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]

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16 thoughts on “How Mustachian can a Doctor Be?

  1. I like the “herd susceptibility” concept. I’ve never heard of those clothing brands you mentioned (I think that’s what they are) so I must be pretty well immune.

    I would never wear scrubs to or from work — that would defeat the purpose of them — but I wear jeans and tee shirts to and fro, changing into scrubs in the locker room. I ride a mountain bike to work half the year and a crappy car the rest. It suits me just fine, and I don’t feel any peer pressure to do any differently.

    Thanks for the mention!

    1. The apparel lineup mostly is for women, although I do believe that they sell men’s accessories as well. 😉

      How far is the bike ride to work, and do you commute during nighttime hours?

  2. I guess that’s another vote for Emergency Medicine!
    You make some excellent points. In addition, regardless of your city, I think each hospital also has its own culture that can influence your choice of car, home, and attire if you let it.
    I wonder what the WCI thinks of being called mustachian–he’s the first to tell you that he loves travel, boats, etc.

    1. Thanks for dropping by!

      Yes, I do believe that EM docs have a higher chance of sliding under the radar due to the inherent nature of the profession and also personality of the docs. WCI is quite Mustachian–his frugal habits during his earlier days were very conducive of building up a sizable nest egg. Only after he built up his ‘stache did his spending habits loosened up. Obviously, I’d probably do the same once I reach that level too.

  3. Wow I never thought about the unconscious bias that doctors would face. But you’re right if a plastic surgeon wasn’t driving a nice car, I might not think they were actually successful and actually a good doctor. This is obviously ridiculous thinking. Thanks for sharing a blind spot for me 🙂

    1. Some of this bias is subconscious, other parts are totally blatant. Most people don’t want a poorly dressed dermatologist giving them Botox or fillers, or an obese bariatric surgeon offering weight-loss surgery. No matter how you spin it, on average a radiologist, pathologist, or anesthesiologist would have a higher shot at reaching FIRE before a dermatologist would. That is life!

      Thanks for stopping by!

  4. I’m not in that world, but I think a big part of it is not worrying so much about what others think. If some semblance of status is necessary seems like a used Lexus would fit the bill as well as a brand new Tesla, so there are still smart $ decisions that can be made.

    1. I find that extended family can be strong negative influences on our psyche too! I agree with the used Lexus option. I might consider that in the future, although I am not a huge fan of having to fill up with premium gas. Cheap or mustachian? ;-P

      What car do you drive?

      1. I have a used Toy Tacoma 2WD, purchased when 2-years old. We did splurge a bit on my wife, she has a Toy Sequoia 2WD that we bought when it was also 2-years old. We did put a nice down on it and paid it off about 18-mos early. We have chains for the rare occasion when we go to the snow.

        1. Toyotas seem to be very nicely built cars. I remember passing through the Sequoia factory out in Indiana during a road trip. That being said, I was shocked to see that one guy’s F450 cost $60k! Didn’t realize that trucks could go for that much.

          What sort of weather would be needed to place chains on a Sequoia?

          1. Snow storm at 7000′. We live near Sacramento and went to Tahoe in January. The normal drive took twice as long. Only 4WD and AWD vehicles didn’t require chains. :O)

  5. Keeping up appearances doesn’t have to be expensive. That’s just an excuse. First of all there are a number of discount shops that sell luxury items: filenes basement, Nordstrom rack etc. I have only a few fancy outfits (approx 10) and I just rotate them. It’s not like patients see you on a daily basis. Also there is no difference between the fancy makeup and the kind you find in the drug store. Manicures for a doctor I personally find are impractical. For those with a different opinion they can be done at home for much less. Haircuts and the like are debatable. Hair maintenance is not always a DIY project. (I’ve tried, not pretty). As to the rest, patients don’t see your car, your purse, your home or your furniture. They also don’t go with you on vacation. Overspending on those is a personal choice and has nothing to do with your occupation. Having said that I do agree living in a HCOL area prevents you from saving more. My brother paid much more for his modest home in a HCOL area than I paid for my McMansion in a LCOL area. Although he is very frugal (their family has just one ten year old small Jetta for a family of four), their saving rate is less than ours by virtue of higher expenses on housing, food and childcare.

    1. Thanks for stopping by!

      I agree with knowing where to shop. Nordstrom Rack, Last Chance, Saks off Fifth (still insanely expensive), and eBay offer great options on outfits. DIY hair styling is doable but can take some practice and time (Youtube).

      How would one deal with appearances to your coworkers or employees who see you every day?

      Keeping up with the Joneses is much harder in a HCOL area where everyone around you is sporting designer brands.

  6. I’m not in a high-octane specialty, and I don’t live in a materialistic area such as LA or NYC, but the way I see it, if the “average” family in the U.S. lives on $50,000 per year, why can’t I?

    1. Right on. HCOL can really eat into your earnings. HOA costs for a tiny apartment in Manhattan can easily run more than your entire mortgage for a house elsewhere.

      How many of your classmates or coresidents now live on >$50,000 a year? How about >$100,000 a year? I’m starting to track my spendings and will hopefully put up a post on that in the near future. That would be the first step in reeling in my expenses.

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