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A race to the highest number is a race to the bottom

Posted on February 11, 2018January 30, 2021 by SmartMoneyMD

Part of the equation of having a great lifestyle as a physician is to focus on the critical aspects of our careers and minimize the amount of micromanaging that can result in unnecessary agony. The second part of the equation is to identify what aspects of our daily living make us most happy.

The source for happiness is not easily identifiable. It will undoubtedly change over time. However, if you constantly strive to be the top at everything you do, you might never find your happiness.

Modern-day medical training is built upon competition

We all strive for excellence in medicine. In order to gain admittance into college, medical school, residency, and fellowship we all have “beaten” out other peers. We’ve all been there too. All of my medical school classmates were “competitive” in some form. I’m sure that this competition turned us into better doctors, but are we better people as well?

Students who receive the highest grades often enter the more competitive specialties in medicine. Are these competitive specialties also more challenging in daily practice? Or do they confer some favorable advantage like better lifestyle or higher reimbursement? One of the plastic surgeons I know from Portugal mentioned to me that medical students in his home country take a cumulative exam in school that essentially covers Harrison’s! For those of you not in medicine, Harrison’s is a textbook compendium of all internal medicine. It is sort of a reference manual that you’re not really able to know by heart. The highest scorer in the country essentially gets to “pick” the specialty of their choice. Talk about competition!

How long do you need to compete for?

We all need to hustle in life. This is what builds discipline. But after these skills are reached, what should the next step be? At what point in your life or career do you set your navigation to autopilot? Do we call it quits at the end of residency when you join a HMO group? Or do you go until you make partner in a private group? Or perhaps ten years into partnership after you’ve made your millions? What about never stop hustling when you join a university practice?

Comparison of wealth is a recipe for failure.

How much can we carry our ambition to our finances? It’s important to have clear financial goals—the more concrete our goals are, the more likely we can gauge and achieve them. However, we have to be careful about comparing our financial success with others. It is a losing battle that will never end well. No matter how dire your financial situation may seem, there will always be others in even more dire than yours. No matter how financially successful you may be, you can always find someone else who has a bigger bank account.

If you choose to race, make sure you are in it for the right reasons.

How to learn discipline from a seven-year-old

Posted on February 4, 2018January 30, 2021 by SmartMoneyMD

I’ve gone through spurts of discipline and motivation throughout my life. I think that the first time wasn’t until high school when I was trying to get into a good college so that I wouldn’t be pan-handling off the freeway later in life. We all have had various productivity spurts in college, medical school, and in our job hunts. The gears are always moving.

Ironically, once we’ve settled down in a stable job life becomes much easier. You show up to work, you see patients, you go to some meetings, and you go home. Some nights we take call. Some weekends we spend at the hospital. But once the routine becomes established, life is easier.

Routine as a gateway to mediocrity

The danger in getting into a routine is simply that–life can get mundane and heaven forbid, your brain might start slowing down. The worse part about autopilot is not knowing that you’re in autopilot mode.

There are doctors who are the same way–they’ve “mastered” their profession, and just opt to expend their energies elsewhere, like venturing into financial education or living the dream on the beach. Are these doctors actually on the top of their medical game? As much as I believe that we have enough multitasking abilities to be great at many unrelated topics, medicine is a field where complacency does actually create mediocrity. I have friends who specialize in treating stroke victims through advanced revascularization techniques–look at it as high-risk unclogging of your plumbing system–they will be first to tell you that if they didn’t put in the hours on call and on emergency situations that they would not nearly be as good as they are.

Another prime example is Dr. Oz, the world-famous cardiothoracic surgeon turned celebrity medical expert. When I scrubbed into his hallowed operating room years ago, there was no doubt that he had expert dexterity with the vascular system. This came from years of long hours in the operating room and labs. If I needed a new heart valve today, I’d probably not want him to perform the high-risk sections of my surgery.

Reigniting the flame of ambition

Fortunately not all of us need to be world renowned surgeons or innovators within our profession. The rest of us mere mortals can still remain well-versed in our professions while running on autopilot. Likewise, it’s even easier to set your financial plans on autopilot. My financial game plan has been set on autopilot for a while now. I clean up a few investments here and there at the beginning of the calendar year, tax-harvest if I truly want some activity, and sit back and enjoy life. It sometimes gets a little stale to keep funding those index funds when Bitcoin offers so much excitement. Maybe I could trade some gold or buy some properties to flip or rent out.

