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Being a Doctor Could be A Guaranteed Way To Have A Stable Job

Posted on June 18, 2016January 30, 2021 by SmartMoneyMD

being a doctor could be a guaranteed way to have a stable job Ever since I started working harder to build my medical practice, I’ve found it more challenging to stay up to date in the digital world. I end up coming home tired, cranky, and famished on days that I don’t take the time to eat appropriately. I stand by my opinion that just as medical conferences are bad for your health, so is working too hard at your job.

I finally was able to catch up on one podcast in the car along the way between meetings by Joshua Sheats, of Radical Personal Finance fame. In the latest episode, Joshua debates the merits of being a doctor with Peter Steinberg, a urologist at Beth Israel in Boston.

Thought provoking discussions, I might say.

I haven’t followed the entire podcasts of Radical Personal Finance from the beginning, but I take it that Joshua (who is not a doctor) believes that becoming a doctor is not worth the cost.

I absolutely agree with Joshua.

To summarize, there is a huge cost in becoming a doctor: time, increased risk, sacrifice of financial growth through compound interest, and sacrifice of talent that could be used in other careers. I agree, to become a family physician or an ER doctor, you need to invest eleven years in your training. You’d be lucky to get a job earning $200,000 as a family physician. We practice in a risky field. Doctors get sued. Patients can and will have bad outcomes. We are more than 10 years behind our peers financially. Our job is hard. In the podcast, Joshua makes an analogy that a plumber can achieve financial independence by starting out early while apprenticing in grade and high school. This hypothetical plumber can earn $100,000 a year around age 20. Additionally, he’ll also learn the value of small business, tax laws, and common sense by working for himself. By age 30, he will have becoming financially independent and be able to do whatever he wants.

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Dr. Sternberg argued that despite the long years and hard work, being a doctor guarantees that you will be employable, have a high income, and have a meaningfully long career since most medical practice is not as taxing as, for example, being a laborer. More importantly, the plumber example that Joshua gave was extreme. What kind of plumber has his act together enough to map out his future starting at age 15? The average vocational worker may not necessarily have the organizational and foresight to become this successful. True.

How successful can a doctor who knows how to plumb be?

Fortunately for these guys, Smart Money MD is a board-certified doctor AND handy with plumbing. I’ve written about cleaning lime deposits from your toilet bowl, maintenance for Kohler toilets, and changing the flush valve in the Mansfield toilet. Plumbing is dirty work, but you can definitely command a high hourly rate. I would not be surprised that plumbers who run a moderately successful business have higher net worths than more doctors up until their early-mid 50’s.

Would I have been successful as a full-time plumber? Most likely. Would I have had a higher net worth as a plumber than I do now as a doctor? Definitely for now. Based on what I earn and the number of years I spent in training I’d need a total of 15 years after fellowship to catch up even with aggressive saving. Of course as a doctor, I’m obligated to have higher living expenses.

I agree with Dr. Steinberg that not all doctors are capable of having any other jobs. Most doctors I know majored in Biology, Chemistry, or other non-vocational subjects that would otherwise condemn them to an income range between $60,000 and perhaps $120,000 (if they’re lucky). Some doctors may not have had the exposure growing up to realize that one can earn a comfortable living as an electrician or plumber.

Where I do disagree with Dr. Steinberg is that not all doctors actually would be better off financially as doctors. Think of the lower income physicians. These doctors’ income ranges are very close to that of many vocational specialties. Some of them choose these specialties because they are misinformed, unsure what they want to do with their lives (more common than you’d think), or ideally because they like it. There are likely more lower income physicians than the higher income ones. The argument for being a doctor is also easier if you are one of those high income doctors (likely urologists!).

Would I have become a doctor? It depends on what I would have been otherwise. Software developer? I would have been equally or more challenged as a software developer. A plumber? I probably would not be as happy if I were a plumber, mainly because I am not sure that it is as intellectually stimulating as being a doctor. The grass is likely greener on the other side, but if I were a plumber, I’d probably wonder what life would be like if I were a doctor…

Fortunately I already am a doctor, so I’d have some more flexibility becoming a plumber if I really wanted…

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(Photo courtesy of Flickr)

How Shark Tank Makes You A Better Doctor

Posted on June 5, 2016 by SmartMoneyMD

shark tank will make you a better doctor I like watching the business ideas pitched on Shark Tank. In this weekly show, aspiring entrepreneurs pitch their services and products to wealthy investors. Not only do I feel inspired by the entrepreneurs while watching their pitch, but I also learn about the thought processes of successful businessmen (women).

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“You’re dead to me.”

