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The hate associated with being a Californian doctor

Posted on May 10, 2019January 30, 2021 by SmartMoneyMD

Geographical arbitrage is a huge component to being able to build wealth in a timely manner. For doctors, the formula for rapid wealth accumulation calls for geographical arbitrage even more strongly as our salaries do not have wide ranges across the country. A doctor in Texas will probably command a similar salary in Arizona (maybe slightly less). A doctor in the midwest might earn more, spend less, and work less than her equivalent in California. By this token, who would want ever want to live in the Sunshine state?

There was a recent post on the White Coat Investor website enumerating all of the financial disadvantages of being a doctor in California. Sadly for those in California, those reasons are backed by fact—on average, you’re going to probably going to work pretty hard as a physician in California, spend $1 million on a starter home, and commute a few hours a week. By the way, gas is around $4 a gallon.

The fuel to the fire

Those of us living in California are probably aware of many other factors that make living in the area financially tough. Some of them that come to mind include:

Private practice physicians can’t establish as an LLC. This basically means that you have to pay a little more and deal with more logistics to get a corporation established.
Payor mix is skewed. There are practices that thrive on taking care of MediCal patients. Actually, in-office visits pay horribly but if you patient needs surgery you can actually get decent reimbursement.
High concentration of doctors. California has over 50,000 physicians. Many of these doctors are clumped in the larger cities so competition is tough. Many plastic surgeons in California operate on Fridays and Saturdays in order to capture the appropriate demographic. Think longer hours.
Potentially malignant physician employers. Those doctors who have potential to join private practices will face employers who will burn and churn you. Full-time jobs at part-time salaries. You name it, and it exists.
Inter-office commuting. One of my friends covers 4 offices for his practice and operates at 3 different hospitals. By the way, he can’t expense it, because he is a W2 employee.

The “special” gas, by the way, has an octane rating of 89.

California is not all bad

There are almost 40 million people living in California. It’s got to be not all bad. Many of the reasons that people use to justify living this fair state are emotionally charged, but there is still good reason that they are valid. Let’s take a look at some of them:

Ethnic diversity. There is more benefit than face value of having diversity. Part of this argument sounds snobby, but this is how some doctors justify working 6 days a week trying to pay off a $1.4 million home that they don’t really even like. This is more than moving to Detroit to take a highly competitive Hospitalist job because it has a sizable Middle Eastern population and good Halal options. Most doctors I know have eaten tasty dim sum rolled around a cart, but probably have no idea that the real stuff can only be found in more diverse cities like Los Angeles, New York, or San Francisco. Does this matter to everyone? For some people it clearly matters a lot.
Proximity to family. We all know that this is important, but sometimes it’s non-negotiable.
Values and attitude. We all know that type of laid-back attitude, culture, and general vibe in California. Sometimes all that you need to know that the world is going to be okay is that jogging path down by the pier, the Iranian supermarket where you can get 6 tangerines for $1, or the sunny weather when you go hiking. Likewise, those die-hard New Yorkers wouldn’t trade their lifestyle for anything else.

Getting hit financially

The average physician in California will likely take longer to build up her bank account. Some two physician households in California will only generate an earning power comparable to a single physician family in the Midwest. The biggest question is whether that is going to be okay with you. If you want to be financially independent by age 40 it might be tough. Most doctors, however, will still be able to manage a respectable living with judicious financial choices–if doctor’s can’t afford to live in California, then who can? Let’s stop the hate on the Californian doctor!

Californians and New Yorkers, I want some love! Why do you choose to live in the cities that you are in?

Disabled but not quite disabled for doctors

Posted on November 17, 2018January 30, 2021 by SmartMoneyMD

Disability can be a devastating outcome to a doctor’s career and self-image. Think about it—you busted your butt to learn how to do a Whipple procedure, end up getting into a skiing accident that ends your career right there. No worries, because you purchased the appropriate coverage of own-occupation disability insurance, right?

Having disability insurance certainly provides a protective cushion, especially you are the sole breadwinner. This is a no brainer, and something that I think all new graduates ought to consider. One of the reasons why many of my coresidents (myself included) shied away from disability insurance during our training was that it did take up a moderate chunk of our income. At that point in our careers, every single dollar made a difference. Some of my colleagues were single without any dependents, so it was easier for them to convince themselves not to get insured. If they were not able to practice medicine, they could rot in the gutter somewhere without putting any family members in a dire financial situation.