I look for inspiration to remain motivated. Sometimes I’m able to see it every day. Other times inspiration only presents every few weeks. Several weekends ago, I attended an intramural basketball tournament for elementary school students. These kids probably ranged from five to ten year olds. They played essentially full-court games with ten-minute quarters!

It’s refreshing to see the hustle in others

These kids hustled down the court on every play, and fought for every point. One team was behind by twenty points, but still played hard until the final buzzer rang. It was refreshing to see that ambition is still alive and well. I high-fived some of the players afterward, went home, and was motivated to vacuum the living room.

What are your sources of ambition?

How to spend $350 a month on your cable bill: A Case Study

Posted on January 10, 2018January 30, 2021 by SmartMoneyMD

A monthly cable bill of $350 isn’t likely to put my physician readers into financial peril, but just because you can “afford” splurging on a big cable bill doesn’t mean that you should. What might otherwise be an annual expenditure of $4200 for tube entertainment will often balloon up over time as cable/satellite companies wean you off their “introductory rates”. Add in compound interest and you will be hurting years down the line.

As part of the obligatory family gatherings over the holidays, we all hear both the good and the bad among family and friends. Somewhere between discussing family vacations and work frustrations, the story about spending obscene amounts of money on cable bills came up. Apparently a coworker of one of my distant relatives was spending about $350 a month on cable bills alone. I know plenty of physicians whose internet, phone, and cable bills hit that amount, but the thought of blowing a serious chunk of change on this really caused my gut to twinge when I heard it. It’s that sensation where your parasympathetic system gets altered, and you wonder which one of the IBS symptoms you’re going to experience next.

The gut-wrenching blow wasn’t the cost itself, but rather that the couch potato had a job that did not exceed an annual pretax salary of $50,000. Most people salaried at $50,000 on a W2 are probably going to pay somewhere between 10-14% of federal tax plus a few thousand on state taxes if applicable. A monthly cable bill of $350 would roughly consume 10% of one’s post-tax income!

We all have different priorities, but initially I couldn’t convince myself that it was possible to rack up a huge cable bill. I decided to embark on a cable shopping spree on my local cable carrier to figure out what it really took to generate a hefty bill.

The marketing folks really have the process down. It seemed that the bonus options were all free:

Tricky Tricky. The discounts look like great deals.

However, the pricing is deceptive. There are fluctuating fees during the first year with variable discounts that wear off after the introductory period:

I was able to rack up a monthly bill of around $400. The bulk of the optional fees, it turns out, come from the equipment rental fees, set boxes for extra television sets, and recording capabilities. One would think that no one should ever need that many channels of passive entertainment but clearly these companies are still in business. I would be inclined to quit my job just so that I’d have enough time to consume what I’ve already paid for.

I polled some of my coworkers, and the majority of them actually do subscribe to satellite or cable television. Some of the more budget-minded doctors at the hospital subscribe to a handful of streaming services to help entertain the kids during road trips (great idea). But I’d say that all of them don’t really have much free time to consume their television subscriptions anyway. Perhaps I’m the outlier, since I axed my satellite subscriptions several years ago?

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Regrets or Resolutions? Reflections from 2017

Posted on January 7, 2018January 30, 2021 by SmartMoneyMD

There are plenty of uplifting points with transitioning into a new calendar year—new 401k contributions, new Roth IRA contributions, and simply a clean start to targeting life goals that perhaps we fell short on from the previous year. A new digit on the calendar can surprisingly impact us psychologically more than we realize.

Just as how we should establish a financial checklist, having concrete reflections on life goals provides us a mechanism to stay focused. The following are five goals for 2018 that all doctors should consider reassessing:

Increase your savings rate.

We all should know by now that our expenses should never exceed our income. The greater the difference between income and expense, the greater firepower you will have to build net worth. Most people are going to be limited by their incomes, so it is important to adapt our expenses accordingly.