Kevin O’Leary, one of the investors, has a demeaning quip whenever the potential investment opportunity is no longer viable to to him. It sounds horrible, but it is an effective approach to running a business. You can’t take things personally in business. What are your goals? Do you plan to make friends or run a profitable endeavor? Don’t expect that you’d be able to run a successful business AND run a profitable business all the time? The last thing you want is to dwell on issues either out of your control or not in keeping with the plan.

This mentality also works in medicine. We are bombarded with information overload—an excessive number of clinical patients, excessive e-mails, and hiring/firing of staff. Prioritize and only sweat the details that you have control over. Even those issues under our direction need to be prioritized. I’m not a big fan of last-minute decision making, but trying to do everything at once is also a recipe for disaster.

Set your plan. Automate, and reassess frequently.

Learn to Hustle

Successful entrepreneurs hustle. They work out of a corner of their living room or build their businesses out of their garage. They eat and sleep their work. Some of them put their families’ livelihood on the line. As a doctor with a stable income, you probably don’t need to be so extreme, but hopefully you understand that there is a correlation between hard work and success.

You will be more productive in your work if you hustle. It may be more stressful, but remember that you are always compensated at a rate that is dictated by efficiency. I have seen plenty of Internists spend an extra 2-3 hours closing notes and following up lab work after they’ve signed out. This is mostly a problem with our healthcare system, but we still have to adapt. How can you function during your work day more efficiently so that you don’t have excess work to deal with after hours? Are you able to take a short lunch break? What about following up on labs in between patients and consults? If you are a dermatologist seeing fifty patients a day, can you get a scribe?

Hustle while you are at work. You might need to do it for a few years, but no matter how much you work, you probably still have a better lifestyle than you did while you were in training. After you hit your financial goals, you can cut back.

What characteristics of an entrepreneur do you mimic?

(Photo courtesy of Flickr).

The Daily life of a Moh’s surgeon

Posted on May 6, 2016February 2, 2021 by SmartMoneyMD

daily life mohs surgeon Moh’s surgeons typically focus their careers on removal of cancers on the skin. They are dermatologists by training, but have completed a fellowship (often lasting one year) on microscopic removal of cancerous lesions. The Moh’s fellowship society tends to limit the number of trainees in their field for various reasons, so availability is scarce. Competition into the field is fierce, since there are already a limited number of dermatology spots and only a handful of Moh’s fellowship positions yearly.

Daily practice

Full-time clinical Moh’s surgeons are either in the office or in the procedure room on most days. Clinical days are spent seeing referrals for skin lesion removals. Most of these referrals come from dermatologists or internists. I would say that a high number of referrals end up requiring surgery. The clinical volume of a Moh’s surgeon runs around 20+ patients a day. This is significantly less than what a general dermatologist will see.

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Surgery days (or half days) are spent removing skin lesions, waiting for histology to assess clean margins (if possible), and closing up the skin lesions. These procedures are tedious, but the RVUs generated are very high. Very busy Moh’s surgeons can have 8-10 procedures a day.

The overall lifestyle of this profession is relatively good. There are very few emergencies. Most of the procedures are planned. Many Moh’s surgeons can structure a 4-day workweek, simply because there are sometimes limited number of cases that need to be performed and revenue rate per procedure is very high. Some Moh’s surgeons starting out in their practice will also see general dermatological cases.

Income generation

Many starting salaries for Moh’s surgeons being around $300,000. I’ve seen salaries around $250,000 in highly competitive markets. A well-established Moh’s surgeon who also owns a histology department can earn serious amounts of money. I once met a Moh’s surgeon who worked 4 days a week and took 2 months of vacation per year tell me that she made approximately $1.5 million (pretax)!

The ability of a Moh’s surgeon to generate high income comes from multiple revenue sources. The professional fees for the surgery itself are relatively high given the complexity of the procedure. However, I would estimate that the revenue stream coming from a histology lab (charges insurance for analysis) would more than double the income of an efficient surgeon.

Conclusion

Sounds great being a Moh’s surgeon, right? The truth is that there are still stresses with the job. You are mostly dealing with cancer. There is limited room for mistakes given that clinical management will change depending on surgical outcome.

Would you want to be a Moh’s surgeon?

(Photo courtesy of Flickr)

Having insurance doesn’t mean healthcare is free

Posted on April 3, 2016April 1, 2016 by SmartMoneyMD

One of my pet peeves is simply the complex healthcare system that I knowingly work in. Hypocritical, yes. What is unfortunate and frustrating is that the majority of our patients don’t really understand how the system works, and assume that doctors are making a killing off of the healthcare system. Doctors, too, are mostly unaware of how the healthcare system works. If doctors knew exactly how the system worked and learned to save their earnings, then there wouldn’t be as much of a need for physician financial education. Case in point:

The bill that your insurance company mails you does not reflect your doctor’s income.