The problem with disability insurance, too, is that it does grow with your income as you decide to increase coverage. If you don’t end up using it, the money is gone into the insurer’s pockets—but that is how insurance is supposed to work.

Enough about that.

What seems to fall into the grey zone is that if you become ailed with something that a medical or psychiatric diagnosis is unable to quantify. Let’s say you fall while rock climbing and fail to break any bones or tear any ligaments. None of the MRI’s or clinical exams reveal any damage, so you don’t get to invoke any of your insurance claims. However when you’re feeding that guide wire when placing that port or stent, something isn’t right. You can still do your job, but it seems that you’re having a much more difficult time accomplishing what you otherwise were able to do with ease.

Sometimes these hinderances are even more subtle. Maybe you tweaked your finger while playing basketball, started getting mild headaches whose only treatments include enough medications to put down a 300-lb wrestler, or simply just lose your stamina to power through an eight-hour cardiothoracic surgery. It could be all in your head, but the problems could also be real. Maybe it’s just a combination of age, genetics, and bad luck, sort of like those vague symptoms your patients with IBS have but you don’t really have any real suggestions to resolve them.

This is the realm that disability insurance isn’t going to cover. You’re not really disabled by any strict definition, and you’d better be sure that your insurer won’t be cutting you any checks when you’re still able to power through more surgeries than ever but just feel like crap doing it.

When you see fibers on your alternator belt but the car drives smoothly, you are working with a ticking time bomb

This is a problematic situation to be in, and I frankly am not sure what percentage of doctors remain in the workforce who are working in what they themselves consider to be suboptimal. I surmise that this number might be higher than we realize. Perhaps this percentage increases as doctors move past their prime and closer to normal retirement age.

How to cope with purgatory

What do you do if you aren’t 100% but function roughly at the cusp of where you think that you need to be to continue practicing medicine? At what point do you hang up your hat and cut your losses?

The easiest answer is to get yourself into a situation where you can walk away at any time without putting your family in a financial predicament in case you fall into purgatory. While there’s no need to live in fear every day agonizing over how to get to some magical net worth number, you can work towards achieving a sustainable lifestyle based on your I/O’s.

You’d want to find that sustainable situation while you are still able to function at 100% of your earning power. Focus on building your earning power while not completely squandering your hard-earned finances. This might simply mean moving a percentage of your paycheck to savings before you accidentally burn through it in one go. Run through the basic financial checklist on the Smart Money MD mailing list.

Heed the wake-up call

If you do find yourself working as your suboptimal self but are unable to leave your work situation financially, consider it to be a wake-up call. No matter what stage in your career you are in, remember that you can always crunch down your expenses just like what you is in residency.

Axe those car payments on your M5, sell the car, and get a used beater. Remember that driving that M5 doesn’t confer you any bragging rights. Nearly every single person in the hospital doctor’s parking lot can also afford that car. You aren’t as special as you think.

Your family will thank you for being diligent about your situation. Get them involved, and have them realize that it’s a group effort to make the financial ship run. No one can depend upon nice doctor incomes forever. I have seen doctors in their mid fifties turn their financial situation around.

Have you gotten yourself in a disabled buy not disabled situation?

A doctor’s account on the negative impact of commuting

Posted on October 6, 2018January 30, 2021 by SmartMoneyMD

As we get older, time becomes are more valuable commodity. I clearly remember that as a college student, I was more than willing to wait in line for over an hour simply to get a free sandwich promotion. Nowadays, I’m not even too interested in waiting 20 minutes to be seated at a restaurant. Our priorities evolve.

One interesting aspect of time that remains relatively unchanged over time is our tolerance of commutes. We commute to and from work almost daily, and whether or not we like it, we do it. We have gone through great lengths to even justify the commutes:

“There’s no way I’d want to live near the hospital I work”
“Junior needs to be in a good school district”
“There aren’t any good home options near the office”
“Housing near the clinic is too expensive”

Most of my colleagues commute at least one hour each day for work purposes. Those who have to commute between offices easily add on another 30-45 minutes to the schedule. One of the recent reports on average commutes shows that one hour expected for everyone living in the Northeast corridor or California, regardless of profession. That’s about five hours of commuting every week, or 240 hours on a 48 working week calendar! Ten days in the car! If you took public transit, you’d easily double that. If you took call on the weekends, you’d clock in another day in the car each year!

Commuters are essentially funding the audiobook and podcast industry by virtue of finding ways to occupy their time between the points A and B!

