Smart Money MD

One 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]

Those 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)