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Category: lifestyle

A race to the highest number is a race to the bottom

Posted on February 11, 2018January 30, 2021 by SmartMoneyMD

Part of the equation of having a great lifestyle as a physician is to focus on the critical aspects of our careers and minimize the amount of micromanaging that can result in unnecessary agony. The second part of the equation is to identify what aspects of our daily living make us most happy.

The source for happiness is not easily identifiable. It will undoubtedly change over time. However, if you constantly strive to be the top at everything you do, you might never find your happiness.

Modern-day medical training is built upon competition

We all strive for excellence in medicine. In order to gain admittance into college, medical school, residency, and fellowship we all have “beaten” out other peers. We’ve all been there too. All of my medical school classmates were “competitive” in some form. I’m sure that this competition turned us into better doctors, but are we better people as well?

Students who receive the highest grades often enter the more competitive specialties in medicine. Are these competitive specialties also more challenging in daily practice? Or do they confer some favorable advantage like better lifestyle or higher reimbursement? One of the plastic surgeons I know from Portugal mentioned to me that medical students in his home country take a cumulative exam in school that essentially covers Harrison’s! For those of you not in medicine, Harrison’s is a textbook compendium of all internal medicine. It is sort of a reference manual that you’re not really able to know by heart. The highest scorer in the country essentially gets to “pick” the specialty of their choice. Talk about competition!

How long do you need to compete for?

We all need to hustle in life. This is what builds discipline. But after these skills are reached, what should the next step be? At what point in your life or career do you set your navigation to autopilot? Do we call it quits at the end of residency when you join a HMO group? Or do you go until you make partner in a private group? Or perhaps ten years into partnership after you’ve made your millions? What about never stop hustling when you join a university practice?

Comparison of wealth is a recipe for failure.

How much can we carry our ambition to our finances? It’s important to have clear financial goals—the more concrete our goals are, the more likely we can gauge and achieve them. However, we have to be careful about comparing our financial success with others. It is a losing battle that will never end well. No matter how dire your financial situation may seem, there will always be others in even more dire than yours. No matter how financially successful you may be, you can always find someone else who has a bigger bank account.

If you choose to race, make sure you are in it for the right reasons.

How to learn discipline from a seven-year-old

Posted on February 4, 2018January 30, 2021 by SmartMoneyMD

I’ve gone through spurts of discipline and motivation throughout my life. I think that the first time wasn’t until high school when I was trying to get into a good college so that I wouldn’t be pan-handling off the freeway later in life. We all have had various productivity spurts in college, medical school, and in our job hunts. The gears are always moving.

Ironically, once we’ve settled down in a stable job life becomes much easier. You show up to work, you see patients, you go to some meetings, and you go home. Some nights we take call. Some weekends we spend at the hospital. But once the routine becomes established, life is easier.

Routine as a gateway to mediocrity

The danger in getting into a routine is simply that–life can get mundane and heaven forbid, your brain might start slowing down. The worse part about autopilot is not knowing that you’re in autopilot mode.

There are doctors who are the same way–they’ve “mastered” their profession, and just opt to expend their energies elsewhere, like venturing into financial education or living the dream on the beach. Are these doctors actually on the top of their medical game? As much as I believe that we have enough multitasking abilities to be great at many unrelated topics, medicine is a field where complacency does actually create mediocrity. I have friends who specialize in treating stroke victims through advanced revascularization techniques–look at it as high-risk unclogging of your plumbing system–they will be first to tell you that if they didn’t put in the hours on call and on emergency situations that they would not nearly be as good as they are.

Another prime example is Dr. Oz, the world-famous cardiothoracic surgeon turned celebrity medical expert. When I scrubbed into his hallowed operating room years ago, there was no doubt that he had expert dexterity with the vascular system. This came from years of long hours in the operating room and labs. If I needed a new heart valve today, I’d probably not want him to perform the high-risk sections of my surgery.

Reigniting the flame of ambition

Fortunately not all of us need to be world renowned surgeons or innovators within our profession. The rest of us mere mortals can still remain well-versed in our professions while running on autopilot. Likewise, it’s even easier to set your financial plans on autopilot. My financial game plan has been set on autopilot for a while now. I clean up a few investments here and there at the beginning of the calendar year, tax-harvest if I truly want some activity, and sit back and enjoy life. It sometimes gets a little stale to keep funding those index funds when Bitcoin offers so much excitement. Maybe I could trade some gold or buy some properties to flip or rent out.

