Author: SmartMoneyMD

Can you achieve financial independence without real estate?

Can you achieve financial independence without real estate?

One of the most frequently discussed avenues for alternative revenue streams among physicians is owning real estate.  Crowdfunding, syndications, private equity, or simply down and dirty rental property are hot topics to increase net worth and provide additional income.  This fervor isn’t limited to doctors only—it seems like everyone including the average Jane has known someone with a great real estate investment story.  The amount of interest among physicians in real estate, however, is fascinating.  Decades ago, it was okay to just focus on one’s professional career.  Doctors could get to retirement relatively easily given the amount of income in their primary profession.  Today physician income is all but secure, and a surprising number of physicians even strive to become real estate professionals.  Being able to find income outside of our profession is an asset—who knows what variables in our practice would make medical practice untenable in the future?  Real estate certainly is a viable route to get to your end goal.

How do you get to Rome?
The name of the financial game is to achieve a means to survive when our primary income source is no longer viable.  Some of us achieve this by simply saving a portion of our earnings during our working years for use during retirement.  Others opt for more material income in the form of alternative businesses or real estate.  Part of this end game involves allocating to charities that support our beliefs, and also leaving a part to subsequent generations to build upon.  

Some of us aim to retire around Medicare age. Others choose to call it decades earlier.  

What is important to realize is that each person’s definition of Rome is different, and everyone’s journey there will undoubtedly take a different course.
What this means is that real estate investing is a great option for only some of us.

In other words, some of us will not do well investing in real estate.

FOMO
I remember a time in the recent past that everyone including those who never cooked wanted an Instant Pot. People spoke of it so highly that I almost bought one myself.

Anyone want to buy this and turn it into a short-term rental?

Or the several weeks where no store had any stock of toilet paper, even though there was no rational urgency to squirrel away a year’s supply of it.
It’s human nature not to want to miss out on a deal or opportunity, even if the thought had never crossed your mind prior to everyone else talking about it.  Real estate investing has a similar allure for those who have never considered it, except that we all probably know someone who claims to be making “good money” on real estate.  We all know that real estate can generate fabulous wealth, but it can also cause a lot of grief.

If you don’t do your homework or master it, it can cause a bit of financial damage.

Why do people love real estate?
The benefits of real estate are too lengthy to discuss in a brief overview, but one of the more commonly discussed reasons for real estate is that it generates cash flow.  There is a real allure about having money coming into your bank account every month.  Whether you are an employee or business owner, there is generally a consistent interval where money appears in your bank account. Real estate as an investment vehicle often provides reliable cash flow that can be used for living expenses.  This is not necessarily the case for stock market investing or purchasing bond funds, where you have to sell the invested currency in order to obtain cash.

Additionally, the endpoint of real estate is that you actually end up owning a building.  Something concrete.  Something that you can physically leave to your heirs.  It sounds more substantial to own a physical building rather than something non-material.

The case for financial success
As with any task we embark upon, nothing comes for free.  In order for us to become physicians, we gave up lots of money and lots of time.  If you choose to become a successful real estate investor, then you have to give up time and money.  Even with syndications, the investor still has to spend time to do the homework.  We all have a finite amount of time, energy, and health to devote towards our interests.  

To answer the original question, it is certainly plausible to achieve financial success without real estate if you are focused on achieving financial success.  

Remember, there are many roads to Rome, and Rome wasn’t built in a day.

What percentage of your total investments are in real estate?

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How to recuperate financially from a divorce

How to recuperate financially from a divorce

I remember reading a post recently on a Facebook physician group that involved cardiologist who asked for help on how to manage her finances after a divorce.
The pertinent aspects of this situation involves the physician being left with essentially nothing in retirement savings.  She is mid-career with children, and wants an option to reduce her schedule eventually to spend time with her children during the weeks she has custody.  Her gross income is roughly $700,000+ a year.

Now most readers are going to pause at that income and say that there’s no financial dilemma, but there are in fact many issues with this situation.  People get into financial trouble for only two possible reasons: (1) spending too much, or (2) not earning enough.  This physician earns enough by most accounts, and is unlikely able to carve out more time to dedicate to earning more.  She should tackle her expenses, especially since it sounds like she is on the short end of the divorce settlement.

