Month: April 2017

How do you handle working night shifts?

Please note that there is no medical advice offered in this article. The topic discussed is only for discussion purposes.

One recurrent issue that healthcare workers frequently face is the unpredictable hours that we have to work. The same goes for any occupation that has long shifts and nocturnal hours—this includes nurses and truck drivers too. How does one adapt to an odd schedule, and what impact does that have on your health?

You need your beauty rest if you job requires keeping people alive!

Since the majority of Smart Money MD readers are in the healthcare profession, I am curious to see what everyone does.

Doctors who take call face this their entire careers. You get called at 1am for an emergency, and your entire evening and following day (or week) is shot.  Working harder in this manner doesn’t even necessarily translate to increased pay.  Doctors who work shifts face similar issues when they’re assigned an overnight shift. This includes Emergency Room physicians, Radiologists, Anesthesiologists, Hospitalists (Apologies if I missed your specialty!). Sometimes these evening shifts alternate between day and overnight shifts. For instance, a Hospitalist may have five straight overnight shifts followed by a week of days. Or even one overnight shift interspersed between day shifts.  These odd hours take a toll on your health, and becomes even more burdensome as we age.

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How do people manage to adjust to these hours for an entire career? I get jet lagged for weeks after travel across the world, and I only make these trips once every couple of years.

Pharmacologic assistance.

Caffeine is a common strategy that almost everyone I know has consumed in the course of life. This commonly comes in the form of coffee, tea, energy drinks, and even mints! A cup of coffee helps me power through a rough day of clinic after no sleep from an evening of call previously.

Melatonin. I’ve seen melatonin tablets in the nutritional supplements section of most grocery stores and pharmacy aisles.  I know doctors who use them to help them sleep during the day after a night shift.  The idea is that these tablets supplement your body’s production of melatonin, which in turn triggers the sleep-wake cycle. The mechanism of action isn’t quite known exactly, but it seems to have some effect on fighting jet-lag and altered sleep patterns. I don’t believe that there is any proven statistical benefit of melatonin supplements but there are clearly people out there who claim it works for them.

Antihistamines / sleep agent. I know people who just take non-specific H1 blocker for sleeping. Some people take prescription medications to help. Long term use of this type of medication is not condoned by any medical professional, but in a pinch, it can help you get by.

Lifestyle modification.

I tend to modify my activities and allow time to readjust my clock.  Fortunately I do not work the evenings often, so I don’t have to deal with the changes as frequently as other specialists.  I usually try to adjust my sleep schedule according to my work schedule. For the first two nights I often am groggy as have not adapted yet. I probably go through at least one sleepless night before I am able to catch up.

I try to stay hydrated. This means additional bottles of water at work, and additional trips to the bathroom! I don’t recall reading any scientific evidence on hydration to combat altered sleep cycles, but mild hydrotherapy shouldn’t hurt if you’ve got working kidneys. ?

I try to exercise to jumpstart my body. This includes mild stretches, runs, or calisthenics. No marathons. Exercise does help me sleep better when my schedule gets flopped. I usually don’t do anything extremely strenuous, as I am probably fatigued anyway from work or the lack of sleep.

I try to avoid other mentally taxing activities outside of work.  You only have so much brainpower.  I need that brainpower for work. If my altered sleep schedule is only a temporary change, I try to minimize critical decisions (like buying a house, semi-dangerous lawn work). Just go to work, come home, exercise, eat and sleep. Simple.

Those of you evening shift workers, what tips do you have?

(Photo courtesy of Flickr)

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How much time do you take off a year?

As a whole, Americans don’t have much freedom in vacation time.  When I first considered working in the tech and finance industry, many starting offers I received granted about 2 weeks of paid time off (PTO) a year.  Some of the smaller startups had one to two weeks of PTO with some flexibility to take more time without pay.  I don’t think that many of their employees ever invoked that privilege unless they had some emergency crop up. Most of these jobs also catered to younger people who didn’t have families either.  They were happy working over eighty hours a week with potential bonuses that more than doubled their initial salary.

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Guess what? The guys running the large corporations know what they’re doing. They can afford to pay you $70k a year, have you average out 60+ hours a week with two weeks of PTO and easily afford to pay you $150k at the end of the year.  Who knows how much you earned the corporation.  They don’t even have to give their employees overtime pay since everyone is salaried.  You just work more for a bonus that you will probably get at the end of the year but at the discretion of your boss. In my book that isn’t a smart situation to be in.

