vacations are simply camping trips with minimal recurring costs outside of the initial equipment purchases.

I’ve met other high-income individuals who live in homes that could be purchased with less than a quarter of their earning potential, but enjoy lavish vacations several times a year.  Compare that to my local orthopedic surgeon who lives in a decidedly mid-seven figure house, sends his kids to private schools, and goes on hunting expeditions throughout the world.  He might have an Ace up his sleeve, but he might also have a very long working career.

Stealth wealth can make you happier.

Having a sizable bank account could probably make you a happy person, but I’ve seen plenty of wealthy individuals who are miserable.  As doctors, dentists, lawyers, and other highly-compensated individuals, we actually have a relatively stable hold on the income generation aspect of our finances.  What leaves our wallet is more likely to impact our degree of happiness.  Stealth wealth provides us a framework to determine what is important to us, and direct our expenses towards happiness.

Who knows, that guy at Starbucks in the corner sipping his latte may be an Internet mogul practicing stealth wealth.

What part of your lifestyle do you consider Stealth?

Should I put nitrogen in my car’s tires?

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Have you ever noticed that some vehicles have a green valve cap on the tires? Is that some sort of special aftermarket modification? In general, the green caps indicate that the vehicle’s tires are filled with nitrogen instead of air.
Wait a second, doesn’t the bulk of atmospheric air consist of nitrogen? Yes.

[/vc_column_text][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column width=”1/2″][pie_chart separator=”yes” percent=”78″ title=”Percentage of nitrogen in normal air-filled tires.”][/vc_column][vc_column width=”1/2″][pie_chart separator=”yes” percent=”95″ active_color=”#dd9933″ title=”Percentage of nitrogen in nitrogen-filled tires”][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_column_text]The last time I was shopping for a car at the dealer, the salesman was heralding nitrogen in the vehicle’s tires as a godsend. This godsend also came with a hefty price tag of $700! What advantages does increased nitrogen in the vehicles confer?

We all [hopefully] have been instructed to make sure our car’s tires are properly inflated. The proper tire pressure for your vehicle is usually indicated inside the driver side door.

Sometimes the numbers are identical for all four tires, but not always the case. My Subaru recommends maintain a pressure of 33psi in the front tires and 30psi in the rear tires. Keeping the the tires properly inflates confers two advantages:

  • Symmetrical wear on tires: Obviously if the tires are overinflated or under inflated for long periods of time, there will be uneven wear on the tires. This is most certainly reduce the longevity of your tires and can result in misalignment with drifting of the car when driving straight.
  • Optimal fuel economy: I remember reading an EPA study showing that there is a 0.3% decrease in fuel economy per 1psi decrease in a tire’s pressure. You can easy have a drop of 25% in tire pressure over a year’s time if you don’t check frequently. For most vehicles, you might lose 1-2 mpg depending on your driving habits.

 

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Nitrogen supposedly is able to remain in the tire more readily than room air because the molecule is larger. If nitrogen is less apt to escape, then the tire will maintain better wear and fuel economy. Does this work in practice? I certainly have not noticed a difference in the brief period that I’ve had nitrogen.

The third benefit of nitrogen in your tires is decreased wheel corrosion. Oxygen, as we know, is a key component in oxidation. After 8 years in the tough northeastern snowstorms, my alloy wheels became quite corroded and had constant rim leaks no matter how much I scrubbed the rims and put bead sealer to keep the air in. In practice, having oxygen in my tires may have helped delayed the corrosion, but with the amount of winter snow, road salt, and ice I went through, I’m not sure if it would have helped.

What situations will nitrogen help in tires?

I’d imagine that mission critical and high performance situations will require stable tire pressure the most. That would probably be for race cars, airplanes, and spaceships. These vehicles undergo significant temperature changes during operation.

Should I put nitrogen in my car’s tires?

If you’re read this far, you probably realize that I’m not too convinced about the benefits of nitrogen in tires, especially if you have to pay some $700 extra for a vehicle. That being, said, I actually have nitrogen in my car’s tires. It came free when I purchased new tires at Costco. You can always have the tire guys there check the pressure at any time.

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Just receive your first job offer? What should you do next?

Congratulations! After a decade of slaving away in your medical training, you’ve got your first job offer in hand! If you’re really lucky, you might have several offers to evaluate. But wait, there’s all this legalese and gibberish—nothing makes sense!

Do you just hire a contract lawyer and be done with it? How much is a good rate for a contract review anyway? You call around to your friends and colleagues who graduated a year or two before you to inquire. They give you some advice, but it turns out that they might not be too familiar either. What should you do?

There are some fundamental aspects to understanding job contracts that everyone should know. These are the things to follow:

Have someone review your contract.

Yes, this means shelling out some money and having a contract lawyer or a review company who is familiar with your area look at the contract. As much as you want to save money, this is money well spent. The last thing you want to do is move your family to a new city for a new job only to realize that you have to take call every other night even though there are ten doctors in your practice!

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This may cost you several hundred dollars up to a thousand, and it will sting especially if you are in your first job. This is something that I don’t recommend skimping out on.

Someone who is familiar with your area may know that there are certain rules or laws that pertain only to your city.  Moreover, they may know the history and track record of hospitals or medical practices in the area. That information by itself is invaluable.

Read the contract yourself. 

