Category: lifestyle

Becoming a rich doctor: having the winning mindset.

mindset of a rich doctorI don’t have a bone with pick with the wealthy, but wealth can help you and your heirs get ahead in life.  Tennis lessons. Music tutors. Private schools with other like-minded peers. Connections that can get you into high places. Wealth is not a bad thing.

 

Most physicians in the United States are considered “wealthy” too. Not Sultan-of-Brunei wealthy, but comfortable-upper-middle-class wealthy. We have a relatively good earning potential despite the length of training we incur.  Despite the similarly long number of years we spend perfecting our trade, there is still a wide income range across medical specialties. Some doctors will definitely become “wealthy” faster than others.

I previously wrote about becoming a rich doctor through building a strong offense through multiple income sources. I think that these remain strong tenants in maximizing our worth, but the appropriate mindset allows you to keep what you earn and build your wealth through passive means.

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A winning mindset to wealth should include retention of wealth.

 

You keep what you don’t spend. This is part one of the winning mindset. Whatever you retain can be used to work for you. Your army of millions of pennies can be put to work with almost no effort in an interest bearing fund. If you want more potential for reward with higher risk, use a P2P lending mechanism or simply the index market. If you want to  manage your financial minions actively, you can invest in other means like real estate. No matter what you do, you still need to be able to retain that wealth to grow for you.

Understand what you really need to be happy.

 

We all have material desires to a certain degree. The goal in wealth accumulation and financial freedom is not to restrict these desires, but to actually assess what we actually need. Having that nice $120,000 AMG in the garage does you no good if you only drive it on the weekend and still pay thousands of dollars a year for maintenance. Could you have done without it, and turned that $120,000 into $240,000 in 7 years?

I see plenty of wealthy people, especially doctors and lawyers, who seem unhappy. Are they unhappy that their jobs consume so much of their life but they are loathe to quit because it pays so well? Are they unhappy that the other partners in their practice make so much more money than they do? Are they just unhappy people?

Clearly the lack of money is unlikely the cause of their unhappiness. This is a situation that you don’t want to get yourself into. Most of us really have never thought about what actually makes us happy. It doesn’t really matter either if you’re a hotshot neurosurgeon or a physician’s assistant—if you don’t really have a strong grasp on your needs, you will spend down your income and risk being unhappy in the process.

How to figure out your key to happiness.

 

What do you actually need to get you through the day? Does that daily Starbucks coffee actually make you happy, or does that just get you through a 10-hour workday? Would you be happier if you got to ride your bike to work everyday? Do you prefer to spend your day tending to your garden? Typically that core set of needs will not cost you millions. MMM is able to pare down his family spendings down to $25,000 a year. Where is your number?

What is your magic list of happiness?

(Photo courtesy of Flickr)

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How Mustachian can a Doctor Be?

how mustacian can a doctor beOne of the guest speakers at this year’s World Domination Summit, was Pete Adeny, of Mr. Money Mustache fame. You can watch the talk online, but MMM essentially summaries his venture into reducing the excesses of life and how it allowed him to transition to early retirement around the same age I finally finished my fellowship training and started my career.

I’ve been a longstanding reader of his online ramblings, and have admired his willingness to carve out his own path off the typical career trajectory that most of us go through. It is also amazing that his trailblazing career decision has gathered a significant following online. Mustachianism, as his “followers” call the mindset, has been an inspiration for me to take a step back and analyze what is important in my life and what I actually need to have to be happy.

 

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I didn’t really consider that this approach to life actually works for doctors until I saw other like-minded physicians like White Coat Investor (WCI) and Physician on Fire (POF) cropping up in the online world. These guys live a frugal approach to life just like MMM. Great! You CAN be a high-income physician and still be practical!

 

Is that really true?

 

I began to wonder where the average doctor falls in the spectrum of luxury, and where I fall in this spectrum. Can this work for all physicians living anywhere in the country? Doctors like WCI and POF live in Utah and the Midwest, respectively. I grew up in the back woods of the Midwest, and I’d agree that these areas constitute the bulk of what it means to live in the U.S.

 

Middle class America.