I look for inspiration to remain motivated. Sometimes I’m able to see it every day. Other times inspiration only presents every few weeks. Several weekends ago, I attended an intramural basketball tournament for elementary school students. These kids probably ranged from five to ten year olds. They played essentially full-court games with ten-minute quarters!

It’s refreshing to see the hustle in others

These kids hustled down the court on every play, and fought for every point. One team was behind by twenty points, but still played hard until the final buzzer rang. It was refreshing to see that ambition is still alive and well. I high-fived some of the players afterward, went home, and was motivated to vacuum the living room.

What are your sources of ambition?

The most common questions asked by college applicants

Posted on January 14, 2018January 30, 2021 by SmartMoneyMD

College application season is in its full swing, and parents are just as anxious (sometimes more anxious) about where their children end up. I volunteer for my alma mater to interview applicants, and it seems like every year there are more students applying.

What is awe-inspiring about meeting these brilliant kids applying for college is that so many of them are so determined to make a difference in the world. At their age, I was simply trying to get good grades and follow the rules. In retrospect, I was not mature enough (or did not have the advice) to realize that understanding the rules is only but a small part of the big picture.

The application process is just as interesting to me as it is nerve-wracking for the students. I find that the questions asked are the most entertaining. I would stratify them in three categories:

Generic but sincere

These are the questions that I would’ve asked when I was in high school. I’d say that the majority of what I am asked fall into this category.

“What did you like the best about college?”

“What do you think helps College X stand out from the rest?”

“Does College X have Major Y or Club Z?”

There is nothing wrong about any of these questions. If I had to make any criticism of them, it would be that the answer to half of these questions could probably be found on the college website. The other half of them are questions that I, as an alum, should hopefully be able to reflect upon and provide my opinion. I enjoy being asked these questions, because they actually help me recall both the great experiences as well as those I wished I could wipe from my memory.

Thought-provoking questions

I’d categorize these questions as relatively thought provoking questions that had stumped me when they were first asked. Over time, I’ve come to find a satisfactory answer for my applicants, but certainly these are questions that have often triggered further questions.

“If you had to do it over again, would you have attended College X?”

“What did you regret about college?” or “What did you regret about attending College X?”

As an honest answer to myself, it really doesn’t matter to me at this point if I regretted going to college, because there is a very low likelihood that I’d ever “repeat” college. Sure, if I had made different decisions, maybe learned a little bit more about handling my money a little better earlier in life, I might not have even entered a career in medicine.

Questions that should not be asked

Rarely, some questions I am asked are far out in left field. These are the ones that be no means should I know the answer to or should be asked in public. I suppose that the students that ask the most bold questions are the ones that get furthest in life.

Last week, one applicant digressed into a discussion about alumni donations. One student casually brought it up:

Applicant: I heard that college are always looking for funding.

Me: [silent]

Applicant: My father’s donated hundreds of thousands of dollars to College X

Me: [silent]

This came after a lengthy discussion of the Model UN club that he was a participant in. In all fairness, I’ve learned not to dismiss speculation or questions that I don’t know the answer to. Maybe if you donated several million dollars to a school, your heirs would get accepted?

Good luck to all college applicants in 2018!

How to spend $350 a month on your cable bill: A Case Study

Posted on January 10, 2018January 30, 2021 by SmartMoneyMD

A monthly cable bill of $350 isn’t likely to put my physician readers into financial peril, but just because you can “afford” splurging on a big cable bill doesn’t mean that you should. What might otherwise be an annual expenditure of $4200 for tube entertainment will often balloon up over time as cable/satellite companies wean you off their “introductory rates”. Add in compound interest and you will be hurting years down the line.

As part of the obligatory family gatherings over the holidays, we all hear both the good and the bad among family and friends. Somewhere between discussing family vacations and work frustrations, the story about spending obscene amounts of money on cable bills came up. Apparently a coworker of one of my distant relatives was spending about $350 a month on cable bills alone. I know plenty of physicians whose internet, phone, and cable bills hit that amount, but the thought of blowing a serious chunk of change on this really caused my gut to twinge when I heard it. It’s that sensation where your parasympathetic system gets altered, and you wonder which one of the IBS symptoms you’re going to experience next.

The gut-wrenching blow wasn’t the cost itself, but rather that the couch potato had a job that did not exceed an annual pretax salary of $50,000. Most people salaried at $50,000 on a W2 are probably going to pay somewhere between 10-14% of federal tax plus a few thousand on state taxes if applicable. A monthly cable bill of $350 would roughly consume 10% of one’s post-tax income!

