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Work-Life Balance & Financial Empowerment

for women in medicine

tired superheroine

what does a momma doc actually do with a week off?
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What does a momma doc do in her spare time?

Balance

As an interventional radiologist at a trauma center, I also happen to be a human and a mom. You might wonder, how do I balance the sometimes demanding, unpredictable schedule of emergency call with the rest of my life? Well, I take a week off nearly every month, for a total of 10 weeks per year. That might sound like a lot, when you’re used to 3 or 4 weeks off per year as a trainee! So what does a momma doc actually do with all this time off? Here the top 10 things you’ll find me doing in my spare time. 

Extended a.m. routine

1. I’ll extend my morning routine. This might involve sleeping an extra few minutes, but I don’t sleep in like I used to pre-child. I get my little man ready and off to pre-school by 8:30. We have some time for coffee, breakfast, and potty. This gives my husband a break, since he does toddler mornings when I’m working. 

Self-care for a momma doc

2. On a week off, I’ll head to some appointments. Whether I need a skin check at the derm, new tires, or a sit-down with my accountant, it’s all part of self-care as a mom who also works outside the home! And every week off is an opportunity to see my therapist, who helps me with relationships and stress management.

3. Eat healthy food. I fast until 11, then fill up on some eggs and avocado toast. If I crave something sweet or feel like a bottomless pit, I might make a protein shake from Body Love

Strategy for the momma doc

4. Whether I’m working or not, I blog. When I’m off, I have more time to brainstorm upcoming topics to share here. I’ll also write drafts, edit, format, and publish posts. I used to plunk down at a coffee shop for a few hours at a time to do this, but I’ve gotten more efficient with practice. 

5. Manage the finances. I look at all our accounts, and make sure the money is going where it’s supposed to. How is my 401k balance doing? Do I need to reinvest some dividends? How’s our progress toward savings goals? Or do I have excess cash lying around, looking for a job?

Family matters

6. Most days, I aim to get outside with my little dude, who is three. Whether we head to the park after school, or visit our equine friends at the local stables, we make it a point to get out for some desert sunshine. 

7. Hang out as a family. This can involve a trip to the local air museum, bubbles in the backyard, or recording the latest musical sensation in our little studio. 

Sharing the message of the empowered doc

8. In the evening, I’ll sign and send some copies of Save Lives, Enjoy Your Own. I love my label printer, which reminds me of my play cash register as a kid. Any chance I can feel like I’m playing is a win!

9. Strategize how to reach more people with my book and its message. This involves researching people of influence like medical school Deans and podcast producers, so I can introduce myself.  

Mind the timeline

10. Though most weeks during the pandemic involve staying home, my list had to include checking off a bucket list item. A recent example: I’d been dreaming of seeing Grand Teton National Park for a decade. So I convinced my husband to get on board, and we piled in for our first socially-distanced RV adventure, traveling from Palm Springs, California to Jackson, Wyoming.

Was it worth the drive? Heck yeah, it was! I relished the change of scenery in a whole new way I don’t think I could have pre-COVID.

Medical training teaches you to put your nose down and work for long-term gains and delayed rewards. But after training comes the rest of your life, and it’s finite. So don’t forget to assemble your own Grand To-Do List, and start checking things off!

What’s on your bucket list? 

What are you most likely to do on a week off, once the laundry is done, and you’ve called your mom?

Tell me in the comments below!

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Important Questions from the Northeast VIR Symposium
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Critical Questions from the Northeast VIR Symposium

Career & Leadership

I’ve been so busy promoting my book, my head is spinning! In the midst of planning the launch of Save Lives, Enjoy Your Own, I was asked to join the 5th Annual Northeast Vascular & Interventional Radiology (VIR) Symposium at my home institution of Brown. So despite the book launch, I was excited to take part in the symposium. It was an honor to join other outstanding women in my field at the event, which happened on September 27th. The questions from the Northeast VIR Symposium were so good, I thought I’d share them here on the blog.