Sometimes clinic seems like an assembly line. One day that will really be true…

Doctors in medical training don’t get bonuses for extra work. We’re not in it for the money…at least that shouldn’t be the primary reason to become a physician.  It’s part of the vetting process. I didn’t really consider maximizing my resident salary either and neither did most of my friends.  I don’t really think that any of my close colleagues went into medicine for the money.  If they did, they probably left after internship or even before.  One could EVEN make a case that the more that one actively cared about money during their medical training, the less accomplished they were. (Cringe. This will be a topic for future discussion).

We spent a lot of time in the hospital work and learning.  Regardless of whatever regulations we had in training, I definitely spent over eighty hours a week in the hospital for at least a three month period.  This doesn’t even include the amount of time I spent outside of the hospital studying or preparing presentations.  That was probably another five to ten hours a week.  The other months probably averaged out to 60 hours a week plus study time.  No bonuses there.  We put in the extra time so that we actually will be good doctors in the future.

But we actually got at least 3 weeks of vacation each year (I did not actually use all of my allotted vacation times in most years however, but that is the topic for another discussion). That’s already more than the average person receives in other industries.

In practice, the amount of PTO/vacation that doctors receive subsequently varies from two weeks to even several months! Some medical specialties that involve shift work may not offer any PTO, but can involve significant amounts of time off of work.  Several of my friends in Emergency Medicine only work 12 shifts a month, which is considered a “full-time” arrangement. I know others who only work 8 shifts a month! I have another friend who is a Radiologist who gets three months of vacation time a year (and still earns a sizable salary)!

Not bad. I usually take about a month (or less) off a year, which is actually considered on the low end. Life still isn’t bad. When you take into account what your hobbies are, what your family obligations are, how much time your kids get off from school, the amount of travel time actually diminishes.  Most people with school-aged kids have activities after school and on the weekends (unless you choose to home-school your kids, and that is another topic for future discussion!)

And ultimately I have decided that while vacation time is great, having a relaxed weekly routine is even better. Space out the week so that you work four full days a week, and you might not need as much vacation.

You might also like: Why doctors need a four day work week.

I’ve considering trying to rearrange my schedule to ease up the week such that my income doesn’t take a significant hit.  In some situations that is not possible, but if you can swing the change your life will improve.

How many weeks do you take off from work annually?

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(Photo courtesy of Flickr)

I submitted my taxes!

It’s a recurring problem. Every year in April I frantically file my taxes at the last moment.    Life doesn’t have to be a struggle to file taxes, but I allow it to be.  Call it delinquency.  I blame all of the institutions that are obligated to send me tax forms to file. They never send it at the same time.  It forces me to wait until I receive all of the paperwork before I can submit everything to Uncle Sam. My motivation to file my taxes waxes and wanes in an unpredictable frequency and amplitude.  You really have to catch me at my high point in order to get everything completed.

I file my own taxes.  Yes, most financial bloggers do. My taxes really aren’t that challenging, as the bulk of my income still comes from a W2.  That means I don’t get to fill out fancy deductions to save money after spending more money.  I started doing my own taxes during internship when I received real taxable income.  I remember that since half of my internship spanned the same calendar year as my 4th year medical school, I essentially paid no taxes.  I think I earned like $20k that year.  The tax software was also free, but I probably paid some amount to file my state taxes online.  I also learned to decrease my withholdings through my W4 that year too so I also came close to receiving no money back afterward.  I felt like a badass.

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Tax filing does become more complicated as we go through life.  Kids. Mortgages.  Tax lost harvesting.  Second homes.  Real estate deals.  Multi-state income.  Foreign transactions.  Trusts.  The redeeming aspect of complexity is the skillset is additive over time.  It is actually beneficial to start learning about taxes when you’re making little money and have either negative of low net worth.  You get through the filing process quickly and you learn.  Tax software like TaxACT and TurboTax allows you to get through the process as painlessly as possible.  Life isn’t as daunting as before the Internet age.  By the time you get five bank accounts, three 401k custodians, a handful of brokerage custodians, and a few real estate properties, you will have had (probably) many years of practice.  It might not be as challenging as jumping in headfirst into an eight-figure portfolio.

I’ve moved up in the world and no longer file 1040EZ forms!

