Month: August 2017

Negotiating the Three F’s: Fame, Fortune, or FIRE?

This entry is more of a philosophical debate that I’m sure many of my colleagues (myself included) have contemplated at least once. Ambition can be a powerful motivator in our daily lives, and I’m sure that every doctor is no stranger to ambition. While one would hope that every person who has any authority to dictate our health have good attention to detail, there are doctors who surpass the normal expectations of being a doctor. We all know those people as “gunners”. Some of us might even be “gunners” at heart.

So how does ambition relate to our finances? For the professional who has dedicated her life to delivering excellent healthcare to our society, ambition can be self-defeating.

Fame

Many of us dream of fame. Some of us strive to be famous.  Only a select few in our profession achieve fame. Some of this fame can even become notoriety. Fame in medicine is represented in many forms. Academic medicine is a common route to achieve fame in our field. We work under the auspices of a university or academic setting. By default, there is some prestige from association with higher learning.

You might also like: Is a prestigious medical school useful for doctors?

There is a trade-off, however. Are you going to earn a similar amount from working at an academic institution? Probably not. Most academic hospitals will provide doctors with a fixed salary with a small incentive for productivity. By working there you are essentially accepting a potentially lower salary in order to have your name tied to an institution of higher learning. Is it worth it? Some people would agree.

Fame in medicine can come in another form.  There is mass-appeal fame. These are the doctors who are known to be public communicators to the world. Mehmet Oz is a clear example of this. Following in his father’s footsteps as a highly skilled thoracic surgeon, Dr. Oz himself trained to become a famed cardiothoracic surgeon. He tied himself to an academic institution and was willing to accept a potentially lower salary.  He then associated himself to daytime television and established widespread mass appeal. In a way, he was able to achieve the fame of being associated with an academic institution and fortune. In the process, he likely transitioned himself out of truly practicing medicine. I doubt that he’s scrubbing into Milstein OR 23 for any heart valve surgeries with any frequency these days.

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Fortune

Aside from Dr. Oz who has the fame and fortune, doctors can simply go the fortune route. This is most commonly achieved by working at regional hospitals or, better yet, a private medical group. Hard work, long hours, and some business savviness can translate into a nice income. These are incomes that can fund family vacations into exotic regions in the world, all without gaming any credit card points or strategizing hotel stays. I’ll be first to admit that I’m sort of jealous of some doctors who can pull in the annual 7-figure incomes. They may not have the fame of medicine, but they can surely get the fortune aspect of it. Pick your poison.

FIRE

Okay, some of us just don’t have the fortune to amass a fortune or fame through medicine. We’re not doomed. In fact, we might be the luckiest of the bunch. These are guys that worked hard to enter a career in medicine and are able to earn a relatively comfortable salary. There is perhaps some flexibility in our schedules and we aren’t necessarily burdened by the perils of crazy-high incomes or fame. We can still achieve some financial independence in the process.

Sipping a cup of ‘joe on a weekend morning at home probably isn’t the worst thing in the world.

Having a relatively high income, saving up a decent amount of our earnings, investing in some real estate, and counting up our pennies isn’t necessarily a bad arrangement. You’re not going to be in any extreme category of medicine, but the lifestyle probably isn’t too much to gripe about either.

I’ve struggled to identify myself in one of these three F’s in medicine. The ego in my psyche wants to achieve the first F. The ambition side of me wants the second one. The rational side of me realizes that I probably belong in the third F, and that is okay. If I play my cards right, I’ll still turn out okay.

Which F do you belong to?

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How to impose financial literacy on your peers

I’m not much of a board game fanatic, but many of my friends and peers are. Perhaps this makes me an outlier, but group games seem to be a common hobby among my social group. There are subgroups among the board gamers too. You have those who go for the mainstream games like Settlers of Catan. Some of my friends like collaborative games like Pandemic, where everyone is playing to achieve a unified goal.

Others like strategic games with some element of chance. Fair enough.