Tell us about yourself & your path to VIR

  • I’m a private practice IR in Southern California
  • Now 6 years out of training
  • I’m Chief of my IR section
  • I’m a wife and a mom to a little cherub
  • In the last couple years I’ve become a blogger and author!
  • My path to IR was via diagnostic radiology. I did residency at Brown and IR fellowship at UCLA. 

What other fields/specialties did you consider going into and why?

  • Family med- because of the breadth of practice, which is similar to radiology. You need to know about a lot of different things, and that keeps it interesting. I envisioned a role in primary care in which I’d do procedures– which is more common in the western part of the country. 

How did you go about seeking mentors during your training? What does mentorship mean to you as a woman in IR?

  • I found the process intimidating. 
  • Ultimately, the process of finding my mentors was somewhat organic. My 1st mentor was a woman in radiology who lectured us in med school. After her talk, I went up to her and made contact.
  • Later: it happened organically. Some people are more supportive than others. But I learned from all! 

What do you think are some of the misconceptions that may deter students from pursuing IR? How can we change that?

  • The idea that it’s not for women
  • That it’s not for women who want to have kids
  • That it’s so competitive that you have to be from an elite physician family
  • The idea that radiation is bad for women
  • How to change it? By being an example of what is possible
  • Showing the positive aspects of the field for women
  • Correcting misinformation regarding radiation and specifically, radiation in pregnancy

How have you been able to balance your career in IR with other interests/non-medical pursuits?

  • I strongly believe everyone has a choice in how they spend their time. Everyone has free time if they care to find or make it. Once you find time, you can harness it with passion and focus. That has allowed me to write my blog between patients, or to apply for a leadership position as I’m waiting for a trauma patient to be prepped. I used to fritter these moments away, but I’ve found satisfaction in using them more intentionally.

Can you speak to your time in leadership roles and give advice on making leadership a part of your career?

  • I like to talk about the messiness of learning to lead, because we all think of leaders as exemplary specimens of perfection. In order to learn to lead, you need to embrace the messy imperfection of leadership in medicine
  • I talk about my own experience and lessons specifically in the context of early career leadership in a private practice environment. 
  • Beyond local leadership, there are countless opportunities to learn to lead in our societies. These can be great places to find leadership opportunities. 

Have you had a particular challenge which you had to overcome on your path to IR that has left you with a lesson you could pass on to students or trainees?

  • Learning to listen to myself as I entered an elite hierarchical world where everyone knew more than me. I needed to learn I still had a valid guiding voice inside. 
  • Learning to nix the naysayers. It’s a skill to parce through advice which may be tinged with baggage or bias. Sometimes you need to discard the advice if it doesn’t suit you or your situation. 

Can you talk about any experiences you have had with imposter syndrome in medicine? What strategies have you used to overcome these experiences?

  • When you enter IR, it’s so foreign. Some students and trainees act like they may understand everything that’s happening, even if they don’t. Sometimes, it takes learning a ton of a field for everything to fall into place. So if it feels that way in IR, that’s OK. It doesn’t mean you can’t do it/ will never get it. 

What words of advice do you have for those interested in VIR and other male-dominated fields?

  • Don’t settle on a career just bc someone tells you it’s “more woman/ family-friendly” 
  • Follow your interest, and your work will always be enjoyable. 
  • Working with your hands in these procedural and trad male-dom fields is some of the coolest most gratifying work in medicine!

Those were some highlights from the Northeast VIR Symposium, which normally takes place in person. The virtual version was the next best thing!

What questions do YOU have about being a woman in VIR or in a male-dominated field of medicine? Leave a comment below!

And if you have a chance to attend the Annual Northeast VIR symposium in the future, I highly recommend it.

I also wanted to let you know about a new podcast called Marriage, Money & Medicine, started by my friend and fellow radiologist Dr. Kate Louise Mangona. I’m one of her inaugural guests! In our episode, we chat about how we came to form our families, and the finances of physician families, specifically as it relates to being a female bread-winner! You can check out that podcast anywhere you listen to podcasts. I’ve been enjoying Overcast, if you’re not totally happy with the medium you’re using. Link to the podcast page and show notes by clicking here.