As with most other people who choose to file their own taxes, I hope to minimize my tax burden as much as possible.  Jeremy from GoCurryCracker is a master at this.  I think I paid more taxes when I earned $20k a year than he does now earning a near six-figure income!  If you had the choice between earned income or passive income, passive income wins all the way in being more leniently taxed.  For W2 employees, the only deductions you really get are mortgage interest, property tax, and business expense deductions.  The business expense part is really a moot point unless you spend significant mounds of money on conferences and meals because these expenses have to exceed 2% of your income.  Generally speaking, on a $400,000 W2 salary you get to deduct business expenses that exceed $8000.  All meal costs are only deductible at 50% too.  I know plenty of doctors who spend more than that in unreimbursed expenses, but that’s somewhat lavish.  I’d say that one could spend roughly $8000 for 2 1/2 fancy meetings (yes, PoF, cringe). Some conference registration fees can easy run over $1000 plus additional mini-courses. Put that in an expensive resort area, and you’ve got hotel fees in the $300 range.  I probably attend one of these meetings a year, but really cringe at how expensive meals can be when there is limited access to grocery foods.

This year it took several hours to sort out my receipts and enter the data into TurboTax. I probably could have shaved off at least one hour had I known my poorly organized folder of receipts did not exceed 2% of my taxable income.  Lesson learned.

All in all, it wasn’t a bad year. I paid more tax than I would have liked, but that’s what you get if most of your income comes from your primary job and you’re still building wealth.  For 2017, I plan to implement the following changes to streamline my taxes:

1) Keep a running spreadsheet of meeting expenses. Fill out the blanks soon after the conferences so that expenses are still fresh in my mind. This will make the year’s end easier.

2) Make sure I keep track of my donations, especially to Goodwill. Ask for receipts so that I can clearly prove that my clothing drop-off is real.

3) Consider switching tax filing software. TurboTax is great. It’s also the most expensive of the bunch. The amount that we truly save is probably negligible ($20-$30) total, but it might create a good review of what is available.

What other pointers have you learned while filing your own taxes?

Budgeting Time for Time-Starved

There simply aren’t enough hours in a day.  I guess that if you are hypomanic, then you probably end up accomplishing more than the average person but you still might not think that there are enough hours in a day.  Fact of life.  As doctors, we think that we are able to budget time and multitask better than the average Joe on the street, but we still have demanding lives.  Patients to see. Kids to pick up from daycare before they charge you an inordinate amount of late fees (Yes, it happens in NYC). Meetings to prepare for. Meetings to attend. It doesn’t end. I am always impressed to see how some of my colleagues are able to accomplish so much with all of their obligations to meet. One could only wish that they had a device to stop time, but the overachievers we know simply find ways to tweak their schedules efficiently. It’s like how one doctor can see two patients and hour and another, four patients an hour.

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While I’m no time management savant, I’ve found myself more and more involved with assignments related to my job and out of work over the years. Some of it is gratifying work, others just a requirement of the job. As I am procrastinating on a budget proposal for my workplace, I’ve decided to reflect on five of the top strategies I’ve implemented for getting stuff done.

Do you wish you could stop the clock? I actually wish that I were younger, poorer, and have fewer responsibilities!

Without adieu, here they are:

  1. Sleep less. One less hour of sleep can accomplish a lot. If you slept one less hour a night for one year, you gain a little over fifteen days and potential productivity! Incredible. The key in trading sleep for productivity is that you have to ensure that you are actually productive. I slept very little during college, and I was probably very unproductive. If you intend to carve out extra time for a project in your already time-starved schedule, make sure you set goals and deadlines. Follow these deadlines and make yourself accountable if you have trouble accomplishing them.
  2. Outline your specific goals and how you intend to accomplish them. This concept parallels point #1.  For instance when I conducted clinical research, I had to follow deadlines to the extreme.  Some research topics were pitted against the clock.  If you don’t get your research published first, someone else will. (That’s right, it actually happened to me). Before anyone embarks on a research project, the research topic has to be deemed appropriate and that the hypotheses could be answered through this research.  We submit proposals to the Institutional Review Board (IRB), and often work against a deadline in order to get the research approved. After all research is completed, there is yet another deadline to get the research analyzed and have a paper written.  Every journal will have different guidelines on publication. Once you submit, there is yet another deadline in order to respond back to the reviewers in order to have your research accepted for publication.  Outlining your goals allows you to have a set schedule to make progress.  The more concrete you make your goals, the more likely you can document your progress. Even though we’ve all been doing this our entire careers, I still find it difficult to accomplish.
  3. Make yourself accountable.  Did your parents ever bargain with you to eat your vegetables by offering you the gift of dessert afterward? Perhaps you do this to your kids too? Bloggers implement this strategy all the time by announcing to the world what they hope to accomplish.  Financial bloggers publicly announce that they plan to reach financial independence by a certain date, and start writing about how they’re going to achieve it.  Then it gets done (Mr. 1500 was the first FI blogger I came across who did this)  It is psychologically more acceptable to let yourself down than it is to let someone else down.  If someone else knows about your goals, you have a higher chance of achieving it because it gives you something to prove. You don’t have to write about your goals online, but you could confide in a friend, spouse, or colleague what you hope to achieve. Keep them posted on your progress. If they care enough about you, they will follow-up on your progress.
  4. Add a wager to your goals.  That’s right, if money if involved, people get serious.  There are a few doctors in my hospital who play semi-competitive golf and they always have a pot.  Most doctors have some sort of competitive blood. Use that to your advantage.  When I enter the NCAA Tournament pool with a buy-in, I get serious.  I dig through the stats and the most recent games that each team has played. If there wasn’t a wager, I probably wouldn’t go through the trouble to study the teams as much. (I did horribly again this year in my tournament bracket despite “working hard”).
  5. Don’t be afraid to ask for help.  That is what teams are for. There is validity in delegation of power. I remember that very rarely in medical school did a single person, no matter how smart she was, solve a problem before a group of people.  If you are short on time, see if there is someone who could help you out. In fact, I think that I should ask my office manager to help me out on this budget proposal…

