lifestyle | Smart Money MD

Category: lifestyle

How much would housekeeping set back your financial plan?

Posted on May 14, 2017January 30, 2021 by SmartMoneyMD

I’ve been thinking about housekeeping services for a while, and have dismissed it every time the discussion has arisen. But those mailers in the junk mail piles are enticing.

Free estimates!

$50 off first cleaning after you sign up for a subscription!

Obviously having too much house to maintain is a problem that I solely created for myself. It’s a vicious problem that most Americans have. Land is cheap. Homes are cheap. Utilities are cheap. Loans are cheap. This is the perfect formula to become enslaved to your lifestyle.

The problem with home maintenance can be divided into two zones: outdoor and indoor maintenance. Both of these can be incredibly time consuming, expensive, and exasperating.

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Outdoor maintenance.

Subdivisions can be great. They are often somewhat planned communities with shared amenities. Some neighborhoods have shared swimming pools or organized neighborhood events. We pay into these associations depending on what amenities are provided. However, these associations also impose restrictions to each household in order to ensure that its neighborhood is presentable. This can often mean that your house has to be painted a certain approved color. Your lawn has to be groomed and watered, even if your water bill has to take a hit. It means that you have to eradicate lawn pests, weeds, and any other element that would otherwise thrive under no supervision.

That’s right. We pay extra to have more land, and more to maintain it. That is the American way.

Indoor maintenance.

The same principles apply indoors. The more space you have in your house, the more space you have to fill your house with “things”. Do you actually need these “things”? Probably not, but who wants to have an empty house? These “things” in the house get misplaced, disorganized, and dusty too. I keep my windows open often to circulate the outside air in the house. This brings in a lot of dust, insects, and various pollen in the house as well. What a mess!

How do I deal with this?

Currently everyone in the family pitches in to organize and clean. Pulling weeds, Mowing the lawn. Cleaning the bathrooms. Dusting the windowsills. I’m suspecting that when all is done and over, I’ll probably have spent a shocking number of months of my life organizing. Yikes!

Despite the number of hours I spend on cleaning and home maintenance, my home still isn’t spotless by any standard. I just don’t have time to do all of this.

Will hired housekeeping help lengthen my working career?

Most likely. I asked around several services, and got baseline yearly quotes on common tasks that I currently complete myself:

Damn housekeeping! No one really likes to clean either.

So I’d probably spend an extra $10k annually on doing most of the things that I am currently doing myself. Over a decade, I will have saved about $100k, and have it grow through investments. This isn’t exactly pocket change.

The biggest question that I have yet to quantify is whether the lost hours I spend cleaning the house could be better spent generating income. Sure, I’d have a higher tax burden, but in theory I should have a much higher hourly earning wage than what hired help should charge even after taxes. I am still not sure, since most of my maintenance tasks occur on my days off, so it would be challenging for me to be able to bring in extra income without taking on more work.

What do you guys think of doing your own chores?

How do you handle working night shifts?

Posted on April 23, 2017January 30, 2021 by SmartMoneyMD

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)

How much time do you take off a year?

Posted on April 16, 2017January 30, 2021 by SmartMoneyMD

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.

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(Photo courtesy of Flickr)

Budgeting Time for Time-Starved

Posted on April 9, 2017January 30, 2021 by SmartMoneyMD

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:

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.
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.
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.
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”).
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 hard should you work as a doctor?

Posted on March 19, 2017January 30, 2021 by SmartMoneyMD

I can’t think of too many white collared jobs that rival the intensity and duration of work endured by doctors. Sure, there are plenty of physically and mentally demanding occupations out there, but what other job involves handling the livelihood of others, triaging life-threatening events, and multi-tasking multitudes of time-sensitive matters?

The work of a lawn maintenance guy.

Take, for instance, the duties of “just” a lawn irrigation serviceman. Let’s say the lawn guy is tasked with installing a drip irrigation system in a lawn. This is an extremely labor-intensive process. A general overview is that supply lines have to be placed, individual irrigation lines have to be delivered to the plants, the valves tested, lines buried, and landscaping created to make the lawn aesthetically pleasing. Even more labor intensive is searching the lines to identify any leaks in the lines after they’ve been buried! Combine this work with the scorching summer heat, and you’ve got yourself one strenuous job.

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Rinse and repeat. Let’s say you and your crew of three guys repair and install new irrigation every day, five to six days a week. Fifty weeks a year. You’ve got yourself a pretty strenuous and repetitive schedule. Plenty of people do it. It pays the bills, and it is hard work.

Falling asleep in front of your computer is probably okay but not in the operating room during a surgery!

The work of a corporate finance guru.

The finance industry works hard. I would consider finance bankers, analysts, associates, or whatever title they may have to be the grunt workers of the white-collared world. Think 80+ hour weeks for projects, presentations galore, and meetings to consume your life. Many financial analysts I know party hard too. Extreme vacations and sports in the limited downtime they may have. Some of these guys get smart and save up a financial nut like Sam from Financial Samurai. Others just spend it on an expensive lifestyle. Many of these people don’t last in their industry. After they move up the ranks, they either transition out of the industry altogether or just move into a more administrative role.