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do residents actually need an emergency fund?
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Does a Resident Actually Need an Emergency Fund?

Financial empowerment

This is a guest post from a blogger who is doing some good in the world. Catherine Burke helps those who’ve been suckered into payday loan schemes to find their way out. When she asked the kind of content she might write for you, I liked the idea of covering the emergency fund. It’s a bit of a loaded topic for residents, who are often saddled with educational debt. Does a resident actually need an emergency fund? Here’s a breakdown from Catherine.

-Barbara Hamilton, MD

Does a Resident Really Need an Emergency Fund?

You could call an emergency fund the backbone of your personal finance strategy. If an emergency arises suddenly, you will have the emergency fund to support you. That is why personal financial specialists have always endorsed having one.

In this article, the focus is on demonstrating how such a fund will work for medical residents who are getting an annual salary of $45,000 to $60,000.

“Keep the emergency fund intact in case you lose your job or income.”

Michelle Singletary

What if you’re a resident earning $60,000 per year?

For a medical trainee, directing an amount of money towards an emergency fund may not seem a practical option, but it is really important.

You don’t know what is going to happen with you tomorrow. Maybe you need money suddenly, like in the case of a sudden accident. Then the money you’ve saved in an emergency fund will come in handy.

That is why you need to save at least 3 months to 6 months’ salary in your emergency fund. Suppose, as a medical resident, your income is $60,000 per year. Then you should aim to save $15,000 to $30,000 for an emergency.

Believe me! Creating an emergency fund and saving at least 3 to 6 months’ savings is necessary for a medical trainee.

What if you are repaying your student loans?

The Student Loan Hero website states that on a standard medical student loan repayment plan where the payment duration is 10 years, you have to pay a regular monthly payment of $2,300 per month on a $196,250 loan amount and 7% interest rate.

In addition, you have to pay for your food, utilities, rent, etc. You may feel like you don’t have enough money left over to save.

So, try to save some dollars in the emergency fund slowly but steadily. The amount of money is not important here. The important matter is to maintain the Emergency Fund and continue to save dollars in the Emergency Fund regularly every month.  

Where should a resident keep her emergency fund?

You can say that online banks are currently a good way to store your savings. Online banks currently offer higher interest rates compared to brick and mortar banks.

So, the ideal account for keeping the money for Emergency Fund purposes is an online account.  

According to the Bankrate.com report and our estimation, if you want to open an online bank account for emergency savings purposes, you can rely on 2 online banks.

These are Citibank and Vio Bank. Citibank is offering 0.90% APY (Annual Percentage Yield). You don’t need any minimum balance to open a savings account in Citibank. You’ll get access to the ATM with Citibank.

Vio Bank is offering 0.83% APY and you need a minimum of $100 to open a savings account in the Vio Bank. (Editor’s note: Ally, CapitalOne360, *Etrade, and many others offer high interest rate savings accounts. Mine is at *Etrade.)

What’s the difference between a savings account and an e-fund?

Financial experts always suggest that you should create a separate account for emergency purposes if you already have a savings account.

The thought may arise in your mind that if you already have a savings account then where is the need to open a second bank account?

Well, the 2 accounts have different purposes. In the savings account, the money you’re going to save is for your future. The savings account will provide you financial security.

The bank account you’ll open for emergency purposes will serve your emergency purpose needs. In case, you need some money suddenly, you can instantly withdraw the cash from your emergency account.

That is why you need to strictly follow the rule that you’ll only withdraw money from the emergency fund just for emergencies that arise.

What if you have other debt?

With the emergency fund, you should take care of your debts too. As a medical resident, maybe you have unsecured debts like credit card debts or a payday loan, in addition to your medical student loans. In an emergency, it is easy to depend on credit cards and payday loans to control the situation instantly. But in the long term, you’ll face problems while paying off the credit card and payday loan balance with a high-interest rate.

If you end up in this situation, you might consider consulting an expert on the repayment of credit card and the payday loan debt. You can use options like debt consolidation, card balance transfer, or payday loan consolidation to solve your problem.