Then you come across the super-intense board game fanatics who delve into games that no normal person would ever understand. Several months ago I was convinced to join in on a game called “Vast: the Crystal Caverns”, which was funded through Kickstarter and apparently very highly rated. Search for it online and you can be the judge.  I think I lost about two hours of my life in that game and still couldn’t really understand how it worked—this is coming from someone whose board game interest ended at Monopoly and Sorry!  Specialized games are just that; if you don’t fall into that targeted audience, you will be lost.

I came across a game the other day that would fit into that similar niche category.

Wi$e Money

Want to scare off your spendthrift friends? Bust out this game during get togethers!

That’s right. I’ve never heard of this game, but I’m not one in this demographic. Looks interesting. You might be able to scare off some of your party guests with this one.

Here’s a teaser question from the cover:

Q: “When you start a new job, what tax form must you fill out, and what does it do?”

I went to the company website and they also have high dollar games for companies. I guess that they aren’t a high volume business:

I guess if you have small number in your targeted audience, you can charge whatever you want for a board game.

Would you be interested in playing Wi$e Money? If so, we should do it at one of the financial blogger meet-ups!

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Replacing the flammable vapor sensor in your hot water heater

Part of the toils of home ownership is the hassle of repairing appliances and fixtures. In the financial freedom world one could rent or even live like a digital nomad. But that doesn’t work if you plan to enroll your kids in traditional schooling or even hold a professional job. The nomadism comes after financial freedom, unfortunately.

This leads us to today’s DIY review. My five-year old hot water heater decided to act up last week and punished the household with cold water. Fortunately with many modern hot water tanks have a gas control kit installed. This control unit helps maintain the pilot light and allows you to adjust the temperature of the water.  In layperson’s terms, this device keeps the water hot, whether through natural gas or electricity.

The beauty of these controls is that they also provide error codes for troubleshooting. My device has a light that flashes and and chart for reference. Think of it like a diagnostic system in ICU ventilators:

Everything is getting computerized these days.

My control unit produced a sequence of 7 flashes, which indicates that I have a faulty flammable vapor sensor (FVS).

The FVS is a relatively newer’ish invention that consists of a silicone type sensor that detects flammable vapors outside of the hot water tank. If you have a gas leak, you certainly don’t want to have an open flame feeding off that fuel. The downside of the sensor is that it can be trigger by other fumes in the vicinity such as paint fumes.

Check to make sure that you don’t have a gas leak.

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The most critical reason why your gas control valve triggers an FVS error is that it might actually be doing its job. Do you have a gas leak somewhere? Make sure that you don’t smell fumes from natural gas, garage off gasses, or even open paint cans in the vicinity. Vent the area where your water heater is located. Only when you are certain that there is no dangerous situation should you proceed to make changes.

Reset the FVS.

Let’s say that there was a temporary trigger to the sensor. Maybe there was a spider that built a nest right on your water heater. Perhaps your dog had a loose bowel movement. Whatever. You can reset your control panel. Every device is going to be different. The user’s manual should have a section on resetting the device. Or try Google. That’s what I did.

I have a Honeywell type control panel. There is one on-off switch, plus a dial to control the water temperature. To reset my controls, I did the following:

  1. Flip the switch to ‘off’.
  2. Unplug the unit.
  3. Turn the temperature dial to ‘low’.
  4. Plug in the unit.
  5. Flip the switch to ‘on’.
  6. Modulate the temperature dial from ‘low’ to ‘very hot’ about 3-5 cycles.

At some point, you will hear a spark. The pilot light will subsequently light, and you will likely hear a whoosh where the flame ignites underneath the water heater. If your hot water heater stays on, then you’re home free.

You might have a bad vapor sensor.

Unfortunately after I performed a reset on the control unit, my water heater shut off after five minutes. My FVS is situation on the edge of the water heater in a plastic cover.

The sensor looks like a power socket plug.

25VS. The little guy that stands between hot and cold showers.