Commuting and your health

I used to sleep on the subway during my commute. I didn’t really have much of a choice. It was a vicious cycle where I lived far away from work, slept less because the commute was long, and ended up getting poor sleep on the train. By the time I got home, I was exhausted from work and the commute. After preparing slides for grand rounds and working on some research papers, any motivation to eat healthily or to hit the gym was essentially put on hold. We all know the ill effects of a sedentary lifestyle. There are zero health benefits of a long commute.

Commuting and your wallet

It is an interesting exercise to calculate your average hourly wage from the moment that you start the day in preparing to get to work until you get home after work. If you get up at 5:50am to get ready for work and step back home at 7pm, your workday is essentially 13 hours. If you are only getting paid for 8 hours, you’re essentially “working” 62.5% more than what is reflected on your paycheck. If you end up bringing charts home to finish after you put your kids to bed, you’re adding to the work hours too. For each hour of “unproductive” commute, you are discounting your services by 12.5% on an eight-hour workday.

No commute, no net worth, but happy as hell.

How these numbers actually reflect your finances ultimately depends on how much you value your time. The premise goes back to the promotional sandwich experience in college. When you have no net worth, are living life on a loan, and have no active earning power, your time isn’t worth much. One would expect that our value on time will increase in an “S” shaped curve over time. If you are early in your career, you might have to bite the bullet and take these onerous commutes until you reach a position to negotiate a more favorable situation. Once you have reached fatFIRE, are earning a solid six-figure doctor income, and need to take your kids to their baseball game by 5 o’clock, it’s time to find a way to reduce that commute.

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Move the goalpost as your priorities evolve

I’m a big fan of moving the goalpost. I still have commute times on par with the rest of the country, but part of my financial plan includes cutting down on the commute times. It’s all about how much we’re willing to put up with. If you are progressing towards financial freedom, you ought to have less willingness to tolerate long commutes. It’s simply not worth your time to sit in the car. By shortening your commute, you are essentially increasing your hourly wage while working less.

We all should have reducing commute times on our financial plans.

Who has better spending power, doctors or executives?

Posted on August 25, 2018January 30, 2021 by SmartMoneyMD

The general consensus among physicians who have a solid grasp on their finances is that they are realistic about their earnings and expenses. Ins and outs. Just like in nephrology, except a net positive in your finances is considered a win. One would expect that doctors ought to be generally conservative in their expenditures, since medicine is a generally conservative profession. But life is unpredictable, and that’s why there are so many physicians in their 50’s who still have unpaid medical student loans.

One of my guilty pleasures includes consuming stories on Refinery29, an online media outlet. Last week, I came across an article that outlines the weekly expenses of a high-income non-physician (executive director) family in Los Angeles. That’s right, down to the monthly car leases that all of the FIRE crowd cringes at. Head over if you’d like to pour through the details.

In summary, this household earns pretax combined income of $1.5 million at the age that many doctors are still getting lowball offers on their second jobs.

Acknowledge credit when deserved

Bravo!

We should all be impressed by the earning power of this couple. Some of us are secretly jealous of the relatively “normal” work hours compared to that of the average physician. You also have to realize that there are also far fewer high income opportunities like this compared to Hospitalist jobs, so not everyone can be a $1.5 million household living in the OC. There is undoubtedly blood, sweat, and tears that numbers simply cannot depict.

Big numbers make us uncomfortable

Big expenses tend to accompany big incomes. When I started earning a salary as a resident, I felt simultaneously rich and poor. There was a biweekly deposit in my checking account, but all of my student loans went into repayment mode. The ones I deferred started accruing interest, so I had expenses that did not exist previously. I was no longer eligible for student subsidized housing, so my living expenses also increased. I experienced the same transition as an attending. Do I still want to live in distressed living quarters in the questionably safe neighborhood around the hospitals? Do I want an apartment or a condominium? How about a detached house that affords a yard to enjoy? Now that I have a yard, I need a lawnmower and maybe a lawn guy. It’s interesting to see how lifestyle inflation self perpetuates.

I like my dining room ceilings to be decked out in gold

That’s one aspect that the financially independent crowd has successfully detached itself from. But big numbers may actually be less shocking that they appear. One of the line items on this expense report is the holiday expense:

Christmas shopping: $7,500

Did they mean $750 or $7,500? To take it into perspective, one of the doctors at the local hospital once declared that he spent $2,000 for Christmas activities since he had relatives from abroad visiting that year. As a hospitalist, his income was approximately $250,000. His holiday expenses were 0.08% of his pretax income. In comparison, the $7,500 Christmas shopping expenses only constitute 0.05% of a $1.5 million income! The executive director family actually spent a smaller percentage of their pretax income than the doctor!