As I mentioned previously, 2017 was a rocky year for medical income for me. I’m sure that some of you have experienced similar struggles or will experience them at some point. I’m also sure that most of us who went into medicine weren’t planning to live as if we kept a five-figure salary for our entire careers either. But how much you prepare for a rainy day can certainly help you weather what you can’t predict. The stock market in 2017 went on a tear, and perhaps it’s getting to the point that even the local departmental store clerks are talking about investing (hint, hint: these are the modern shoe shiners). Don’t expect it to continue indefinitely. I know some people out there save 50% to even 70% of their incomes, but we should fine-tune our own savings rate. Find your comfortable savings rate, and try to top it. You might be pleasantly surprised.

Time management and organization.

Time management is obviously critical for all physicians, but it is ironic that I know plenty of physicians who are derelict on their own time. This includes time at work and outside of work. The doctor who stays to chart notes in the electronic health system after signing out is the common scene at the hospital. Likewise, I know physicians who fiddle around on their free time tinkering with home maintenance that would actually be better managed by outside help. I am guilty of this myself. You only live once. Only you can dictate the value of your time.

Improve your health.

Monetary wealth is useless without physical and mental health. This is why disability insurance exists. We can become injured even if we live in a bubble. However, there are factors that we can control in our own health. Decades ago, we saw doctors discouraging their patients from smoking yet are puffing on their own cancer sticks. Today, I see some doctors preaching the virtues of weight loss and diet yet are overweight or obese themselves. Lead by example.

What is interesting is that I often see discipline correlate with health. Many of the superstars in medical school were also marathon runners or triathletes. Coincidence? Maybe there is a correlation between efficient use of time, health, and success.

Job Satisfaction

Even though the satisfaction of bringing back life every day at work justifies your career doesn’t mean that you are happy with your job. Regulations, compliance, and insurance mandates are the factors that make doctoring unpleasant. It doesn’t hurt to reassess your job satisfaction and determine whether any of the active issues are deal breakers in your job situation. If they are, you’d better strive to fix them.

Career longevity

Life does not go on forever. How many years do you have left in your career? Are there any health issues that might curtail your working years? One can go into a deep philosophical treatise on your career, but look at things practically: do you have enough savings to live off of? Are you able to put your kids through school? What do you plan to do with your time if you call it quits? This is where you decide whether your financial plan is sufficient to secure your future based on the existing trajectory. If not, then you’d better figure out an alternative.

What situations do you plan to reassess into the New Year?

How do you handle working night shifts?

Posted on April 23, 2017January 30, 2021 by SmartMoneyMD

Please note that there is no medical advice offered in this article. The topic discussed is only for discussion purposes.

One recurrent issue that healthcare workers frequently face is the unpredictable hours that we have to work. The same goes for any occupation that has long shifts and nocturnal hours—this includes nurses and truck drivers too. How does one adapt to an odd schedule, and what impact does that have on your health?

You need your beauty rest if you job requires keeping people alive!

Since the majority of Smart Money MD readers are in the healthcare profession, I am curious to see what everyone does.

Doctors who take call face this their entire careers. You get called at 1am for an emergency, and your entire evening and following day (or week) is shot. Working harder in this manner doesn’t even necessarily translate to increased pay. Doctors who work shifts face similar issues when they’re assigned an overnight shift. This includes Emergency Room physicians, Radiologists, Anesthesiologists, Hospitalists (Apologies if I missed your specialty!). Sometimes these evening shifts alternate between day and overnight shifts. For instance, a Hospitalist may have five straight overnight shifts followed by a week of days. Or even one overnight shift interspersed between day shifts. These odd hours take a toll on your health, and becomes even more burdensome as we age.

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How do people manage to adjust to these hours for an entire career? I get jet lagged for weeks after travel across the world, and I only make these trips once every couple of years.

Pharmacologic assistance.

Caffeine is a common strategy that almost everyone I know has consumed in the course of life. This commonly comes in the form of coffee, tea, energy drinks, and even mints! A cup of coffee helps me power through a rough day of clinic after no sleep from an evening of call previously.

Melatonin. I’ve seen melatonin tablets in the nutritional supplements section of most grocery stores and pharmacy aisles. I know doctors who use them to help them sleep during the day after a night shift. The idea is that these tablets supplement your body’s production of melatonin, which in turn triggers the sleep-wake cycle. The mechanism of action isn’t quite known exactly, but it seems to have some effect on fighting jet-lag and altered sleep patterns. I don’t believe that there is any proven statistical benefit of melatonin supplements but there are clearly people out there who claim it works for them.