We all have different priorities, but initially I couldn’t convince myself that it was possible to rack up a huge cable bill. I decided to embark on a cable shopping spree on my local cable carrier to figure out what it really took to generate a hefty bill.

The marketing folks really have the process down. It seemed that the bonus options were all free:

Tricky Tricky. The discounts look like great deals.

However, the pricing is deceptive. There are fluctuating fees during the first year with variable discounts that wear off after the introductory period:

I was able to rack up a monthly bill of around $400. The bulk of the optional fees, it turns out, come from the equipment rental fees, set boxes for extra television sets, and recording capabilities. One would think that no one should ever need that many channels of passive entertainment but clearly these companies are still in business. I would be inclined to quit my job just so that I’d have enough time to consume what I’ve already paid for.

I polled some of my coworkers, and the majority of them actually do subscribe to satellite or cable television. Some of the more budget-minded doctors at the hospital subscribe to a handful of streaming services to help entertain the kids during road trips (great idea). But I’d say that all of them don’t really have much free time to consume their television subscriptions anyway. Perhaps I’m the outlier, since I axed my satellite subscriptions several years ago?

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Regrets or Resolutions? Reflections from 2017

Posted on January 7, 2018January 30, 2021 by SmartMoneyMD

There are plenty of uplifting points with transitioning into a new calendar year—new 401k contributions, new Roth IRA contributions, and simply a clean start to targeting life goals that perhaps we fell short on from the previous year. A new digit on the calendar can surprisingly impact us psychologically more than we realize.

Just as how we should establish a financial checklist, having concrete reflections on life goals provides us a mechanism to stay focused. The following are five goals for 2018 that all doctors should consider reassessing:

Increase your savings rate.

We all should know by now that our expenses should never exceed our income. The greater the difference between income and expense, the greater firepower you will have to build net worth. Most people are going to be limited by their incomes, so it is important to adapt our expenses accordingly.

As I mentioned previously, 2017 was a rocky year for medical income for me. I’m sure that some of you have experienced similar struggles or will experience them at some point. I’m also sure that most of us who went into medicine weren’t planning to live as if we kept a five-figure salary for our entire careers either. But how much you prepare for a rainy day can certainly help you weather what you can’t predict. The stock market in 2017 went on a tear, and perhaps it’s getting to the point that even the local departmental store clerks are talking about investing (hint, hint: these are the modern shoe shiners). Don’t expect it to continue indefinitely. I know some people out there save 50% to even 70% of their incomes, but we should fine-tune our own savings rate. Find your comfortable savings rate, and try to top it. You might be pleasantly surprised.

Time management and organization.

Time management is obviously critical for all physicians, but it is ironic that I know plenty of physicians who are derelict on their own time. This includes time at work and outside of work. The doctor who stays to chart notes in the electronic health system after signing out is the common scene at the hospital. Likewise, I know physicians who fiddle around on their free time tinkering with home maintenance that would actually be better managed by outside help. I am guilty of this myself. You only live once. Only you can dictate the value of your time.

Improve your health.

Monetary wealth is useless without physical and mental health. This is why disability insurance exists. We can become injured even if we live in a bubble. However, there are factors that we can control in our own health. Decades ago, we saw doctors discouraging their patients from smoking yet are puffing on their own cancer sticks. Today, I see some doctors preaching the virtues of weight loss and diet yet are overweight or obese themselves. Lead by example.

What is interesting is that I often see discipline correlate with health. Many of the superstars in medical school were also marathon runners or triathletes. Coincidence? Maybe there is a correlation between efficient use of time, health, and success.

Job Satisfaction

Even though the satisfaction of bringing back life every day at work justifies your career doesn’t mean that you are happy with your job. Regulations, compliance, and insurance mandates are the factors that make doctoring unpleasant. It doesn’t hurt to reassess your job satisfaction and determine whether any of the active issues are deal breakers in your job situation. If they are, you’d better strive to fix them.

Career longevity

Life does not go on forever. How many years do you have left in your career? Are there any health issues that might curtail your working years? One can go into a deep philosophical treatise on your career, but look at things practically: do you have enough savings to live off of? Are you able to put your kids through school? What do you plan to do with your time if you call it quits? This is where you decide whether your financial plan is sufficient to secure your future based on the existing trajectory. If not, then you’d better figure out an alternative.

What situations do you plan to reassess into the New Year?