Time to get critical

What the author of this article doesn’t mention is how long they have enjoyed the earning power. A neurosurgeon who earns $600,000 a year at age 34 is in a more precarious financial situation if he was only earning $60,000 a year ago as a resident. Given the career trajectory of executive directors, it is safe to assume that they have enjoyed at least several years worth of high earnings at age 34. Based on their numbers, it’s not clear how much total net worth they even have to their names. Are they millionaires yet? How much are they actually saving each year, and is it enough?

Assuming that the healthy earning potential continues throughout their working careers, this executive director family will do just fine. If they work until age 65, they will likely become multi-millionaires. If they wanted to quit their jobs at age 40 and move to Belize, they would still be fine if their expenses are reduced significantly.

Is there a moral to the story?

It is human nature to judge. As a physician who will unlikely ever experience the earning power of this executive director household, it is difficult to imagine how my life would be any happier with bigger numbers. When I showed this article to several of my colleagues who do have incomes in this range, they laughed at the fact that they only wished that they had the time to even spend their earnings.

Maybe it is better to strive to become an executive director with a C-suite rather than a neurosurgeon working 90 hour weeks?

Frugality does not guarantee financial independence

Posted on August 18, 2018January 30, 2021 by SmartMoneyMD

Medicine is a humbling profession in that no matter how advanced healthcare becomes, we are far from guaranteeing a particular result. Fate, as one might say, is fate. Financial temperament, on the other hand, fortunately has a more manageable learning curve. Investments really don’t have guaranteed returns, but if we invest enough relative to our income and expenses, the math inevitably works in our favor. We are all not doomed!

Ego is the enemy

What we don’t know can actually hurt us. We all are guilty of overestimating our own abilities at some point in our lives. Sometimes we pay the price. For many doctors, believing that we have more earning power than we actually do serves as our downfall. There are plenty of smart people in medicine who simply don’t acknowledge that small expenses in great numbers can overtake even the biggest of salaries. Two fancy car leases? $1600/month. Restaurant nights several times a week? $1000/month. Take-out meals for the family? Another $1000. Each one of these purchases is achievable alone, but together can whittle away a solid physician salary.

Put aside the ego, and you can get far in life.

Life can deal you the worst of hands

Sometimes even with judicious financial planning, you can even come up short. My heart aches when I hear about these unfortunate stories, but we can all learn from others. This is the case of Doctor D, who conglomeration of several of my colleagues’ financial situations. Doctor D, despite having sound fundamental financial sense, will likely protracted medical career beyond her control. Let’s delve into the details:

Doctor D, an anesthesiologist, enjoys a relatively high physician income with shorter work hours than the average physician. Her husband, armed with a business degree from a top 5 institution, commands an income after bonuses in the mid-$300k range. Along with prudent real estate ventures, their combined pretax income will hover around $700,000. They live in an expensive part of California, and will roughly have a net state and federal effective tax rate of 45%. For most people, $385,000 is a generous annual fund to work with.

Keep on hustling, and maybe you’ll get your lucky break.

Doctor D has two children, one of whom requires lifelong extensive healthcare expenses. She also has aging parents with recurring medical and lifestyle expenses that require financial support. These two factors alone will erode most of their savings:

Therapy and cognitive classes – $120,000/yr, 50% of which is covered by health insurance.

Senior living and healthcare expenses – $100,000/yr

Rough Total: $160,000

Fortunately, her parents do have some savings that offset some of the senior care needs, but if you add the rest of their expenses, there is really nothing much left to invest:

Property tax – $30,000/yr

Mortgage – $60,000/yr

Nanny – $3000/month – $36,000/yr

Food – $3000/month – $36,000/yr

Household/misc – $2000/month – $24,000/yr

Total: $186,000

Finding the escape plan

I have been wondering how one can escape from this vicious cycle. When you have fixed health expenses consuming roughly 50% of your post-tax income, you are already starting the race with one foot. Let’s look at several options that might be palatable:

Geographical Arbitrage

Those who practice geographical arbitrage swear by it. The fact is that not everyone will be able to adjust their interests to a particular region, no matter how financially advantageous living in Wisconsin is (sorry Badgers!). Doctor D would do well packing up from the OC and reducing taxes, mortgages, and essentially all other food costs. A recent article by @HiringLab shows just what you can account for with geographical arbitrage. Even if there is a comparable region-adjusted salary for Doctor D and her family, it may be tough to pick up the family and move.