Sure, I’m biased, but why do people in the this industry eventually leave? The guys that I know who are in their first five years of financial banking tell me they love the challenge, hard work, and helping improve our economy and quality of lives. Huh?

The work of doctors.

Yes, I’m a doctor, but I do think that our line of work is genuinely gratifying. Take away all of that administrative B.S., healthcare regulations, and management issues of any workplace, and you’ve got a profession that is out there to do some good. Look at the Hippocratic oath. I don’t know of any other profession that makes you swear by such a statement.

You might also like: How to identify physician burnout.

You might also like: Why doctors need a four-day workweek.

I know doctors who spend six days a week working to care for their patients. Some of them take only two weeks of vacation per year. Some others work either three to four days a week. Some others take twelve weeks of vacation. There is amazing flexibility in medicine—you just have to make a decision to what is most important to you.

Is the the money?

Is it the lifestyle?

Do you want to work 70 hours a week, take only two weeks of vacation per year, and make $1 million a year? Some of us don’t have the luxury of titrating our work-money-lifestyle balance due to the nature of our work, but this is a subject that I’ve been contemplating for a long time. Given the intensity of our line of work, there has to be a breaking point.

I once had a patient who was in the truck driving industry for thirty five years. He ended up getting placed on dialysis because his kidneys shut down after going for so many years in an occupation that didn’t necessarily allow for bathroom breaks!

Another one of my patients was a construction worker for twenty years, but ended up getting on disability not because of an injury, but simply because his joints broke down after many years on the job.

At what point will you draw the line on balancing your work, money, and health?

(Photo courtesy of Flickr)

How would your life change if you earned an extra $100,000 a year?

Posted on March 14, 2017January 30, 2021 by SmartMoneyMD

I’m sure all of us have either wondered or openly discussed the prospects of having a higher income. We’d actually be able to “afford” those outfits that the celebrities sport or cruise into the hospital parking lot with that dream car. On a smaller scale, perhaps we could choose to have more meals out in restaurants or splurge on a nice vacation that would otherwise be lengthen your working career.

Interestingly, being a physician actually awards us the experience of incremental income growth over many arduous years. We start out in debt during college and medical school, build up to a positive but meager resident income, incur a potentially lower income as a fellow (Yes, this can happen!), and finally a decent but questionably delayed higher income. How does that affect the psyche? Let’s take a look:

The guy who becomes unleashed

We’ve all seen this. There are people in medical school who always seem up for a round of drinks at the bar or a hedonistic winter vacation. Obviously these guys are either funding their lifestyle through family money, a spouse, or loans. Once they secure a solid five-figure income during residency, they spend as if they had a six-figure income with a seven-figure net worth. The expenditures grow at every step of the trajectory. The present lifestyle is essentially supported by future income. Can this be sustainable? Absolutely if the future self makes good on his earnings. I know a guy who did just that. He is doing fine, but working like there is no tomorrow.

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Ironically, this model of lifestyle represents much of our society. That is why there is so much consumer debt and how credit card companies survive. If this guy earns another $100,000, I frankly don’t think that he’d change much of anything to his lifestyle. He is already on a mortgaged lifestyle. A pretax increase of $100,000 in income may only mean another $55,000 of post-tax take at the higher federal and state marginal tax brackets. This welcome addition might mean additional frivolous purchases in someone with already frivolous spending habits. Nothing else.

The ultra spender can pick up one of these the first year she has a salary bump.

The ultra-saver

I think that most financial bloggers out there are in this camp. The debt-adverse, ultra-saving, crazy bunch prefers to stash away everything towards retirement. This camp of doctors were frugal during medical school, residency, and are still living the conservative lifestyle. These guys just like watching their Personal Capital accounts build up, gloat when their investment accounts actually increase after several years of retirement with 4% spending, and take extended month-long family vacations since they are not beholden to any boss after retirement.

You could imagine that a windfall of an extra $100,000 might not impact the habits of this camp either. This extra income is going straight to the bank or index fund of the ultra saver. Give it some ten years, and the bank of ultra-saver will have an extra $1,000,000. If invested prudently, this additional income can shave off a few years of your working career, or fund some great charities. Either way, the lifestyle of the ultra-saver doctor isn’t going to change with a salary bump of $100,000.

I wished that I could be in this camp, but I’ve unfortunately been tainted with a moderate desire for materialism, overpriced foods, and luxury. ?

Ultra savers log into their Personal Capital accounts several times a day!

The average middle of the pack doctor

Most doctors are in this boat. They have a higher-than-average income compared to the rest of society, but they aren’t in the ultra-celebrity net worth range. A salary bump will likely have an immediately positive impact on her lifestyle. It can be used to pay down some student loan debt, contribute to a mortgage downpayment, or fund a well-deserved vacation.