Divorce

The original poster did not mention any further details about divorce settlement other than the spouse works in the financial sector and “made out like a bandit”.  Fair enough.  If we assume roughly a “worst case scenario”, the physician might have to pay out five years of alimony, maybe a chunk of childcare expenses, and some lawyer fees.  Maybe the payouts for the first year might look like this:

Alimony – $150,000

Childcare – $100,000

Lawyer fees – $50,000

The second to the fifth year might incur $250,000 each, and childcare costs may never end (only half-joking about the childcare costs).  Note that one can raise children for much less than $100,000 a year, but her financial strategy should function independently of childcare expenses.

A $700,000 pretax salary on a W2 will likely result in a 30% effective federal tax rate.  If you assume that state and local tax rates chew up another 10%, then she will bring home roughly 60% or $420,000. After divorce payments, the physician should have $120,000 in the first year and $170,000 in subsequent years.  

Live like you’re poor (because you are)

This mid-career cardiologist may be in her late 40’s or early 50’s.  She will likely need to dedicate the rest of her working career of 15 to 20 years rebuilding what is lost, but her options might be significantly more favorable depending on the terms of the divorce settlement.  There is a good chance that childcare expenses are not nearly as high as portrayed but this would not alter the financial recovery strategy.  Should ought to be able to retire at a “normal” age, and even opt for fewer hours if her financial situation recovers quickly.

The most challenging aspect of handling finances in mid-career is that it is not easy to go counter to lifestyle creep.  Any physician who is at least decade out of residency is going to have difficulty cutting back, but this physician will need to itemize her lifestyle expenses and figure out how to pare everything down.
Car lease, mortgage, travel consumption, food consumption, discretionary spending should all be assessed and slashed.  

The goal in financial recovery is to assess all variables that are under her control.  This includes everything that is unrelated to her divorce expenses.  However unfavorable, she might benefit from downsizing her home or reducing costs on her vehicles.  These recurrent costs typically consume progressively substantial amount of earnings that could be better invested elsewhere for retirement.

Back to the basics

This physician simply needs to go back to the fundamentals of building wealth for residents and new graduates.  She should maximize her pretax retirement vehicles like her 401k and contribute to any profit sharing plans that her practice offers.  She should also make sure she is contributing to a Roth IRA as long she does not have savings already in a Traditional IRA.  She should immediately try to save at least 20% of her post-tax, post-divorce fee income and build up.

Sometimes all we want is a guidebook to tell us what to do.

Remember that the longer that your investments are in the market, the more they will have time to grow.  After her divorce payments are completed, she should contribute that same amount towards her retirement.  Even with conservative estimates, she ought to be able to retire comfortably by age 65.

Reducing hours

Going to part-time is solely a practice-specific and specialty-specific endeavor. Shift-based professions tend to be more conducive to part-time status simply because colleagues can simply pick up the shifts that you don’t do and receive clear-cut compensation.  Cardiology tends to be more challenging, especially in the proceduralist subspecialties.  For instance if you are an Interventional Cardiologist, you will likely need to make compromises in the on-call schedule if you opted for reduced hours.  The math doesn’t always work out in your favor, but the hope is that your financial health is able to take the hit if going part-time significantly reduces your income.  It would not be surprising if a 1.0 FTE cardiologist making $700,000 would see her salary reduced to $250,000 if she were to drop to 0.5 FTE.  

She is going to be fine

Wealth is often defined by a relative number.  This cardiologist will unfortunately not have the option to live a wildly extravagant lifestyle had her divorce not occurred.  But she will not likely be out on the streets and there is a good chance that she will be able to enjoy many purchased luxuries that her colleagues in less lucrative (and less busy) fields may not necessarily be able to.  What this means is that if she is able to quickly rebuild wealth in the next five years, she will have the option to cut back to spend more time with her children. 

If her salary were “only” $300,000, her divorce settlement will likely be less and she ought to be able to recover similarly. 

The moral of the story? Financial disasters can happen to everyone.  Obviously having a greater earning potential will get you out of trouble sooner, but everyone has the ability to rebuild financially no matter where we start out.

Doctors working in tech cities are losing the rat race

Doctors working in tech cities are losing the rat race

Populous cities are populous, well, because people want to there.  Whether the appeal comes from greater career opportunities or simply being closer to family, these places have continuously grown over the last few decades.  The growth is seemingly self-sustaining—certain industries and businesses exist because there is a population that desires these services.  In return, these businesses require workers, so they attract people to the region.   Add nice weather to mix, and these desirable places could even be called Utopia.

Utopia might be a bit of an exaggeration, but isn’t it nice to be the first to experience innovations in our daily lives, whether it be a food delivery service, personal assistant service, or simply a new Broadway musical?  Who actually wants to experience the bubble tea craze two decades after it began?