What do personal financial experts say about the emergency fund?

Personal finance experts like Suze Orman and Dave Ramsey are quite vocal about the emergency fund.

Dave Ramsey has advised that all Americans should start by saving $1000 in an emergency fund. Once you have saved $1000, then you can aim for the larger goal of saving 3 to 6 months of your annual salary.

Suze Orman states you will be in a better position if you save 8 to 12 months of your annual salary.

So, the personal finance experts have supported the emergency fund quite vocally. 

A final word on emergency funds

Your emergency fund is the test regarding how much you’re prepared to face an unexpected scenario. If you are generally living a paycheck-to-paycheck life, start by saving $100 each month. The best option is to use a high-yielding savings account, as previously described. You’ll be glad you have it in case of an emergency.

As Greg McBride, Chief Financial Analyst for Bankrate.com has said, “Nothing helps you more than knowing you have money tucked away for an emergency.”

What is your experience with the e-fund: do you have one? Where do you keep it? Does it help you feel financially secure?

Catherine Burke is a financial writer for Online Payday Loan Consolidation. She provides resources to help people get out of predatory debt. She lives in Kansas and has hard-won knowledge when it comes to payday loans. 

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practical financial considerations for the budding doc
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Practical financial considerations for the budding doc

Financial empowerment

I don’t actually talk about personal finance in my book, Save Lives, Enjoy Your Own. I allude to the fact that as a physician, you will be able to make a living that allows you to make choices that suit you and your family (if you choose to have one). You’ll have the resources to get help as your career makes demands on your time. I left personal finance out of the book because it’s a huge topic, and will likely be the subject of its own book. So as we prepare for book launch, and the important task of finding your place in medicine, here are some financial considerations for you, the budding physician. And read through to the end to find out how you can learn more about setting up your finances with my friend, Dr. Bonnie Koo, a.k.a. WealthyMomMD.

1. Your career choice should not be made based on financial factors.

Most of us incur educational debt on the path to medicine. But it should be kept low/ manageable enough so as to NOT affect your career choice. I know, six figure debt a huge amount, but you can do it. Even if you choose a lower paying specialty with a high debt burden, you can always go for a student loan forgiveness program. If you want to read about the different kinds of student loan forgiveness programs available, The Physician Philosopher’s Guide is a great resource. TPP delves into these programs in detail, in an understandable way.

So what should career choice be based upon? Well, I did a deep dive into that topic in my new book. My approach is tailored to those who think they might want to work with their hands, in a procedural or surgically-oriented field of medicine. Check it out!

2. You’re learning to tolerate debt right now, but you can regain control of your finances, once you have the tools. 

As you accumulate student debt, it can be really anxiety provoking. I know this first hand. As you work and study so hard, and push yourself to exhaustion at times, you just can’t afford to lose sleep thinking about your loan balances. It’s not good for your well-being. As a defense mechanism, professionals in education debt become numb to it. As you do the best with what you have, know that you’ll have more resources to deal with your debt when the time comes.

Basically, you have a mortgage on your mind. It is a valuable investment, even if there isn’t a lot of tangible evidence of its value just yet. Hang in there. One day you will have a paycheck large enough to make real decisions about where the money should go. Whether you decide to tackle your debt head-on, or refinance and let it simmer for decades, that’ll be up to you!

3. Lifestyle creep is a practical financial consideration!

As you make your first moonlighting paycheck, or that first sign-on bonus, you might be wondering when you’re ready for a lifestyle upgrade. This can be an incremental process. It’s enjoyable to increase your lifestyle, after all. It’s part of why we work so hard!

One mistake I see is people making a lifestyle leap. They get their first job and lease a luxury car. They make decisions based on a lack of financial goals. 

Speaking of financial goals: Do you know how to setup your finances? You might even feel the pressure of being the breadwinner of the family. That’s what prompted me to start learning all about personal finance. 

Let me know what personal finance questions are on your mind.

To your health, wealth, and happiness!