Down to earth folks who you’d say “hi” do when you see them walking down the road.

 

How does Mustachianism and frugal living apply to doctors living on the coasts?

Does this belief and lifestyle work for a doctor trying to live in California, New York City, or Boston? There is a different mentality in these areas. I hate to generalize, but we have a more materialistic life in New York City than in Milwaukee. It takes a lot more convincing of someone living in Boston to save 50% of her income than her counterpart in Indiana due to external pressures (cost of living, high-end foods, general habits of your peers) in Boston.

In medicine, there is a term coined, “herd immunity”, which means that if enough of a population is immune to a certain condition (immunized), it essentially can provide protection to those who aren’t immune simply by numbers.

In financial terms, I’d call this “herd susceptibility”. If the bulk of your doctor friends in Manhattan wear Louboutin’s or Tory Burch’s, you might look like a pariah if you wear a pair of Xhiliration flats (Target brand) as a Gastroenterologist.

I’m all for driving a normal car, avoiding yearly $3000 a night safari vacations in Tanzania, or cooking your own dinner, but you most likely are expected to have a baseline appearance and level of living as a doctor. This baseline expectation is higher in Manhattan than in Memphis. Who wants a hobo as their doctor?

You would need to have a higher level of financial discipline working in the metropolitan areas. It can clearly be done, as there are plenty of MMM followers who live in NYC and Boston. As a doctor, you have to be extra motivated to live in a modest apartment, seek out like-minded peers, and desensitize yourself from you coworkers who frequent the Michellin-starred restaurants on the weeknights.

 

Some medical professions are more conducive to Mustachianism.

Some physicians work in outpatient clinics while others work in the hospital. Some of us see patients essentially only once and hopefully never again (Emergency Room physicians, Hospitalists, Anesthesiologists). Some of us never see patients (pathologists and radiologists). Some of us take care of patients for our entire career and see them every year (primary care, dermatologists, internists, ophthalmologists).

The frequency and duration of interaction with the patient determines the level of expectation from the patient of the doctor.

Let me explain.

For example, Emergency Room physicians take care of the acutely ill. The majority of these doctors wear scrubs to work or other clothing that they don’t mind soaking up the smell of vomit in the middle of the night. Their patients are sick and probably don’t care what car this doctor owns, what clothing she wears, or whether that is the latest Apple Watch on her arm. You can be driving an $80,000 Tesla or a $20 bike to work and no one will care.

In contrast, Plastic surgeons are most likely well-dressed, and their patients expect them to have a higher “expenditure for appearance”. How would you feel if your plastic surgeon drove a 12 year old Honda Civic and wore Tevas?

The disconnect is that an ER physician earning $400,000 a year living in Memphis will be more likely to reach financial independence earlier than a plastic surgeon earning $500,000 in the Upper East Side.

Ironic, isn’t it?

Who would have thought that it might be harder to save your money if you became a plastic surgeon or dermatologist than an Emergency Room doctor, even though your earning potential might be higher as a plastic surgeon?

How would you guys approach this conundrum?

 

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[Photo courtesy of of Flickr]

Why doctors need to be financially independent

Most people would want to become financially independent, but some of us want to be financially independent (FI) much earlier in life. There are plenty of reasons (including some very obvious ones) why anyone would want FI, but I’ve seen one consistent theme over the years regarding FI:

Work is more enjoyable if money is not a factor. 

I’ve wavered on this conclusion for years, and no matter how much I try to dismiss this notion, it keeps recurring. I see the most blatant of this in the doctors in my clinic. Many doctors gripe about having to see more patients. Often the finances dictate that in order to remain net neutral, a physician needs to see one more patient. Sometimes, it’s one more patient per day. Other times, it’s one more patient every other day. Is seeing one additional patient per day or week too onerous? Perhaps, but the interestingly, the doctors that fight the most about seeing one more patient often spend their weekends or vacations volunteering at free clinics!

How ironic is that?

 

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How can one logically refuse to see one more patient in a day of clinic yet be willing to spend an entire day doing the same thing pro bono?