Antihistamines / sleep agent. I know people who just take non-specific H1 blocker for sleeping. Some people take prescription medications to help. Long term use of this type of medication is not condoned by any medical professional, but in a pinch, it can help you get by.

Lifestyle modification.

I tend to modify my activities and allow time to readjust my clock. Fortunately I do not work the evenings often, so I don’t have to deal with the changes as frequently as other specialists. I usually try to adjust my sleep schedule according to my work schedule. For the first two nights I often am groggy as have not adapted yet. I probably go through at least one sleepless night before I am able to catch up.

I try to stay hydrated. This means additional bottles of water at work, and additional trips to the bathroom! I don’t recall reading any scientific evidence on hydration to combat altered sleep cycles, but mild hydrotherapy shouldn’t hurt if you’ve got working kidneys. ?

I try to exercise to jumpstart my body. This includes mild stretches, runs, or calisthenics. No marathons. Exercise does help me sleep better when my schedule gets flopped. I usually don’t do anything extremely strenuous, as I am probably fatigued anyway from work or the lack of sleep.

I try to avoid other mentally taxing activities outside of work. You only have so much brainpower. I need that brainpower for work. If my altered sleep schedule is only a temporary change, I try to minimize critical decisions (like buying a house, semi-dangerous lawn work). Just go to work, come home, exercise, eat and sleep. Simple.

Those of you evening shift workers, what tips do you have?

(Photo courtesy of Flickr)

How much time do you take off a year?

Posted on April 16, 2017January 30, 2021 by SmartMoneyMD

As a whole, Americans don’t have much freedom in vacation time. When I first considered working in the tech and finance industry, many starting offers I received granted about 2 weeks of paid time off (PTO) a year. Some of the smaller startups had one to two weeks of PTO with some flexibility to take more time without pay. I don’t think that many of their employees ever invoked that privilege unless they had some emergency crop up. Most of these jobs also catered to younger people who didn’t have families either. They were happy working over eighty hours a week with potential bonuses that more than doubled their initial salary.

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Guess what? The guys running the large corporations know what they’re doing. They can afford to pay you $70k a year, have you average out 60+ hours a week with two weeks of PTO and easily afford to pay you $150k at the end of the year. Who knows how much you earned the corporation. They don’t even have to give their employees overtime pay since everyone is salaried. You just work more for a bonus that you will probably get at the end of the year but at the discretion of your boss. In my book that isn’t a smart situation to be in.

Sometimes clinic seems like an assembly line. One day that will really be true…

Doctors in medical training don’t get bonuses for extra work. We’re not in it for the money…at least that shouldn’t be the primary reason to become a physician. It’s part of the vetting process. I didn’t really consider maximizing my resident salary either and neither did most of my friends. I don’t really think that any of my close colleagues went into medicine for the money. If they did, they probably left after internship or even before. One could EVEN make a case that the more that one actively cared about money during their medical training, the less accomplished they were. (Cringe. This will be a topic for future discussion).

We spent a lot of time in the hospital work and learning. Regardless of whatever regulations we had in training, I definitely spent over eighty hours a week in the hospital for at least a three month period. This doesn’t even include the amount of time I spent outside of the hospital studying or preparing presentations. That was probably another five to ten hours a week. The other months probably averaged out to 60 hours a week plus study time. No bonuses there. We put in the extra time so that we actually will be good doctors in the future.

But we actually got at least 3 weeks of vacation each year (I did not actually use all of my allotted vacation times in most years however, but that is the topic for another discussion). That’s already more than the average person receives in other industries.

In practice, the amount of PTO/vacation that doctors receive subsequently varies from two weeks to even several months! Some medical specialties that involve shift work may not offer any PTO, but can involve significant amounts of time off of work. Several of my friends in Emergency Medicine only work 12 shifts a month, which is considered a “full-time” arrangement. I know others who only work 8 shifts a month! I have another friend who is a Radiologist who gets three months of vacation time a year (and still earns a sizable salary)!

Not bad. I usually take about a month (or less) off a year, which is actually considered on the low end. Life still isn’t bad. When you take into account what your hobbies are, what your family obligations are, how much time your kids get off from school, the amount of travel time actually diminishes. Most people with school-aged kids have activities after school and on the weekends (unless you choose to home-school your kids, and that is another topic for future discussion!)