Hiring someone to review your contract simply isn’t enough. You need to spend some time reviewing the legalese as well so that you can be informed about what your contract reviewer is going to say. Here are a few key items that I considered:

  • Salary: How much are you going to get paid? How long is that guaranteed for? Are the any incentives to exceed the standard salary? I would compare the offer salary to what is considered the norm in your field (MGMA, AMGA), and how many years that you have been in practice. For instance, there are different ranges for starting salaries depending on your given specialty. Try to find out what they are, and figure out where you stand in the range.
  • Noncompete: Some contracts have restrictive covenants that prevent you from working within a certain distance and duration of the employer in the event that you decide to leave the group. The laws vary depending on which state you are in, and you can determine if any of these rules are enforceable. How much do these laws actually matter to you? If there is any possibility that you would need to stay in the area if you left your job, you should consider getting this clause removed or negotiated.
  • Growth: Will your job be any different after your first few years? Do you have any possibility of becoming a partner, owning any equity in the practice, or expanding? Is there any real estate in the practice that you could potentially own?
  • Time off: Is there PTO? Does it accrue? Is it enough for your needs?
  • Maternity leave: This is huge. Some hospitals or employers will stiff you on the maternity leave. They may not have a clause at all for this. If there is any possibility that you would need to invoke this benefit, negotiate this in or walk away.
  • Locations: Some practices have multiple offices in different locations in different cities. How much do you want to travel? Do you have to fly to satellite offices (Yes, this can happen)?

Compare your offer with others that you might have received.

You can really learn quite a bit if you have two different offers on the table. There is unlikely going to be one ideal offer that is a no brainer. You will have to settle on certain conditions. Some practices or hospitals are just arranged differently. If everyone else in the group is taking call for the entire state, it’s not likely that you can get away with negotiating that out of your contract.

Consider the overall terms of the contract.

This category includes everything that is not objective. How is the writing in the contract? Are your potential employers sticklers? Do they nickel and dime you? This really calls upon your Spider Sense. Some of us are great at identifying things that could go wrong. Others, not so much. How flexible is the employer? Do they want to hire you badly enough to amend their rules?

Remember. Don’t push your luck and burn bridges. If an employer is unwilling to agree to your terms, don’t get angry. If the subject in contention is a deal breaker for you, just walk away. I think that most people are willing to be open amenable to negotiation as long as it does not put them in a financially or logistically challenging position.

Good luck!

What other terms have you considered in contract negotiation?

(Photo courtesy of Flickr)

Why are you a doctor, lawyer, or engineer?

No, this isn’t an interview question, but I’m sure that all of us who are doctors, lawyers, or engineers have been asked this very question at least once in our lives. I do think that this is a valid question that we should all reassess at certain points in our careers.

Because the moment that we can’t honestly tell ourselves why we continue our daily 9-5 jobs (or 11pm – 8am shifts) is the moment that we should consider what we can do to change our situation. It’s also not wrong to tell ourselves that we’re doing it for the money either.

We’ve got to live and get to retirement somehow, right?

I would add that doing our jobs for the money is okay until we truly decide that it’s no longer fun.

I took a poll of my colleagues and acquaintances regarding why gets them out of bed every day. It’s interesting how much variation there is in their responses.

 

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One dermatologist told me that she wanted to eradicate all frown lines, wrinkles, and skin cancers from the world. Fair enough. She does see over 70 patients a day, so by virtue of numbers alone, she is probably fulfilling her end of the bargain. Sure, the money is good, but she’d continue doing it until she couldn’t anymore. She definitely had a strong affinity to her profession. But the money allows her to wear those $1200 heels and that $10,000 clutch.

One engineer I spoke to was not so convincing. He had an advanced degree in physics and electrical engineering so he spent a considerable number of his younger years studying these topics. He worked for a research facility conducting various tests for both private industry and the government. Even though I had a science background, I really had a tough time following what he really did. He did take advantage of his employer’s arrangements with the local university and took continuing education classes in his free time. He probably didn’t love his job, but he probably didn’t hate it either. I guess it paid the bills. I actually think that he would have wanted to become a lifelong student if he had the option. His primary job allowed him to do just that.

One of my lawyer friends who graduated from a top tier private law school actually spends her time working for both the local public radio, taking care of her kids, and writing scripts for various broadcast programs. I could tell that she loves her current occupations. I’m sure that given her capabilities, she could have also been working at a high-profile law firm. More power to her. The law degree probably cost around $150,000 at the time, as did her private university degree. That’s a $300,000 investment plus seven years of your life. Now her income has been essentially zero except for whatever scripts get accepted. I do wonder how she lives in a $2 million home, though. 😉

In contrast, another one of my lawyer colleagues works at a corporate firm. He works over 100-hrs a week on certain weeks where deadlines loom, and about 50 hours a week at other times. He lives like he has a serious income (he probably has a serious income). I’ve wondered whether he’d have any ability to retire before age 70, but it’s not clear that he does unless he has a huge inheritance at some point (he actually might).

How does this apply to me?

Hearing from the four colleagues above, I am even more convinced that money does buy happiness. The dermatologist appears to enjoy her role in helping people, and also enjoys her healthy income. The engineer probably hasn’t found his calling yet, but his current situation appears to allow him to pursue his version of happiness. Lawyer #1 clearly has lined up her priorities to her liking. I suspect that she has been able to pursue her passion only because she has a bank account to back up her standard of living. Lawyer #2 may or may not be happy. I think he has allowed his success define his occupation and lifestyle. I guess it’s probably not a situation I’d want to be in long term, but I have seen plenty of doctors get consumed by their jobs.

What I’ve concluded from this thought exercise is what I’ve pushed along on this website—we really should consider molding our lifestyle to what makes us happy. Wealth is a source of our happiness and potentially our misery. The sooner that we can free ourselves from working towards getting wealth (and have that wealth work for us), the happier we can be.

Have you asked yourself why you continue your career or what your daily activities are (if you’ve reached FIRE)?

Photo courtesy of Flickr)