Humans are illogical. I know doctors who come from significant levels of inherited wealth (read: several generations-worth of extreme wealth) who work at academic institutions at salaries in the tenth percentile of the expected norm. Frankly, I’ve never asked them why they do this, but my impression is that this particular type of job is absolutely rewarding for reasons other than financially. Kudos to them that they didn’t have to rack up over $148,000 in medical school debt.

With FI, you can always walk away 

Sometimes patient care is stressful. Sometimes the administrative aspects of medicine are stressful. Administration and insurance companies are the two aspects of medicine that I hate the most. Sometimes these are the factors that cause doctors to quit or retire.

If you are not working for the money, you can walk away from a bad practice situation without worrying about feeding your family. You could find other career options elsewhere without having to clamp down your finances. Hell, even if you don’t leave a bad practice situation, FI might allow you not to care so much about the small stuff.

Life is just better if your livelihood doesn’t depend on your day job. Period.

 life_is_better_without_money

Why would a doctor even want to retire early?  

The general population of doctors really do balk at the notion of early retirement. Why? We leave a relatively high income on the table by not working. A significant amount of our life is spent training to achieve our unique skill set. It would be a waste to curtail a potentially 25-30 year working career to do something else, especially if you had taken up a valuable medical school and residency spot from someone else who would have otherwise worked for thirty years.

The truth is that the goal of financial independence is not to quit early—it’s to allow yourself the option of not having to your job dictate your life. The premise of FI is that you can choose to do whatever the hell you wanted and still have enough to feed your family, take reasonable vacations and trips, and stay healthy and happy. It doesn’t mean that you take excessive luxury vacations every month.

For a doctor, this means that you can spend more time taking care of your patients, taking care of your family, and taking care of yourself. Most doctors I know actually like what they do.

What are you doing to get closer to FI?

 

Photo courtesy of Flickr.

How much net worth should be put into your house?

net worth homeGiven the easy access to credit that we have in the United States, it is easy to purchase a house that commands several times your salary. Physicians are prime customers for lenders, as we are low-risk clients who have high earning potential and stable jobs. Easy access to credit is also a curse for us, since it is incredibly easy to overextend our earning potential to buy a McMansion.

 

Consider your home as a stable asset.

Those who encourage us to maximize the amount of our net worth into our primary home (not just real estate) really seem to argue that our home is a stable asset. A house is unlikely to lose its value overnight. Even if it burns down or gets wiped out by a hurricane (assuming you have hurricane insurance), you can recover a large portion of the loss through insurance. We need a place to live anyway, so keeping part of your assets under your roof is a logical approach, right? If you need to withdraw cash out of your property, you can obtain a home equity line of credit (HELOC). Your home provides you with an additional “bucket” to store your wealth.

 

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How liquid is a home asset?

While you can withdraw your assets in your home from HELOCs and reverse mortgages, it may only be practical for one-time uncommon large-ticket purchases. It’s not like you can cash out your home to pay for hospital bills and a new car to move into an RV without having to sell your home outright. You can withdraw equity in the home relatively quickly, but you can’t unload it completely without selling it. And as we all know, you can’t force your home to be sold. What if you ended up getting a new job in a new city? Many doctors change jobs after purchasing a new home and end up having to pay a mortgage for a house that they can’t even enjoy.

The liquidity of homes are highly variable, even within the same market. Homes in the Bay Area move like hotcakes—I have a friend who sold his house in Burlingame, CA within a week after listing. Other homes in San Francisco can be sold before hitting the market. In contrast, higher priced homes (>$500,000) in second and third tier markets can sit for years before being sold. One of my friends in Iowa has had his $550,000 home in a Grade A school district sit on the market for over a year without any buyer interest, but another friend whose $600,000 updated home in a Grade B- school district in the same city sell within a few weeks.

What I’ve concluded so far is that you can’t rely on your home to be much of any asset. You have to get lucky and sell it quickly (preferably cash deal) in order to withdraw all of your equity in it.

 

How do I approach home ownership in terms of net worth?

