Welcome to Smart Money MD

Hi! I’m an ophthalmologist (Note that there are two ‘h’s!). I’ve made a lot of career mistakes along the way. Many of these were financial and business decisions. Some of them were personal. All of them probably could have been averted had I better insight at the time. These are the same mistakes that all physicians will likely encounter in our careers. Most of us will recover from these roadblocks, but it doesn’t mean that they won’t sting.

This is where Smart Money MD comes in. To reduce the sting or prevent it altogether. In my career, I’ve dealt with six-figure student loan debt, ran on a never-ending hamster wheel at work, and, among other things, run a medical practice. The anecdotes I’ve accrued could either fill a handbook on what to do or serve as a script for one very long stand-up comedy act. As physicians, we need to know how to properly manage our debt, lifestyle, time, and earning in order to have a sustainable career.

Too many doctors today are getting burned out. The healthcare system is mostly to blame, but physicians will need to learn to adapt. I want competent doctors to be around when I need medical care.

Buckle up and enjoy the ride!

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20 thoughts on “Welcome to Smart Money MD

  1. 11th grader trying to decide between the following career paths. Also trying to decide between attending JC, state school or UCSD or 1K, 8K or 31K (w/room and board), respectively.

    School psychology, psychiatry or non-invasive cardiology. Education ranging between 7-13 years with 100K to 450K income, respectively.

    Quality of work life:
    School psychology – 185 days/year 6.5-8.0 hours/day

    Psychiatry – Assuming 9-5…not sure about vacation time

    Non-invasive cardiology – Assuming 9-5…not sure about vacation time

    School psychologist: 75-100K by 25 and opportunities for private practice assessments side gig. Pension and no malpractice insurance needed.

    Psychiatry – My understanding is 175-250K.

    Non-invasive cardiology – My understanding is 350-450K

    School psychologist – MA (7 years)

    Psychiatry: MD 11-14 years

    Non-invasive cardiology: MD 11-14 years

    Thoughts? 🙂

    1. Hi Average Joe. Thanks for stopping by!

      It certainly does look like you’ve done your research. Be aware that many of the numbers are subject to change given that you’re at least 7 years (if you go the school psychology route). I see many people contemplating the psychology vs psychiatry routes, but how does non-invasive cardiology come into your decision tree?

      The other consideration is how you would feel if you were doing school psychology and wondered years downstream whether or not you’d be happier doing psychiatry. I wouldn’t even consider looking into the lifestyle aspects yet–you want to figure out if you want to be a medical doctor or not. Fortunately you have time!

      How much does income vs lifestyle vs challenge play into your decisions?

      1. Quality of work life and income are the primary factors being considered for the three choices. Both parents are school psychologist and make 100K(+) for working 185-195 days a year. Schedules align with kids school schedule, etc., so quality of work life for a future mother is about as good as it gets. Psychiatry is a logical comparison if pursuing more money in cognitive behavioral science. Increased earning potential (minus cost of education, lost earning years, and malpractice insurance cost). There would also be a quality of work life hit. Probably far less time off and required to treat serious adult issues (perhaps criminal) unless specializing in pediatric psychiatry.

        Non-invasive cardiology made the short list due to what appears to be far greater earning potential when compared to school psych and psychiatry. It was also selected over other high earning medical specialties after factoring in quality of work life (no stress of surgerical procedures, assuming typical office hours/shorter hours compared to other types of doctors). Lastly, to justify taking on the sacrifice that is med school, it would have to be justified with one of the higher/highest paying specialties that don’t require the stress of surgerical procedures or long hours. Non-invasive cardiology appears to meet that criteria. I could be wrong on the last part though.

        1. I think your parents chose well. Obviously since both of them have relatively good earnings with working 2/3 of the year, their effective annualized income is much higher.


          That being said, you might actually like doing procedures. You never know until you try. In contrast, there is still quite a bit of stress with being a cardiologist even if you don’t perform procedures. The hours can be long or average too. It all depends on where you end up working and how you carve out your hours.

          It’s pretty important to consider lifestyle and income in pretty much everything you do. However, don’t let that consume your decision-making. Most cardiologists will still make good money compared to most other professions, but you might be unpleasantly surprised if you’re fixated on a certain income amount or even number of hours worked.

          How are you deciding among JC, state school or the UC schools?