What other time management strategies do you implement?

(Photo courtesy of Flickr)

How to waste money by trying to save money

All of us who are cost conscious have been there.  You believe that you can save a few bucks by cutting corners only to realize that your frugal tendencies didn’t save you anything.  Perhaps it even cost you more money. Don’t do it.

I’m a sucker for discounted bakery items at the grocery store.  Day-old donuts at a deep discount.  I’m in.  I buy six nearly stale donuts for $1.99.  Fresh ones are 69 cents each.  This means that I need to eat three of the six discounted donuts to justify the cost of fresh ones.  Stupid.  If I eat all six of the donuts, I come out ahead financially.  My arteries? Not so much.  Most recently I fell for the discount donut trap and only ate about 3 donuts before tossing the box.  I don’t even think that I was happy afterward.  These grocery store donuts are mediocre at best even when fresh.  And each one of these packs in a jaw-dropping 14 grams of fat apiece!

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Lesson learned: If you want a good donut, just go to Krispy Kreme, spend $1.10 for an awesome donut and go on with you day. You’re going to consume 14 grams of fat either way.

Big ticket items can really become money pits.

We all know that “luxury” items like swimming pools, boats, and time-shares are money pits.  Moe, the doctor who spends a $1 million salary, once told me his monthly pool maintenance costs (water, heat, pool guy) costs several hundred dollars a month!  What about items that you purchase to actually save money?

I’m becoming more and more skeptical about expensive maintenance equipment like riding lawnmowers, weed eaters, drills, and chainsaws.  I don’t expect that most of my readers will ever deal with serious manual labor, but this is a clear example of how trying to save money can actually cost you more. Let’s say that you decided to hang up a flood lamp in the front of your garage.  You have no tools, but there is a sale at Costco for a flood lamp so you buy it. You know that power tools can be expensive, so you go to Harbor Freight Tools to buy a drill.  The drill costs $50.  You buy discounted drill bits for $6.  For $56 and 30 minutes of your time, you can have a great working flood lamp. Wrong.  Since you’re an amateur handyman, you don’t realize that your house is made out of stucco, and your cheap drill bits are useless.  You go back to Harbor Freight and buy masonry bits for $19.99.  You spend another hour trying to drill and mount your flood lamp.

Total cost: <$75.

Total time spent installing light: 4 hours including agony and driving to and from the hardware store. You might not ever use the drill any more after this ordeal. Moreover, you probably didn’t even do a great job installing that light.

Solution: If you aren’t much of a handyman, just find a handyman, pay him his rate to install the light for you.

This little guy paired with an inexperienced operator has ruined many a hedge…

Do it yourself is overrated if you know nothing about what you’re trying to accomplish.

Do you want a family practitioner biopsy something that looks like a melanoma? That’s right. You probably don’t want your Dermatologist installing your hot water heater either. You have to realize that not everyone has the time or interest in dealing with unthinkable chores.  And that is okay.  We all specialize in a profession so that we can offer our services for a fee commensurate with our training.  If you don’t want to mow your lawn in a crappy manner to save a few hundred bucks, either hire someone to do it or get rid of your lawn.