And ultimately I have decided that while vacation time is great, having a relaxed weekly routine is even better. Space out the week so that you work four full days a week, and you might not need as much vacation.

You might also like: Why doctors need a four day work week.

I’ve considering trying to rearrange my schedule to ease up the week such that my income doesn’t take a significant hit. In some situations that is not possible, but if you can swing the change your life will improve.

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(Photo courtesy of Flickr)

Springing some positive attitude our surroundings

Posted on March 12, 2017January 30, 2021 by SmartMoneyMD

Whew! This year has gone by quickly. It’s already time to move our clocks ahead and “lose” an hour. I’ve taken many hours recently reflecting on our accomplishments at the workplace, in life, and in my colleague’s lives. It’s easy to keep trucking along going at full pace, but in order to maintain a healthy balance we really have to remind ourselves of our accomplishments and goals.

How have the New Year’s Resolutions progressed?

Well, it’s very easy to meet all of your resolutions if you had none to begin with, right? I came into the year without having many defined goals outlined other than staying sane in the workplace, tracking my finances more accurately, and come up with good content that my readers would want to see. Let’s take a look at each one:

Sanity in the workplace

Everyone has stress at work, whether you are a bartender, IT professional, or neurosurgeon. We deal with stress in different ways, and as doctors, I think that we generally do a good job of handling stressful situations. That’s our job.

Eating cake every day to stay positive would NOT be a long-term solution for stress reduction!

Now in the medical profession, there is no single cowboy or hero that can solve all of the problems. We work as a team. It doesn’t matter if you are the only person in the ICU who can intubate someone and interpret blood gas levels. If you have four patients crashing at the same time, you are beholden to all of those around you to help keep the ship afloat. If you are the Intensivist and the most qualified person in the ICU, you need to delegate, teach, and positively enforce good behavior among all of those around you.

That is not easy.

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I would hope that all of us strive for self improvement. These goals don’t have to be lofty and earth-changing. In an ideal world, all of our colleagues should share the same vision. Reality, I have learned over and over, is never the case. I work with a technician who has had over twenty years of experience in my profession, but is relatively fixed in his routine. Whenever there are tasks that build up throughout the day that require organization, things fall through the cracks. If Patient Y calls in a 9am with a question about her lab results and Dr. X calls in at 10am for a consultation, there is a high possibility that neither task gets completed. It appears that no amount of coaching over two years had made much of a dent in any improvement. He claims that with a stressful workday, it is difficult to remember everything that comes in.

Is this type of deficit correctable? Is this technician actually trying to improve himself? Or am I, the doctor, simply expecting too much? In our profession, it is not possible to outline every single expectation for an employee in a manual, so should this technician be expected to remember to complete tasks that come in?

What if I, as a surgeon, don’t always remember to tie off the veins before I resect them? If a bad outcome occurs, you’d better believe some legal person will be knocking down my door!

No matter what pace those around us actually improve, I have constantly reminded myself to present each situation positively to others. It makes for an overall more positive work experience.

Positive attitude in tracking finances

Most financial bloggers out there just love money. They love spreadsheets, and can pull out their monthly expenses for the past five years. I sense some OCD in this department. I prefer to reserve my OCD tendencies in making sure my surgeries go well. It doesn’t leave much left to tracking all of my receipts.

However, I have started tracking my expenditures by cataloguing them on a spreadsheet. Some of my numbers are tracked on Personal Capital, but I use gift cards for many purchases so many of my expenditures have to be tracked manually. I am happy to say that I will soon be able to post my results! No, I’m not going to have amazing savings like other money bloggers out there—I just spent $40 on a lunch for a restaurant week outing! But I hope that my numbers will give some motivation for those still pulling out of debt that you don’t have to eat instant cup ramen (Not the fresh stuff from Japan either) to get a positive net worth.

Positive content

This part is for you, my readers. I am grateful for the support of the online community and the readership for helping unite the physician and professional community. I want some feedback. What do you want to see? What do you want to learn? Should we have some guest posts here? Do you want more DIY tutorials unrelated to medicine or money? One of the most popular articles on this website is the guide to changing the headlight bulbs on a Subaru!

Comment below, or send me an e-mail on the website!

Thanks again for your support this year!

(Photo courtesy of Flickr)