          1. You mentioned having time to make a decision about the career path. However, the school selection is probably going to be heavily influenced by that decision. UCSD is about 31K per year including room & board. Parents are too rich for aid and too poor to pay cash. That said, it’s the dream school for numerous reasons (also want to eventually live in San Diego or Orange County). State school is about 8K and would probably live at home and work during undergrad. The state school also has one of the better school psych grad programs and wouldn’t require the UC undergrad to be accepted. JC would be 1.5K and would allow for transfer to state school but probably not UCSD. UCSD has the #1 cognitive behavioral science program in the country which I’m guessing could impact acceptance into med school/psychiatry program. It would also benefit school psych path but wouldn’t be necessary to get accepted. I’m guessing UCSD would help get accepted into med school in general if the psychiatry or cardiology path is selected, but not sure. 4.0 student that will graduate HS with anywhere between 5-7 AP courses completed. Worked hard in HS (academically and athletically) to end up at a JC or state school but understand the importance of making financially responsible decisions. Unfortunately, UCSD doesn’t have much available in the way of athletic/academic scholarships unless GPA and SAT scores are through the roof (competing against top 5-10% academically) with 100K applicants per year.

          2. Tough call. I’m probably somewhat biased, but the tuition difference between JC and the state school (I guess you aren’t a California resident?) might not be that big in the long term. Obviously if you’re thinking of the salary ranges for the MD professions you are considering, the tuition at UCSD isn’t that huge in the span of one’s career. Sounds like with your AP courses (taking all the exams, I assume?) 4.0 GPA you’d be in pretty good standing for at least some merit aid even at UCSD. I remember getting the Regent’s scholarship at Berkeley–I don’t even think that I had to apply separately–does UCSD have something similar?

            The way I view things, you’ll never know what you’d get if you don’t apply. Go for it, and see what you get!

            College does seem much more difficult than it was back when I was applying, and I was not conscientious about finances until almost two decades later!

          3. I am a California resident. Definitely taking the AP exams and hoping to pass all with at least a 3. Continuing to push myself with AP classes could lead to a B or two, which could impact my unweighted GPA but weighted will stay 4.0(+). Probably worth the potential GPA hit it to save the money on the credits that will transfer in. I was told UCSD is so competitive and gets so many applicants that academic scholarships are hard to come by without a really high unweighted and weighted GPA from sophomore/junior years in HS and an incredibly high SAT score. In fact, I was told there is a good chance that I wouldn’t even be accepted without sports.

          4. Be aware that some schools only offer you accelerated track in a subject that you have AP scores on (lets you skip the beginning class without offering you credit towards graduation). That being said, don’t forget to enjoy your youth! It’s easy to get caught up figuring out the next step and only realize that you may have missed out on activities or enjoyment that you would otherwise not be able to do later in life!

          5. Keep us posted! You’ve got another 9 months or so before you start applying during senior year!

          6. Hi Average Joe,

            Yup. I know quite a few successful doctors who went through this program. It is one of the few accelerated BA/MD programs out there–there aren’t too many of these around. There are a few others that are 8-year programs, so it doesn’t shorten the training process. I personally think that you miss out on some aspects of college if you opted for an accelerated program, but I’m sure most people turn out okay either way.

          7. Oh, interesting that you know several successful doctors that went through the program. What type of aspects are you referring to? College experience stuff or gaps in the quality of the education? I guess no MCAT would be needed. I wonder how it would impact residency placement versus a traditional program? I do like the idea of making money two years sooner and potentially two less years of acquired school debt. Could be in residency by 24 making a little money and a Fellow Doctor by 27.

          8. Since your college is shortened by two years, you get less time to explore other interests outside of the medicine track. Does it make you a less capable doctor? Unlikely. Will you be a less well-rounded person? Maybe. You probably won’t be taking an advanced literature course on Hamlet in a BA/MD problem. Would you have taken it anyway? You’ll never know.

            I certainly remembered having a great time towards the end of college exploring other courses, extracurriculars, and fun things.

            btw, you’d probably still have to take the MCAT even if you’re enrolled in the accelerated program. Advanced is usually contingent upon grades, testing, and all of the standard criteria.

          9. Gotcha. Please feel free to share any other accelerated programs you are aware of. Mt. Sinai also offers an interesting “FlexMed” program.

            “FlexMed allows college
            sophomores in any major to apply for early assurance of acceptance to our school. Once accepted, you are free to pursue your studies unencumbered by the traditional science requirements and the MCAT.”


          10. 5/2017 Update
            Well, I’m 5 months closer to the school decision and it appears like I will be a student athlete at UCSD. Leaning heavily toward the Cognitive Science major due to the tremendous flexibility it appears to provide in terms of grad/med school. I have also ruled out cardiology and I am for sure deciding between school psychology (7 years) and psychiatry (12-13 years).

          11. Congratulations! It’s a big accomplishment to become a student athlete! I’m sure that you’ll do well. Keep us posted in the future.


    1. It’s a process, and does take time. As I have gotten more involved with a full-time practice and administration, it’s easy to run out of hours in the day for yourself. I do feel that the online venue to relax. What we really want to focus on is to provide meaningful topics for discussion and education.

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