This is the number one deceit. Your patient sees you in the office, and the insurance company sends her a statement of performed procedures and charges made. The charges on the bill absolutely do NOT indicate the amount that your doctor receives from the insurance company. In fact, I have had instances where the insurance company actually denied my claims, sent my patient a billing statement of charges, and have a patient comment on “how much I made on her 25 minute patient visit”. Disgusting. I didn’t even get paid for taking care of a patient, and my patient thinks I got paid a ton for her visit. So much for altruism.

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The copay also does not reflect how much a doctor is paid.

Another one of my patients commented that her copay went up to $50 per visit from last year, and that she hopes that “I am getting a good raise” now that I’ve raised my copayment charges. Score one for the insurance carriers. They’ve successfully convinced the public that higher copays equate to more money to the doctors.

Having health insurance doesn’t mean that you never have to pay for care.

A common patient complaint I receive is that they are upset that the insurance company did not pay for all of the care. That is the definition of a deductible! One of my colleagues complained to me that one of his patients basically received a free knee replacement because he refused to pay for any of the deductible for the surgery, and was not willing to pay for any of the postoperative medications. My colleague still had to see the patient for all of the postoperative care. It was okay, because the patient was sporting a new Apple Watch and iPad Pro in the waiting room.

You can still win the lifestyle and financial game even in medicine.

Despite the skepticism and cynicism with how broken our healthcare system is, we can still win the game. Remember, we entered this profession to care for patients. No matter how misguided our patients are with how the healthcare system works, we can still deliver great care to them and earn a decent living out of it. Here’s how to do it:

Win the lifestyle game. Find a way to carve out a four-day workweek. Maximize your productivity while you are at the hospital, and minimize the amount of work that you take home. Know your value, and grow your value. Prevent your obsolescence to avoid getting fired.
Win the financial game. Save more than you earn. Hustle to increase your income. Learn to become a successful doctor. Generate your income stream and work hard.

What other strategies have your implemented to win the financial and lifestyle game?

(Photo courtesy of Ubi Desperare Nescio)

The Daily Life of a Family Practitioner

Posted on March 31, 2016February 7, 2021 by SmartMoneyMD

daily life family practitioner The family practitioner represents the stereotypical doctor—a generalist who helps maintain the well-being of people. This includes well-patient visits to upset stomachs to respiratory illnesses. Classically, these doctors also performed in-house visits before offices existed.

Daily Clinical Lifestyle

Family medicine physicians typically train for three years of residency after medical school. Afterward, clinical practice typically involves outpatient care. Hours worked are relatively reasonable in the 9am-5pm range, or 8am to 5pm five days a week. A family practitioner typically sees approximately 15-25 patients per day. Many of these are well-patient visits to sick visits. Illnesses treated include hypercholesterolemia, hypertension, diabetes, upper respiratory illnesses, sinusitis, and musculoskeletal issues.

Stress levels are relatively low, except for the occasional hospital-bound sick patient. Even then, most family practitioners opt not to have hospital privileges. In these cases, Hospitalists take care of inpatients and offer a buffer to a more sanitary lifestyle of an outpatient based family practitioner.

Documentation and increasing requirements for patient volume tend to be the common stressors in this field. Overall, the lifestyle of a family medicine practitioner is very manageable in the spectrum of physician specialties.

Concierge Medicine

One of the advantages of a family medical practice is that equipment needs are relatively low. This allows the doctor to have increased flexibility to perform exams both in the office and even at the patient’s residence. One possible venue to combat against the ever increasing number of clinic patients as governed by insurance companies is to care for patients on a per subscription basis. This allows patients to have more exclusive access to their doctor while allowing the doctor to personalize care to a smaller number of patients. Does this translate to a higher income? Likely, but the compromise is that the stakes will be higher and the clientele will likely be more demanding. Expect to see more family medicine doctors transitioning to concierge medicine in the future.

Perils of being a family practitioner.

Healthcare will always continue to become more complex. Increasing regulations, increasing number of administrators, and increasing healthcare costs will continue to squeeze all doctors. “Physician extenders” have become a more common term these days to describe adjunct nursing staff to assist with healthcare. Some of these physician assistant and nursing positions have frighteningly similar daily tasks as a family practitioner. Will the role of a family practitioner be obviated in the future? Who knows, but I would assume that there should be distinguishing between someone with a medical degree and that of everyone else.

Are you a family practitioner? Are there other aspects of your field that you would like to add?

(Photo courtesy of Flickr).