Because of relatively instability in where we live and how our primary jobs turn out, I don’t consider a primary home an investment, only a luxury. While I am building equity while paying down my mortgage, I have not seen much of a tax benefit yet from tax deductions yet. Additionally, the cost of owning a home for me has been significantly higher than renting. I have to deal with broken fixtures, lawn work, and regular upkeep costs that I would not have had to worry about in a rental.

Ultimately once I own my property outright, I can breathe easier about the rest of the expenses. I do not reside in a highly competitive real estate market, so I do not expect my property value to rise significantly if I decide to sell and move out.

Do you intend to keep any part of your net worth in your primary residence?

 

(Photo courtesy of Flickr)

Common Expenses Incurred by non-Financially Independent Doctors

lifestyle inflation methodsThrough observation of myself, my colleagues, and reports from other physicians through the grapevine, I’ve compiled a list of examples of lifestyle inflation that occurs among professionals who ultimately grow into their incomes. Some are modest. Others, not so much. What large expenditures have you witnessed or are actually guilty of in your growing lifestyle?

  • Purchase of a large television. This is not uncommon, especially with “curved” TVs, super-hi def LEDs, surround sound systems, and home theater systems. Costs can range from $4999 for a “modest” flat LED set to $20,000 for a home theater with reclining movie theater seats and surround sound projector system.
  • Fancy car. This is also not uncommon. It seems like every other new residency/fellowship grad springs for a new set of wheels. I actually have a tough time assessing whether this lifestyle inflation is simply due to a sudden increase in income or longstanding family money that they were hesitant to flaunt during training. I was shocked to see one of my cardiology friends spring for an $125,000 Mercedes AMG within a month out of fellowship, but I suppose that his income can still support the car through a lease. Cars I’ve seen out of training include an $80,000 Tesla Model S and a used Lambo (no idea how much that would cost).
  • Increased restaurant tabs. Again, a common finding among everyone I know. Weekly $20 beer tabs (alcohol only) grow to $50 a week, along with eating out for lunch every day, and Michelin star restaurants on a regular basis. There is probably some satisfaction in building a refined taste in food, but that easily can grow your waist as well.
  • Fancier grocery purchases. It starts from eating store-brand yogurt in medical school to Fage in residency, to Noosa as an attending. Waist inflation will come with eating Whole Foods $24.99/lb salmon and $49.99/lb special grocery store porterhouses.
  • Fancy furniture for a fancy home. You can really go crazy in this category. Think interior designer mandated custom dining rooms with marble-top formal dining tables with chairs starting at $2000 apiece. Lawn design with feng shui elements that cost $60,000.
  • Upgraded work and formal attire. Add in a couple pairs of Loubutin’s, several sets of $300 work outfits, fine jewelry, custom dress shirts and suits, and you’ve got a money pit in your wardrobe. Worst yet, these costs are easily recurring as you cycle through new outfits.
  • Upgraded outfits for your kids. Children’s clothing is big business, especially at the age where kids will easily outgrow their clothing. A hip outfit including a baseball cap, t-shirt, shorts, socks, and shoes from Under Armour for your 5-year old can easily run you $200! Don’t worry, he’ll outgrow it after a year or even sooner when he gets new clothing a few weeks later.

These expenses actually aren’t morally reprehensible if you actually have a self-propagating bankroll to fund it, but I find it hard to imagine that any of these expenses translate into true happiness.

What other lifestyle inflation examples have you experienced?

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(Photo courtesy of Flickr)

Are LED bulbs worth the cost?

are led bulbs worth costAs part of my cost saving habits, I started looking into changing out my lightbulbs to LEDs, since I’ve read that they are more akin to incandescent bulbs in tones yet are as energy efficient (or more) than CFLs. Many of the local hardware stores also have rebates subsidized by the local utility companies (maybe they have governmental subsidies as well?).

Many of my fixtures are already using old CFLs from years ago—they take about 30 seconds before becoming sufficiently useful. I’ve found that with my short amount of patience even thirty seconds can irritate me. Moreover, none of my CFLs support dimmer switches. I still have a few residual incandescent bulbs for those fixtures.