Running lean on what you already have

This is the strategy that we should all employ if we need to work with what we have. Perhaps one could find a more economical nanny, groceries, or recurring daily expenses. Doctor D is in a predicament because her recurring expenses really aren’t necessarily the problem. Running leaner on these expenses may only make the family less happy without significant savings.

Find an employer who can front the medical bills

This is an interesting option. Big players in the tech industry are often known to offer generous benefits to its employees. There may be options in the healthcare industry that have similar arrangements. Large public hospitals and the Veterans Affairs are two options that come to mind. Perhaps there are options for their employees to purchase healthcare benefits that will cover the high cost of healthcare for Doctor D. In exchange, Doctor D will accept the lower salaries or perhaps more inefficient medical practice.

The bottom line

I feel badly for Doctor D. But her situation is more common than we realize. She may not be able to retire by 45, but there is still light at the end of the tunnel.

What alternatives would you suggest she take?

Happy doctor basics for the early career doctor

Posted on July 21, 2018January 30, 2021 by SmartMoneyMD

It’s always nice to have an escape plan for happiness. As a doctor, you don’t want to be tied to your practice at age 68 because you still have to fund your daughter’s college education. If you are practicing medicine at that age, you’d want to be doing it because you love being a doctor. Fortunately the effort you put into becoming a medical doctor does pay off with a relatively good income, no matter where the healthcare system ends up. This allows you have that luxury to control your financial future. All you have to do is to play your cards right.

I often overhear discussions in the doctor’s lounge on how to “get out of medicine”. Sometimes I get sucked into the discussion peripherally. There are often two categories of doctors who seem to get involved: (1) late-career doctor who is still working due to financial needs, and (2) early career doctor past her happy-that-i’m-making-some-money phase but realizes that the hospital is paying me pennies on the dollar for my work. It’s unfortunate that there is a lot of negativity floating around, but the key to longevity in our profession is to focus on the positives while crafting what you envision your future to be.

Goals for the early, early career doctor

You’ve finished either residency or fellowship! Congratulations! Maybe you’re even board certified now. Perhaps you feel very comfortable with your specialty already and are willing to tackle all of the challenging cases that are thrown at you. The truth is that you still need a few more years to really become a hotshot. This is your opportunity to become highly proficient in your specialty. This is what you should focus on.

You might not be getting the best salary for your field, but remember that this is your post-training training. If you’re lucky, you might even find a few mentors who could help guide your way. Watch out for lifestyle inflation, start repaying your loans, and you’ll be ahead of the game.

All doctors need to focus on their savings rate

There is evidence that your percentage savings rate impacts your happiness level. This is independent of your income. If you are the paycheck to paycheck type, now is the time to make the change. You will never be happy with a $50,000, $200,000, a $500,000, or even a $2 million income if you grow into your earnings. The wave doesn’t last forever, and we all will need the prepare for that day. I’ve met a few ER doctors who travel the world, live in luxury, but always seem unhappy. Some of these gals (and guys) are picking up more shifts in the process. They also seem pretty unhappy during these shifts too. Maybe they have a big purchase coming up, who knows. Most ER doctors earn more and work less than the average internist, so income probably isn’t even a problem. Maybe the problem is really a spending problem.

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The beauty of focusing on a savings rate is that you will never exceed your earnings. Your expenses will also be tied to a percentage of your income. If you don’t cheat yourself, you will always be able to save. Your lifestyle can improve as your job position grows, but you can keep ahead of your savings by controlling the percentage of income you spend. Some of the more popular money bloggers out there actually treat their savings rate like a game, and track their savings rate obsessively every month. Fortunately, we don’t have to to micromanage our savings rate in order to win the finance game. Slow and steady wins the race, and doctors don’t have to have to play any strategic financial game in order to win. Focusing on your savings rate will get you far into your financial career.

Sometimes being basic works. Don’t try harder than you need to be happy.

Financial happiness comes automatically with the appropriate savings rate

Financial happiness appears to correlate with savings rate. The more you save, the less you become dependent on your day job. Early in your career this tends to be more psychological, although staying ahead of your basic financial needs builds your financial independence. The less you depend on your day job, the happy you will become.