Sounds great, but there are two sides to the coin.  Yes, these are certainly amenities but there is also a lot of compromise in order to enjoy these perks.  The reality is that if you aren’t retired or living completely on passive income, you still have to go through the daily grind.   That grind in a major city is likely much worse than you realize if you haven’t lived the part.  

Take, for instance, New York City.  It might even be considered the best city in the world.  Most visitors to NYC tend to rave about the energy, the food, and the sights.  These visitors aren’t going to know that it’s not cheap finding good housing (apartment brokers take a cut for finding you a rental), the subway schedules are only a rough approximation, and the vast variety of food options will eventually consume your budget (unless you eat at 99c pizza for all your meals).  

Being a physician in a large city

It is true that a greater population ought to support a greater number of physicians.  In reality that is absolutely true.  However, there are inherent issues with being a physician in these areas.

Despite a greater demand in more populous areas, our profession is still beholden to insurance companies and managed care organizations that dictate reimbursement and certain practice patterns.  There is often a cost of living adjustment (COL) in the reimbursement, but the numbers don’t add up.  For instance, an insurer might pay a physician $165 for a Level 4 visit in Columbus, OH and $180 for the same visit in Sunnyvale, CA.  Your medical assistant in Columbus earns $18.50 an hour, but in Sunnyvale he commands $29/hr.  Oh, and by the way, a $350,000 home in Columbus will cost $2 million in Sunnyvale.  
There are also many immeasurable factors thrown in the mix, like commute time, actual cost of living differences, and other like-minded physicians who are competing for the same subset of patients.

The numbers simply don’t add up.  That $250,000 salary in Columbus will get you quite a bit further than the $300,000 salary in Sunnyvale, AND it’s a whole lot easier to get.  If you’re unlucky, you might only earn $180,000 a year for the first six years of your practice while in Sunnyvale too.

Engineer salaries exposed!

Continuing along the lines of big-city bashing, most physicians practicing full-time are going to have income in the six-figure range.  There are plenty of occupations whose compensation is equal or greater than what a physician can earn in these populated cities.  Engineering and tech jobs are the ones that come to mind when you’re looking at areas like the Bay Area, Seattle, Austin, Los Angeles, and NYC.  
Highly competent software engineers at successful companies can command base salaries in the $150,000 range.  Year-end productivity bonuses could add another 30%, and stock options can double the base salary.  You might be looking at a total annual compensation package of $350,000 for a 25 year-old!
What is interesting is that the growth potential and tax benefits of stock options could potentially amplify the compensation package substantially for the software engineer.  Anyone who’s compensated strictly on a salary and bonus will not realize these perks.

Gotta keep up in the rat race

You might also like: How much money do doctors make?
Whenever there are a large number of people in the same income range living in an area, the housing  and service market will adjust to cater to these groups. Those who are on the fringe of the group will be financially stretched.  Many physicians in these area are actually the ones that are financially stretched.  

There is still light at the end of the tunnel
It’s also important to be aware that people aren’t actually leaving the large cities en mass.  There are still plenty of doctors in these areas, many of whom are likely doing quite well financially.  We all have  to realize that if physicians aren’t able to afford living in HCOL area, then who is?

Just remember that life isn’t a huge race.  We face decisions daily, and ultimately make compromises to get ourselves and our families in the best possible situation available.  Physicians living in HCOL areas can and actually do retire, but there is no doubt that they face unique lifestyle challenges that their counterparts living elsewhere do not.

Are you stuck in a rat race?

Your doctor car is a luxury item

Your doctor car is a luxury item

Most people look at their vehicles as a necessary expense.  Most cities do not have robust options for public transit, and the rest of the country is too vast for any other form of common transportation to be useful.  In contrast, I’ve met a smattering of diehard bicyclist fanatics who swear that leg-powered, two-wheeled transport can suffice even if you’re hauling lumber or a two-year-old child in a snowstorm.  These are the same people who appear to have exquisitely muscular physique, and claim that biking everywhere contributed to their abs of steel and plaque-less arteries.

Which came first, the biking or the toned abs? Should you just keep an extra set of heels and outfits at the office? What about a vanity kit, hairdryers, irons, and extra shower room too?

The majority of people will unlikely go against the grain of owning a car, but it’s still critical to be aware that what starts as a necessity often transforms into a luxury.  Our cars likely account for the top two or three expenses in our budget.