TiredSuperheroine

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Save Lives, Enjoy Your Own: Finding Your Place in Medicine
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Save Lives, Enjoy Your Own: Finding Your Place in Medicine

Career & Leadership

Writing a book is like giving birth again. How did this even happen? Where did I find the time? I thought I’d write a little e-book on finding your place in medicine. Then, I stumbled upon a book coach in a physician Facebook group. My coach is a neonatologist, preventive medicine specialist, and social entrepreneur who is making the world a better place through the cultivation of first-time authors. And as a coach, she delivered. She told me where I needed to add a story here, or clarify something there. That’s when Save Lives, Enjoy Your Own started to look like a real book in the making.

Who it’s for

This book is for those in medical school, who are staring down one of the biggest decisions of their life– choosing a medical specialty. That’s why I focused on medical students as I wrote and edited (and edited… and edited) this book. Yet I also wrote the book as a person who found herself at a fork in the road mid-way through residency. I had to decide whether I’d be a diagnostic radiologist, or dive into the ultra-male-dominated, adrenaline-soaked field of interventional radiology. That’s why I understand that some residents may need the book when they’re in the midst of their training. And still others may find the book as a pre-medical student or non-traditional post-baccalaureate student. There is value in the book at each of these stages.

Many women entering medicine will identify with the messages in the text. As they begin to encounter some of the more traditional and even outdated ideas about gender in medicine, I hope this book helps to light the way. Others who want to learn more about what their female colleagues face as they become physicians may read the book as he-for-she advocates. Finally, students and trainees who identify as underrepresented minorities may find guidance and comfort in the pages of Save Lives, Enjoy Your Own. For aspiring and training doctors finding where you belong in the medical field, I’ll show you how it’s not easy, but it’s worth it.

We are a month out from book launch in October. In order to tease some of the contents of the book, here are the foreword and mini-bios of the amazing physicians who contributed.

Foreword

Sometimes the phone rings just after the first precious hour of sleep. The trauma surgeons need my help. When I rush into the hospital for an actively bleeding patient, I might not return home until dawn, but as I work, I’m in the zone. This work is a part of me. Being able to save a life is worth it every time. And I want you to find the kind of work that engages and fulfills you, too. 

But how do you find the right field of medicine, in which you can harness your unique talents and skills? How do you find your calling while drinking from a fire hose? I’ll address these important questions, with the help of some colleagues in various medical specialties.

What’s keeping some women from saving lives?

Unfortunately, the male-dominated atmosphere, outdated ideas about what constitutes women’s work, and concerns about work-life balance can discourage some women from surgically-oriented fields like my own. If your desired field is a boy’s club, how do you figure out if you truly belong there? How do you navigate a sometimes foreign environment and succeed, despite the lack of female representation there?

If you dream of transforming from an uncertain student or trainee into one who confidently pursues her career path, you’re in the right place. From the decision to work with your hands, to finding the right balance and learning to lead, this book will light the way. I’m so excited for you to join me as a physician who saves lives and enjoys her own!

Contributors for Save Lives, Enjoy Your Own

I would like to thank the women who contributed to this book. It’s a privilege to call them my friends and colleagues. They know it’s possible to save lives and still enjoy your own. The following are abridged biographies, which highlight some of their many accomplishments.

Theresa Caridi, MD, FSIR 

is an interventional radiologist who was named a Washingtonian Top Doctor in 2018 during her time at the MedStar Georgetown University Hospital in Washington, D.C. At the time of this writing, she is transitioning to her new roles as an Associate Professor of IR, IR Division Director, and Vice-Chair of Interventional Affairs at the University of Alabama at Birmingham.

Hannah Clode 

is a third-year medical student pursuing an MD/MBA degree at the University of Miami Miller School of Medicine. She aspires to be efficient, autonomous, and joyful throughout her career. Her specialty choice is yet to be determined, and she plans to take a year off to consider her options, which include IR, surgery, family medicine, and OB/GYN.