Can doctors lose their jobs? How to protect yourself from getting fired

Posted on February 26, 2016 by SmartMoneyMD

We went into the medical profession to heal others. One of the perks of spending a decade of your life training to become a doctor is that you are likely to have job stability. With aging baby boomers and simply an insufficient number of medical graduates, we are projected to have a huge physician shortage over the next 10 years. If that’s the case, then doctors will always be in demand, right?

Not necessarily so.

Can doctors get fired?

Absolutely. Aside from misconduct, doctors can definitely lose their jobs for the same reasons why any white-collar worker can lose his. Hospitalists are a common example. They are typically employed by a hospital or through a medical group contracted by a hospital. If the hospital decides to contract out their Hospitalists or terminate an existing contract, then doctors may be out of work. Hospital employed specialists can lose their jobs in a similar manner if a hospital decides to eliminate coverage of a particular field.

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Take necessary steps to prevent your obsolescence

Fortunately, you still have control over your future. You can take proactive measures to both ensure that you are indispensable for your organization and prepare yourself in the unlikely event that you do find yourself kicked to the curb.

Remember that everyone else is dispensable except for yourself. Suppose that your department is financially unstable. If the budget does not become neutral by the end of the year, the losses will come out of your salary. That is unacceptable. As the physician, you are the revenue generator. Find out where your funds are going towards and don’t be afraid to fire staff if you have to.
Make your hospital/practice need you. This boils down to knowing your value. What experience and skills do you offer to your organization? Is it your profound medical expertise or your leadership skills? If your organization no longer had you, would they crumble? Find out what your strengths that you bring to the table and make it known.
Make time to enrich your skill set. Read. Blog. Learn about your field. Learn about your organization, and figure out what you bring to the table.
Network. This includes physicians outside and within your organization. You have to be known, and understand what you can offer to others outside of your group.
Maintain contact with headhunters. You don’t have to actively solicit these recruiters if you have a relatively stable job, but definitely keep the doors open. You never know what options might present themselves and when you might need their assistance. Maintain contact with your colleagues in academia, and keep your skills sharp. Sign up for the mailing list for your society’s career bulletin.

Be mentally prepared if you are released.

If you are let go despite your best efforts, then you should already have your escape plan in development. You’ve engaged with your medical community, shown them your skills, and also kept in touch with other viable medical groups in your field where you could potential jump ship to. Job loss and job changes are psychologically taxing. If you have taken adequate precautions, any changes will be more palatable.

What lessons have you learned about job changes in medicine?

How a dysfunctional residency trained me to run a department

Posted on January 20, 2016 by SmartMoneyMD

Ideal jobs are rare. If you find one, you’d better do your best to keep it. Likewise, there are very few ideal residency programs. Everyone who I’ve spoken to has a list of reasons why their residency or fellowship program is the worst in the world. I get that. This is a painful time in our lives. My experience was no different. We encountered numerous inefficiencies in the department that hindered our education and experience. It wasn’t until several years later that I realized that this experience actually helped prepare me to run a department.

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There is often a silver lining in the midst of despair.

I had the unfortunate (or fortunate) opportunity of having to fire staff during residency. Not one, but two members who had been working at the hospital for over 15 years. Everyone knew that they were disruptive, but this impacted mostly the residents. Many generations of trainees had attempted to rid of the inefficient staff, but there was always a hurdle that prevented us from doing so. As transient workers in the hospital (residents and fellows), we knew that our pain was finite. Most trainees gave up after seeing the logistical nightmares in dealing with departmental protocol. If you worked with union employees, you are fighting against a brick wall. Let me tell you, it is nearly impossible to fire union workers.

Somehow my class succeeded. It took several years, hundreds of hours of documentation, and probably fifty hours of meetings, but we fired the deadweight and hired better staff. We left a better legacy for those after us and essentially forgot about the pain that we endured.

What I did not realize was that the process that we went through to discharge staff during residency is no different in any business or medical practice. I now run a department using those same skills that I honed during the painful years of residency.

The following is a list of core applicable principles that I discovered during residency that still apply to managing a practice:

Everything is political. Yelling, screaming, and demands never fly in the course of business.
Everything can be negotiated. It does not matter what the terms are. Life is not a multiple choice test.
Running a business boils down to profits and losses. If you don’t make a profit in a line of service, then you must correct that or risk going out of business.
Negotiate upon what your perceived value is. In this regard, you have to grow your value and prove that you deserve what you are asking for.
Expect to fail. If you don’t fail, then you won’t learn from your mistakes.

I can write a book about my mistakes (I might do just that!), but hopefully the principles above will serve as a good start for you to build yourself into a leader.

What other tips do you have to become a leader?