Every person has different interests and strengths.  As doctors, we all have different strengths outside of medicine as well.  The plastic surgeon who is an expert woodworker is going to fare better customizing a desk for his daughter in college than the Radiologist  who is an expert painter. What should the Radiologist do? Send his daughter off to college with an Ikea desk and a custom painting if he wants to contribute something unique.

How much DIY do you accomplish?

Note: I haven’t purchased a box of discounted half-stale donuts in 4 weeks! Hopefully I can keep that streak alive!

Do doctors even need to have ancillary income?

We focus a lot on finances and keeping realistic lifestyle standards on this website.  As doctors, we are privileged to have a relatively high standard of living compared to the rest of the population.  Of course, this does come at a price of a long incubating period before doctors “become” useful and a relatively high level of stress in our work.  What is important to realize is that despite a nice paycheck, doctors are far from immune to financial ruin and bad decisions.  Much of these bad choices come from generalized overspending and bad investment decisions.  I remember seeing an oncologist in my hometown open a Baskin Robbins and Popeye’s fast food establishments only to have them close down after a few years.  Just because you can cure cancer doesn’t mean that you can run a fast food business.  But hindsight is 20/20, as they say.  If you are going to hit it big, you’ve got balance risk and reward while adding in a touch of luck.  If I truly had that formula, I’d be selling it through my informercials.

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Diversification protects us from obsolescence.

I’ve long believed in branching out our revenue stream. It doesn’t ever seem wise to be a one-trick pony in income generation.  What if a younger, better version of yourself comes along to take your job? In middle school, I remember seeing kids trade baseball cards.  Sometimes the trades involved cash, but only in small amounts.  After all, 5th graders were limited to allowance money.

Later, Magic: The Gathering cards came about and kids started trading and selling those.  It was a mini-economy.  I remember that there was one kid who seemed to have the most valuable cards that everyone else wanted.  The kingpin.  I always considered that kid to be a successful entrepreneur until the game fell out of fashion, and no one wanted to buy any of his cards anymore.  Amateur.  He should have diversified.

If you didn’t protect your trading cards from Kool-aid spills, your investment could be worthless!

You might also like: Why every doctor needs a side hustle. 

Unfortunately, most people never diversify either.  Most doctors I know certainly put all of their eggs in one basket.  Myself included.  Most of the time we just don’t have the time, energy, or interest in diversifying income.  The people I know who actually do really love money.  Sometimes more than their families. The rest of us just buy disability and life insurance and move on.

But having ancillary income isn’t necessarily a bad thing.

What is even better than income diversification is passive income diversification.  Who doesn’t love passive income? (That’s you @PassiveIncomeMD!)  Many doctors I know buy real estate, flip homes, write books, and even host wine tastings as means of additional income.  Some of it is passive. Others seem far from passive.  Many of these options do bring income outside of their primary occupations.  Who knows, at some point your hard work will actually pay off.  The book you wrote that you spent months away from your family can actually produce a lasting income stream for years. Think of it like paying it forward with delayed gratification.

Bullshit! I trained 12 years to become a thoracic surgeon, and you want me to flip used furniture on Craigslist on my hours off?

Point well taken.  You have to look at the situation in two aspects:

1) How much time do you have to spare? What are your family obligations? If you spend that extra 5 hours per week writing an ebook after being at work for 85 hours that week, will your wife divorce you? How much do you like money? How much potential earnings and gratification would you get for doing extra work?

2) Will this ancillary business venture affect your primary income stream? You see this as a recurrent theme in Shark Tank.  You have bustling entrepreneurs who aren’t willing to quit their day job yet but have potentially groundbreaking businesses that need more dedication. Which one do you choose?

You have to look at what your passion lies.  The anesthesiologist who spends his residency looking at foreclosures clearly has a passion in real estate (not in medicine).  If you are a thoracic surgeon who spent twelve years of your life to learn about cracking open chests, you’ve probably found your passion.  You probably don’t want to (or need to) find a side hustle.

Doctors really don’t need to have supplemental income. 

This goes back to my main premise—doctors don’t need to have ancillary income outside of their jobs.  We work relatively hard in our primary jobs, and make good money.  Just because some doctor you know from the hospital brags about flipping homes in his spare time doesn’t mean that you do too.  Likewise, just because some doctor blogger on the internet starved himself for two years to pay off some egregious amount of student loans doesn’t mean that you do either.

You just have to know what is important to you, play your cards strategically, and fold when you have a bad hand.  If you have a potentially lucrative hobby, you can decide whether it is worth your time to venture into commercializing it.  If not, you can still be a successful doctor even if you are a one-trick wonder.