Going the fancy car route

Doctors have to look the part, right?  It is important to look the part in the physician’s parking lot at the hospital, and frankly, the barrier to ownership of a luxury vehicle isn’t actually that high.  Many of my colleagues also opt to lease vehicles in order to maintain the flexibility of having access to a new car and not worrying about the maintenance. 

A lease on a $90,000 SUV may only set you back roughly $1200 a month, or $40 a day.  Gas might run you $250 a month ($8.33/day), and insurance perhaps $2000 for six months ($11.11/day).  In total, this might cost $60/day.  While this amount may not be a huge dent to a Hospitalist earning $120/hour, remember that these purchases are made using post-tax dollars.  At an effective income tax rate of 30-40%, that $60/day may be costing you closer to $90+ of pretax dollars.

Is ownership of a luxury vehicle worth 10% of your ten-hour shift? 

The amount of detail you can analyze this situation is endless—most shift worker physicians are only posting 15-18 shifts (often less) a month.  This lease might actually eat into more than 15% of your monthly gross income.  Two of these leased vehicles would consume 30% of your income, just to get from A to B.

Keeping a beater until it no longer starts

In contrast, there are plenty of physicians who purchase a vehicle outright, and drive it until the car no longer works.  This might translate to a decade of use for the average non-technical car driver to maybe 15-20 years for the car hacker.

Modern safety features are optional.

Ownership might still cost you $30/day if you amortize the cost of maintenance through the life of the vehicle.  If you are unfortunate enough to buy a lemon that dies after year 7, you’ve effectively increased your daily cost of car ownership.

For the high net worth individual who needs umbrella insurance, there is a trade-off with owning an old beater.  While umbrella insurance itself is relatively inexpensive, the policies often require a certain amount of pre-existing coverage of your home and vehicles in order to pass underwriting and avoid gaps.  This additional amount of auto insurance coverage might be more than what you’d like to pay for an old car, but you have no other choice.

The moral of car ownership

It’s unlikely that your life circumstances allow you to circumvent car ownership completely.  Even as a high-income earning professional, you are likely still giving up 10% of your earnings to this luxury.  With teenage children, you’ll easily double the expense.  If this amount has no impact on your well-being, then look no further.  You needn’t worry about it.

However, the most important aspect of car ownership is realizing that it can and will sting your wallet.  If that sting is sufficient to disrupt your financial plan, then and only then should you analyze what to do to reduce the financial burden.  

What is your stance on ownership of a luxury vehicle?

Do I need to establish a trust?

Do I need to establish a trust?

One of the more commonly pitched financial protection vehicles to high-income individuals is a trust, or living will.  It is essentially a document that lays out instructions to distribute your belongings to your heirs at the time of your demise. We briefly discussed an overview of this vehicle in a prior post, Do doctors need to establish a trust for their heirs?

In this post, we will review step-by-step how to decide whether you and your beneficiaries will benefit (get it?) from a trust.  Remember that there are essentially two goals of a trust: (1) to eliminate any ambiguity with distribution of your wealth when you are pushing up the daisies, and (2) to avoid probate court.  Why is probate court so bad? It really isn’t, but the process can delay the distribution of your estate by months and chew up a chunk of funds for legal fees. 

In some cases where your heirs might not have the money to pay the legal fees, a trust can allow you to set aside a certain amount of your estate to pay the legal fees.  The options can be endless.

Estate Tax

Right off the bat, if you have greater than $11.58 million or more in the year 2020 you probably need to establish a trust and enlist the advice of an estate professional.  This is a sizable amount, and it would save a lot of headaches if there were explicit instructions to distribute your wealth.  Additionally, many states impose estate taxes on a much smaller amount.  Check with your state’s limits to help decide if you’d benefit from a trust.

Step One: List your valuables

The first step is to decide what you have that is worthwhile to give.  This includes bank accounts, retirement accounts, real estate, and the various pieces of artwork that you collected while you were in Egypt.  The greater number of people and items that you have to distribute, the more likely a trust would prove helpful.  Think about it.  If you only needed to give everything to your spouse or single child, then there is usually not a huge need to establish a trust. 

Step Two: Eliminate accounts with POD options

Payment on death—this is essentially an option that many investment and bank accounts have that allows the owner to list a beneficiary to the account.  Sometimes these are listed as beneficiary options on your accounts.  By default, your beneficiary receives access to the account when the primary owner of the account expires.  There is no probate process needed to reassign ownership of a bank account to a beneficiary.