An extra $100,000 income can be used as a temporary patch for an immediate need. After a few years, your lifestyle will either transition to a higher baseline, but it’s unlikely to make a significant impact on happiness, lifestyle, or your hobbies. There will be a new steady state, but the steady state will still be in the same tier as the doctor of ten years prior.

The percentage change in income is what counts.

In all three scenarios, an increase of income didn’t really change much of anything. For the average doctor, a $100,000 salary income could represent anywhere between a 10% increase in income to a whopping 100% increase in income (I do feel sorry for those doctors out of training who slave at a $100,000 income). Either way it’s not enough to quit your day job. How much would it have to change to make a meaningful difference? 500%? 1000%? Either way, most doctors aren’t going to reach that level of change.

To this end, doctors need to realize that any narrow range of income that they may fall under may not necessarily impact their lifestyle in a significant way. A Hospitalist can double her shifts to bump up her income from $200,000 to $400,000, but working harder would be best suited if there was a goal in mind. Do you want to retire earlier? Do you want to buy a nice stove? Is it worth the stress of putting in the extra shifts? Figure these questions out, and you’ll be a happier person.

How much of a salary change would it take to change your lifestyle?

(Photos courtesy of Flickr)

Springing some positive attitude our surroundings

Posted on March 12, 2017January 30, 2021 by SmartMoneyMD

Whew! This year has gone by quickly. It’s already time to move our clocks ahead and “lose” an hour. I’ve taken many hours recently reflecting on our accomplishments at the workplace, in life, and in my colleague’s lives. It’s easy to keep trucking along going at full pace, but in order to maintain a healthy balance we really have to remind ourselves of our accomplishments and goals.

How have the New Year’s Resolutions progressed?

Well, it’s very easy to meet all of your resolutions if you had none to begin with, right? I came into the year without having many defined goals outlined other than staying sane in the workplace, tracking my finances more accurately, and come up with good content that my readers would want to see. Let’s take a look at each one:

Sanity in the workplace

Everyone has stress at work, whether you are a bartender, IT professional, or neurosurgeon. We deal with stress in different ways, and as doctors, I think that we generally do a good job of handling stressful situations. That’s our job.

Eating cake every day to stay positive would NOT be a long-term solution for stress reduction!

Now in the medical profession, there is no single cowboy or hero that can solve all of the problems. We work as a team. It doesn’t matter if you are the only person in the ICU who can intubate someone and interpret blood gas levels. If you have four patients crashing at the same time, you are beholden to all of those around you to help keep the ship afloat. If you are the Intensivist and the most qualified person in the ICU, you need to delegate, teach, and positively enforce good behavior among all of those around you.

That is not easy.

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I would hope that all of us strive for self improvement. These goals don’t have to be lofty and earth-changing. In an ideal world, all of our colleagues should share the same vision. Reality, I have learned over and over, is never the case. I work with a technician who has had over twenty years of experience in my profession, but is relatively fixed in his routine. Whenever there are tasks that build up throughout the day that require organization, things fall through the cracks. If Patient Y calls in a 9am with a question about her lab results and Dr. X calls in at 10am for a consultation, there is a high possibility that neither task gets completed. It appears that no amount of coaching over two years had made much of a dent in any improvement. He claims that with a stressful workday, it is difficult to remember everything that comes in.

Is this type of deficit correctable? Is this technician actually trying to improve himself? Or am I, the doctor, simply expecting too much? In our profession, it is not possible to outline every single expectation for an employee in a manual, so should this technician be expected to remember to complete tasks that come in?

What if I, as a surgeon, don’t always remember to tie off the veins before I resect them? If a bad outcome occurs, you’d better believe some legal person will be knocking down my door!

No matter what pace those around us actually improve, I have constantly reminded myself to present each situation positively to others. It makes for an overall more positive work experience.

Positive attitude in tracking finances

Most financial bloggers out there just love money. They love spreadsheets, and can pull out their monthly expenses for the past five years. I sense some OCD in this department. I prefer to reserve my OCD tendencies in making sure my surgeries go well. It doesn’t leave much left to tracking all of my receipts.

However, I have started tracking my expenditures by cataloguing them on a spreadsheet. Some of my numbers are tracked on Personal Capital, but I use gift cards for many purchases so many of my expenditures have to be tracked manually. I am happy to say that I will soon be able to post my results! No, I’m not going to have amazing savings like other money bloggers out there—I just spent $40 on a lunch for a restaurant week outing! But I hope that my numbers will give some motivation for those still pulling out of debt that you don’t have to eat instant cup ramen (Not the fresh stuff from Japan either) to get a positive net worth.

Positive content

This part is for you, my readers. I am grateful for the support of the online community and the readership for helping unite the physician and professional community. I want some feedback. What do you want to see? What do you want to learn? Should we have some guest posts here? Do you want more DIY tutorials unrelated to medicine or money? One of the most popular articles on this website is the guide to changing the headlight bulbs on a Subaru!

Comment below, or send me an e-mail on the website!

Thanks again for your support this year!

(Photo courtesy of Flickr)