Let’s look at the energy consumption of the three bulbs:

Incandescent CFL LED
Power consumption 60W 14W 10W
Initial cost free (already using) free (already using) or $2 $4
Energy cost $0.12/kwh $0.12/kwh $0.12/kwh
Extra hours of use needed to equate cost of Incandescent 4.3x + $2 (cost of new bulb) 6x + $4 (cost of new bulb)

If you look at the extra number of hours of use needed to justify the cost savings, there is no way that any energy-saving bulb is worth the cost. Sure, incandescent bulbs blow out and you have to replace them yearly, but most of us have boxes of them in storage.

CFL vs LED Bulbs

I do see the merit of having LED over CFL bulbs if you are choosing between the two. In my experience, LED bulbs only cost marginally more than CFL bulbs. However, CFL bulbs have two major downsides:

(1) Most of them do not work with dimmer switches.

(2) It takes much longer for a CFL to “warm” up and become bright. Usage for short periods of time actually decrease longevity of the bulb.

If you already are using CFLs, the energy savings difference seen in switching to an LED is negligible. The cost LEDs, while much lower than they were several years ago, still lags behind that of CFLs. It would take several years of extended use to replace a CFL in use with an LED.

What bulbs did I switch?

My pre-existing fixtures with incandescent bulbs on dimmer switches were all switched to LEDs. Costco was selling 60W equivalent LED flood bulbs for $2.49 apiece. I use these lights approximately 3-4 hours a day in the kitchen, and more on the weekends. The rest of my CFLs remained CFLs. I saw no need to replace them since they were already energy saving.

How much of your home is powered using LED bulbs?

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(Photo courtesy of Flickr)

Reasons why you want to be financially independent

financial independenceThose who are financially independent justify their desire to be free from their daily grind. This grind supposedly allows us to earn enough to retire on and enjoy our decades of hard work. In a way, it does seem ironic that we spend the majority of our lives working towards sustaining our existence for the last few decades of our life.

I started to reflect on why I go to work every day (other than that I like practicing medicine), and the ways that a full-time job negatively impacts my life.

Health

Just as how conferences are bad for your health, working through the daily grind can also be bad for your health. My consumption of junk food increases while my exercise frequency decreases during a busy work week. I am unfortunately in a field where I still have to deal with patient and administrative care outside of the normal working hours. Even though my working hours are relatively sane, the work does carry over into my personal time. I certainly experience the typical aches and pains after a long day/week of work. The most common ailments that I hear about include musculoskeletal pain (upper and lower back pain) from over working. The likely result of over working, lack of exercise, and poor dietary habits is increased heart disease, obesity, and poor health. Is that what you want to have after 30 years of hard work?

Stress from work

Along with physical health ailments from the daily grind, there is a level of stress involved. My dentist tells me that he notices that I have evidence of teeth grinding (bruxism) on my molars? Grinding? Me? No way! The truth is that there are issues that probably linger subconsciously and cause stress in ways that I don’t visibly perceive. If I didn’t subject myself to this daily torture, would I grind my teeth less? Probably.

Stress from bills 

Bills suck. Utilities, internet, cable, phone bills, car payments, mortgages, credit card bills, and various cash bills all dig into our bank accounts. Most of us keep our day jobs in order to afford these luxuries. Whether we are aware, these expenses contribute to our anxiety. I curse my internet provider every time they increase the rates. Sure, you can threaten to cancel your service, but how much of your time can you waste waiting on the phone dealing with customer service trying to talk you into upgrading your service? My blood surely boils when that happens.

 

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Decreased time with other activities 

If you’re working, that means that you aren’t at your kids’ baseball games. For that matter, any time that you are at work or dealing with work-related issues, you probably aren’t doing anything that you would other be doing, whether it’s reading a book, shopping, research, or exercising.

I consider the luxury of time to be a good motivator to strive for financial independence. The more time I want outside of my normal job, more I should aim to become financially independent. Am I there yet? Not even close. Will I get there? Absolutely.

Financial independence affords you the time to do what makes you happy. If happiness involves working at your normal job, then consider yourself lucky. For everyone else, stick with your financial plan

(Photo courtesy of Flickr)