The accounts that you have listed in Step One that have a beneficiary option do not necessarily need to go into a trust.  What you are left with will help you decide whether it would be worthwhile to establish a trust.
For simple estates, most people are left with their primary home, their vehicles, and any other items of value that may not have a title or deed, like a painting or jewelry.  The big ticket item is usually the primary home.  

Alternative options to transfer ownership of property

Just like your investment and banking accounts, there are few options to transfer ownership of real estate without going through a trust.  As of 2020, the following states allow a form of “transfer on death” deeds on property:

  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Hawaii
  • Illinois
  • Indiana
  • Kansas
  • Maine
  • Minnesota
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Mexico
  • North Dakota
  • Ohio (similar concept in the form of an affidavit)
  • Oklahoma
  • Oregon
  • South Dakota
  • Texas
  • Utah
  • Virginia

There are states that also offer enhanced life estate deeds, also called Lady Bird Deeds:

  • Florida
  • Michigan
  • Texas
  • Vermont
  • West Virginia

If you do not live in any of these states, then this option is does not apply to you. A Lady Bird Deed is simply an equivalent to the payment on death forms that banks often provide.  While every state has different rules, you simply need to transfer your existing deed to the new deed and record it with the local government.  Many legal services will offer this option for no more than $100—if you do it yourself, your cost would only be your county’s recording fees and the cost of a notary.

Making the lives of others easier is not a bad thing

If you life in any of the above mentioned states and your primary household is the only big ticket item that you own, then you can still avoid probate court by updating the deed to your house.  

What is left can go into a trust

Personal artifacts and jewelry can certainly go into a trust, but you have to decide whether there is truly any benefit for doing so.  How many of these items are there, and how many people do you intend to distribute these items to?  Would it be possible to gift these items to them while you are still alive? 
Ultimately, you have to decide how much simpler you can make your heirs’ lives when you’re no longer around.  If that means establishing a trust to simplify the inheritance process, it would be worthwhile investment.

Do you have a living trust for your heirs?

All statements in this article and website are only opinions and should NOT be construed as professional advice.  Consult a tax planning professional if you are seeking help in the matters discussed in this post.

Protecting your financial future from other physicians

Protecting your financial future from other physicians

Unfortunately, hospitals and healthcare systems are not the only ones that take advantage of doctors.  Physicians in private practices are just as likely to take advantage of their colleagues, and sometimes the severity may be much greater than what you’d see in the hospital setting.

Those of you younger doctors in outpatient specialties, take note.  This list includes gastroenterologists, ophthalmologists, vascular surgeons, oncologists, internists, or anyone who would join a medical practice with another doctor.  Anytime there is a younger physician joining a practice run by senior physicians, there will always be potential for inequity.  Why do these problems arise?

Greed. 

Greed of money, and greed of exploiting someone else. It just happens.  Perhaps the senior doctor thinks that she put in blood and sweat into a practice that a junior associate is simply getting in for free.  Blood must be drawn in order for a new doctor to be accepted. 

How you can get taken advantage of as a junior doctor
Most of us learn from getting burned ourselves.  These situations can occur in any of the common three ways:

  1. Reneging on a prior promise — This is typically the most obvious scenario that younger doctors encounter.  A new doctor joins a practice with the promise of partnership after a certain period of time.  When that time is reached, the owner-physician declines the partnership offer for some infraction.  The junior doctor is then stuck remaining as an employee indefinitely or move elsewhere.  Sometimes this cycle repeats with a new hire.
  2. Withholding critical financial information — Sometimes a partnership isn’t really a partnership.  Or maybe not all partners are created equal.  The problem with healthcare is that there are business nuances that you will only learn with experience in your profession.  This is where a less experienced physician can get taken advantage of during a partnership agreement.  
  3. Exploiting mentorship role for financial gain — Greed.  It never makes sense to me that a physician who has had an entire career of earnings would feel the need to maximize financial gain of a younger physician.    Typically the amount of financial gain is quite negligible for the senior doctor’s retirement plan.  I’ve seen instances where the senior doctor owns the building in which the practice rents from, and the lease arrangements benefit the landlord significantly.  I’ve seen instances where the junior doctor is heavily dependent upon the senior doctor’s goodwill to refer patients over, but the senior doctor does nothing to help the cause.