Even if you never receive a raise for the rest of your career–and you might not in this existing healthcare climate–you will be able to estimate how much you will have saved when you decide to retire. If you need more for your nest egg, you can increase your savings rate by spending less or earning more. Easy peasy.

Track your progress towards financial independence with Personal Capital. Sign up for a free account. You’ll love it!

Happy doctor basics: how to care without caring too much

Posted on July 14, 2018January 30, 2021 by SmartMoneyMD

Empathy. If you don’t already have it while in medical school, it will get beaten into you through practice-based learning, role-playing, and in the brutalities of the inpatient ward. I’d expect that every single doctor has had to deliver unwanted news to her patients, and it is never an activity that one volunteers for without hesitation. That’s okay, because we should care as doctors. We heal, but we also face the frailties of life. Each uncomfortable encounter we face fortifies our will so that we can prepare better for the next stressor. In some instances, unfortunately, the doctor breaks down too. We are, after all, humans.

If you add in the privilege of working in the exceedingly imperfect healthcare complex, our mental fortitude becomes tested even further. Meaningful use. Pay cuts. Extra hours. Extra clicks. I’m all for regulation and oversight, but it’s clear that something is awry when healthcare premiums rise along with the inherent cost of healthcare expenditures. My naive view as a doctor is that if I have to significantly alter my ability to care for my patient, whether spending less time with them, spending more time checking boxes, or hearing more about why I need 12 digits in my login password but cannot use a ‘-‘ or ‘#’, I cannot perform at the level that I am capable of as a doctor.

This is one way you can get burned out as a doctor: by caring.

My colleagues will never run out of anecdotes about the inane tasks that they have to complete. It really sounds miserable. We also hear enough about the mental health of doctors. It’s clearly being taxed by the imperfect system. The problem is that there is evidence that caring doctors in general are better doctors. But caring too much burns you out.

The late-career physician has an escape plan to happiness

Late-career doctors have an easy out—they’ve put in their decades of hard work, didn’t throw too much of their earnings away with misguided investments, and can hang up their hat at any point. The trade-off, of course, is that late-career doctors are perhaps late-career in life as well. There are plenty of otherwise fully capable doctors who have practiced 30+ years in their professions who often retire before they truly wanted. Why? Retirement for them was a means to escape the whatever ails them about their job as practicing physicians. More often than not, the reason for retirement is not the dislike or inability to do their jobs.

Everyone else will need to create an escape plan

The goal of being in medicine is hopefully not to quit medicine, but it sure seems like a goal for some doctors. Some of the gals I work with seem to be counting down the years before they can throw away the white coat. What’s holding them back from handing the resignation letter in right away? Over time, I am becoming more suspicious that medicine may be the golden handcuffs for some doctors, or at least handcuffs of any sort.

Think peaceful thoughts when you start feeling that eyelid twitch…ducks in a pond!

The mental, physical, and financial investment to becoming a doctor is overwhelming. Maybe only sushi chefs who train to make tamago train longer than doctors. Doctors are invested in their careers. It would be uncommon for doctors to go through this amount of training only to switch careers. Doctors commonly have two reasons to stick out their jobs even though it may seem unpleasant at times: (1) we like taking care of people, (2) it would be difficult to find another career that has a similar pay rate. Golden handcuffs indeed.

We just have to figure out a way to escape the handcuffs.

How to care…but not too much

I recently had a discussion about this with a retired high-ranking Navy physician who now practices medicine as a civilian doctor. We discussed the common gripes about where medicine is heading, and also how different it was to practice medicine in the military. After about fifteen minutes of channeling our negativity into the system, he aptly stated:

No matter where our health system spirals down to, you’re probably not going to starve, get put into prison, or die.

An interesting take on our situation, but I could not agree more. The sky is not falling. As long as you are ethical, competent, and conscientious, you will not starve. A doctor’s skill is always marketable, and we all have to realize that we shouldn’t sweat the small stuff. You should care about your profession, but you shouldn’t need to care about the issues that are out of your control. Focus on what you can control, how you can improve, and control your finances intelligently.

Now, this is a financial website after all. The key solution to escape the golden handcuffs is not to become beholden to the gold. Again, reasons why doctors stick out their jobs include the love of the job and the need to support our lifestyle. If you eliminate the need for salary, you’d only be tied to your profession by your enjoyment of it. Find your way to financial independence, and you might actually enjoy practicing medicine even more. What are you waiting for?

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