Correlating expenditures with happiness

Posted on December 17, 2017January 30, 2021 by SmartMoneyMD

One of the goals of establishing financial security is to have an adequate net worth to sustain our living. In order to get there, we invest in vehicles to grow what we have saved. If we choose (and most doctors don’t really have to), we can also establish streams of passive income (shout out to @PassiveIncomeMD) as a means of cash flow. For most of us, getting to that gratifying number will take time and effort. As physicians, we no strangers of delayed gratification. It is no fun.

The journey to financial security will likely span much of our younger years, so it is important not to lose sight of the present. Amidst the stresses of healthcare changes, we should focus on what we can control. Doctors need to be able to control our happiness while we are building our financial security. This starts the moment we commit ourselves to a financial strategy. A simple strategy to approach happiness is to stay ahead of the curve. We did it all through college and medical school. In finance, we can view this in two ways:

Expenses as a Percentage of Net Worth

Aspirational early retirees rejoice! This is the same formula that we use to determine when we reach financial independence. If you use the oft-butchered 3-4% safe-withdrawal rate as a reference, you can roughly determine your financial progress.

For instance if you spend $10,000 a year, save $10,000 a year, and have $100,000 in net worth, you should be able to reach a 4% safe withdrawal goal rate ($250,000) within 15 years. How happy would you be if it’ll take you 15 years to reach your financial goals?

The longer it will take to reach your goals, the less happy you will likely be. For the mathematically inclined:

Happiness ∝ 1 / (Number of years to FI)

If you throw expenses and percentage of net worth into the mix, you can make some more equations:

Happiness ∝ Net worth / Expenses

If you don’t care much for distilling life into a core set of math equations, just realize that the more your expenses dig into your net worth, the less happy you will be. As you are building your net worth, stay happy by watching your expenses.

Expenses as a Percentage of Income

I find that tracking expenses as a percentage of net income a more manageable approach to happiness. As long as you can keep that ratio low, you know that you are working towards your financial goals.

Another way to look at this method is simply your savings rate—the higher your savings rate, the sooner you ought to be reaching your financial goals. Most financial professionals that I speak to strongly recommend saving at least 20% of your income. (Pretax or post tax, no one ever specifies!) This also means spending 80% of your income. As I have progressed throughout my career, I’ve discovered that percentage of income spent has translated to increased happiness. There was a minimum threshold that I needed to exceed, which was anything beyond my residency and fellowship income. Afterward, the closer I became to a net zero net worth (repayment of student loans) the happier I became. Setting realistic goals and achieving them allowed me to sustain my financial happiness. As each one of my mini-goals was reached, I’ve found that lowering my expenses as a percentage of my net income has helped remind me that I was succeeding in reaching financial independence.

Can you achieve happiness with a milk stout?

That caveat is that this method is going to look a whole lot better for people with high incomes. The key is that each one of us is going to have a different savings velocity. The key in happiness is not to treat our earnings and savings as an arms race with others—as long as we are progressing according to our means, we are doing well and living a healthy lifestyle in the process.

How do you track your happiness?

The FBI is calling for Emergency Medicine Doctors!

Posted on December 6, 2017January 30, 2021 by SmartMoneyMD

Yes, this is the Federal Bureau of Investigation.

Are you getting burned out by those late night opioid addicts hitting up the emergency room during your shift? Is the stress of the conventional ER bringing you down? I’m sure many of us have dreamed of finding an alternative career at times when we’re getting burned out by our healthcare system.

If you’re an emergency room doctor and want to have even more action, look no further. I was perusing the FBI website (yes, the Federal Bureau of Investigation), and one of the specialists that they are looking for include EM doctors.

Accountants and Emergency Medicine doctors welcome! Anesthesiologists need not apply!

That’s right, Emergency Medicine doctors would be a good fit for the FBI! Many doctors speak another language too, so you could potentially fit several criteria for employment! I would imagine that physicians could actually be deployed in the field, since they can perform life-saving measures in combat.

Interestingly enough, there is a strict age requirement between 23-37. I assume that these positions are physically demanding, and anyone over that age may not meet the health requirements.

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@WCI, you’re over the hill! Would a log of all your heli-skiing and canyoneering trips count for physical fitness?

Emergency medicine doctors are in a unique situation in that their residency training is relatively short–many programs still train for 3 years while some train for 4. On average, you can be a board-certified EM doctor at age 29. That means you can have a solid 8 years to apply for the FBI before you get ousted for being too old. If you are accepted, you can work up to the mandatory retirement age of 57.

What is more important for our finances is whether joining the FBI will count towards your years of PSLF…

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