Justification of greed
Why do we even see doctors getting exploited by others in their profession? The answer likely lies in the competitive nature of those who enter the profession.  Look back to medical school—we all have been witnesses (or instigators) to cutthroat behavior in medical school.  There is a desire to get ahead.  These behaviors carry over onto everything we do. 
Those of you just starting your careers will need to be aware that malfeasance can happen anywhere and anytime.  Even if you ask the right questions and do all of the right things, you can still get swindled financially by a fellow physician.  
Those of you who are senior physicians bringing on junior physicians, be mindful of what you went through and try to mentor your younger colleagues properly and fairly.  Do the right thing. Our profession needs to stick together to fight the good fight. 

Survival tips for new interns – 2020 Edition

Survival tips for new interns – 2020 Edition

It is never easy starting a new job.  For medical doctors, July 1st typically marks a transition to a new role: medical student to intern, intern to PGY-2, or senior resident to attending.  Some aspects of these transitions are easier than others, but there will always be challenges in medicine.  This year includes another level of complexity for the transitioning medical crew, notably COVID-19.  What a mess.  Not only do doctors have to master their trade, they also have to stay alive and figure out how to treat disease that our profession knows very little about.
Those of you in a hospital-based practice or are still in training, kudos to you.
Looking back at my own experiences as an intern, I wish that I had a list from my future self to follow.  But a time machine doesn’t exist [yet], so I’d figure that I could share some of my experiences that could have made my own internship a bit simpler.

Take care of yourself

Self care is ironically neglected in medicine.  Patient care, presentations, studying, and whatever else it takes to get through the wards often get prioritized. Residency is taxing no matter how you spin work hour restrictions.  However, you are in it for the long haul.  Don’t forget to take care of yourself.  This means:

  • Get adequate sleep – No intern ever gets enough sleep.  There are simply too many tasks to contend with, and obligations to fulfill.  Somehow we all manage, possibly because most doctors in this point of our careers are still young and have enough energy to power through on inadequate sleep.  Just because you can power through on minimal sleep doesn’t mean you should.  Don’t forget to find a free weekend to rest.
  • Implement an exercise plan — I wish I had done this during my training years.  This is difficult especially if you were never one to exercise even if you had free time.  However, we all know that physical activity is mandatory for good health.  Start slowly if you normally do not exercise.  Walking, yoga, stretching, or even brief exercise warmups are a great start.  You’ll sleep better, and feel better.  That’s why you tell your patients to exercise, right?
  • Don’t forget to eat — This also means trying to eat as healthily as circumstances allow.  That occasional binge on potato chips is probably okay the night before you present grand rounds, but you’ll feel better if you eat better.

Work hard

Medical training is probably the only time in your medical career where you will be learning and working in a protected environment.  What this means is that you have like-minded peers who are going through the same highs and lows, and mentors who could help guide you.  Some of the most challenging yet gratifying experiences we will ever encounter will be during training.  There is a time limit on your training, so don’t lose sight that working hard during this time will carry you through your entire career.  

Are you lost yet?

Don’t forget that you work with sick people

Yes, you are a physician.  That means there will be bodily fluids, ways to contract and spread illness, and basic rules that you ought to follow.  Many of my colleagues would wear their hospital shoes through their homes.  Don’t do that.  Here are a few more recommendations for hygiene:

  • Change your clothes — It doesn’t matter whether there is a pandemic in the world—it is always a good idea to keep your hospital work clothes and shoes separate from everything else.  There are plenty of contagions and simply filthy substances that healthcare workers encounter in their daily routine.  Some can impact your health, others simply should not mingle with the carpet that your children crawl on. While you’re at it, consider taking a shower right when you get home or even at work before you leave.
  • Keep that mask on — If you are working in an area where there is a risk of aerosolized contagion, keep that mask on.  This includes sign-outs between teams even if you are not directly in an area with patient care.  The less you are touching your face and eyes, the less likely you can also transmit disease.  Don’t be like that person who takes off his mask while talking. 
  • Hand hygiene matters — Sure, some of us have been guilty of scarfing down that breakfast sandwich during morning rounds or carrying that coffee while you’re rounding in the ICU.  It doesn’t mean that you should make a habit out of it.  Hospitals have cracked down on this over the past decade, but it is still important to be cognizant of what our hands touch and where we are working.  Yes, hygiene hypothesis has validity, but most of us will get plenty of exposure through raising kids!

There is light at the end of the tunnel

Don’t forget that there is a finite time for internship and residency.  Work hard and you will be prepared to build upon your experience for the rest of your career. 

For those of you who survived internship, what other tips do you have for the newbies?