When the sensor detects a sensitive fume its resistance increases and closes the circuit. On average the working range of these resistors is somewhere between 9-45 kilo-ohms. I was able to test the resistance of my FVS using a multimeter, and mine was somewhere around 196,000 kilo-ohms! (196 mega-ohms). Clearly the FVS had simply gone bad.

Mega amounts of resistance indicates a bad vapor sensor.

One hack to get your hot water heater going in a pinch (DON’T DO THIS) is to install a resistor in the circuit. If you have access to a Radio Shack or electronics store, you can pick up a 15k-ohm resistor. Tie it into your hot water heater, and you will have bypassed the safety mechanism of your hot water heater.

Replace the vapor sensor.

If you have a bad sensor, the fix is easy—get a replacement and install it. Many of the big box chains like Lowe’s and Home Depot will unlikely carry these parts, but a specialized plumbing company might.

You can also find replacement parts on eBay or Amazon. I have a Whirlpool water heater, which is actually made by American Water Heater Company, whose parent company is A.O. Smith.  This is important because many of the replacement parts are interchangeable. Through some detective work, I found out that my flammable vapor sensor was also manufactured by Rheem. The part online was $25 with free shipping.

How much did I save?

Plumbing is a specialized profession (like gastroenterology). It may not be the most challenging line of work, but it can be dirty.  The local plumbing chain charges $150 per visit ($300 on weekends), $150/hr for labor, plus parts. This probably would have been about a $450 job. Plus the agony of calling the plumbing and potentially taking a day (or half day) of work off.

Not a bad trade-off, especially in post-tax dollars.

Priceless.

How much home maintenance do you deal with?

Five Reasons to quit a career in medicine

Rough days in the office or operating room take a toll on you. Mentally. Physically. Cognitively too. Sometimes you get distracted by your work and put your family as priority number two. I can see why some doctors just quit. On my evening commute, I was mentally paging through some reasons why some of my colleagues choose to leave such a career. Here are five of those reasons:

  1. Regulations in healthcare have always been annoying, but are only getting worse. Some rules are made with the intention of protecting those we care for, but I’ve become quite skeptical about the hoops that we jump through just to get reimbursed by the medical insurances. The claims that we submit get denied for the most asinine reasons (or often without explanation).  Those who deny our medical claims often think twice when they’re on the receiving end of denied claims.
  2. Medicine is actually a service industry.  Yeah, some of us clearly did not realize this when we decided to enroll in medical school.  Some of us still didn’t realize when we chose our specialties either.  People can be nice. People can be rude. Some people are downright mean. Doctors are glorified service workers that have to cure diseases and make people happy.  Imagine doing that for thirty years, with demands increasing every year.  Get out of medicine to escape the pain.
  3. Our profession can be bad for your health. I know a surgeon who still practices at age 74, and is on the top of his game. But guys and gals like him are few and far between.  Imagine zapping your hands under fluoroscopy every day on the job when you’re a vascular surgeon or interventional radiologist. Yeah, looking at you @FutureProofMD. You might get some arthritis sooner or later.
  4. Medicine is an ever changing profession.  Some of the ways I treat patients have changed quite a bit even over the past few years.  If you’re not able to keep up with the technology and practice of medicine, get out. Do yourself and your patients a service.
  5. Medicine can be a boring career.  I hope that most doctors don’t think that medicine is boring, but sometimes it just is.  I do get tired of the daily grind, but there are doctors I’ve met who clearly hate practicing, teaching, or research. Perhaps they are just hateful people in general. If that describes you, get out.

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I wouldn’t mind having one of these every morning before reading the newspaper…

Note that financial independence is intentionally left off the list above.  There are physicians who are FI who still practice medicine. That’s the beauty of a career that has traditionally been gratifying.  Having enough money to choose how to live your daily life is a luxury that not many people have, but that reason alone should not be why you ought to leave medicine.

If you plan to leave your career in medicine, what are your reasons? (Don’t become an auditor for an insurance company!)

(Photo courtesy of Flickr)