Laura Findeiss, MD, FSIR, FAHA

is a Past President of the Society of Interventional Radiology. She is a Professor of Radiology & Surgery at the Emory University School of Medicine and the Chief of Service for Radiology at Grady Memorial Hospital in Atlanta, Georgia. She’s passionate about leading patient-centered change in healthcare and is an avid cyclist, skier, and snowboarder.

Anna Gasparyan, MD 

is a board-certified vascular surgeon in private practice in Southern California. She specializes in endovascular & vascular surgery including the treatment of venous disease. In her free time, she enjoys quality time with her son, Bikram yoga classes, and long-distance running.

Anne “Annie” Gill, MD

is an Assistant Professor of Pediatric Interventional Radiology at the Emory University School of Medicine. She is a leader within the Women in IR Section of the Society of Interventional Radiology, in which she works to increase the gender diversity of selected speakers at national meetings.

Lara Hasan, MD

is a board-certified obstetrician-gynecologist in private practice in Southern California. She’s a world-traveler, outdoor adventurer, burgeoning cook, and trivia geek.

Aneesa Majid, MD, MBA, FSIR

is an interventional radiologist who has spent the majority of her career in private practice. She continues to find her balance with the help of entrepreneurial endeavors since completing her MBA at the Kellogg School of Management. A leader within the Society of Interventional Radiology (SIR), she led the development of the first Women in IR Champion Award.

Natosha Monfore, DO

is an early career IR in private practice. She is a passionate advocate for mentorship, with countless projects completed with the Residents, Fellows, & Students (RFS) Section of the SIR. As a leader within the Women in IR Section and as a SIR delegate for the Young Physicians Section of the American Medical Association (AMA), she continues to lead into early attendinghood.

Lola Oladini, MD, MBA

is a rising PGY-3 IR/DR resident at Stanford Hospitals and Clinics. She aspires to be compassionate, creative, and relentless in the pursuit of leaving her community a better place than how she met it. She likes improv and baking cookies.

Arghavan Salles, MD, PhD

is an academic bariatric surgeon. A former Scholar in Residence at the Stanford University School of Medicine, her research focuses on gender equity, well-being, and the challenges women face in the workplace. She is an internationally recognized speaker and an activist against sexual harassment.

Nancy Yen Shipley, MD 

is an orthopaedic surgeon in private practice. She is also a mother, half of a dual-physician couple, a writer, a speaker, and a podcaster (The 6% with NancyMD). Through these roles and her online content, she helps open doors for those that wish to be more and do more in their own lives.

Agnieszka Solberg, MD

is a practicing Vascular & Interventional Radiologist who is board-certified in Internal Medicine (ABIM), Nuclear Medicine (ABNM), and Radiology (ABR). She is a Clinical Assistant Professor at the University of North Dakota. A passionate advocate of women in radiology and informatics, she founded the Facebook community Radiology Chicks.

These women prove it’s possible to save lives and still enjoy your own. I’m inspired by them, and I know you will be too. They’ve found their respective place in medicine. From academics to private practice and beyond, they represent several different subspecialties. They share their experiences and career lessons to help you see that there are many ways to be a woman in medicine.

You can still purchase a signed special edition of the book by clicking right here.

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afraid of burning out
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Afraid of Burning Out? Empower Yourself with Knowledge of the Alternatives

Career & Leadership

This week’s blog is a guest post from an allied health provider who has transitioned to an alternate career herself. With the ubiquitous concerns around physician burnout and the ramifications for our health systems, I felt this was an interesting share. Are you afraid of burning out early in your career? Let me know what you think in the comments below. -Barbara Hamilton, MD

Working in a healthcare environment is intense and demanding. The epidemic numbers of physicians experiencing burnout has grabbed the attention of third–party payers, legislators and professional organizations.

As the level of technological advancement in medicine rose, healthcare leaders hoped it would improve the levels of physician productivity and satisfaction. Yet digitizing processes had the unintended consequence of producing alienation and disillusionment in even medical students, residents, and early career doctors. 

Knowing the factors that contribute to burnout can help keep you from burning out yourself. Just knowing the viability of alternative career options can reduce the risk you’ll feel stuck, should you experience burnout in your career.

Burning out by the numbers

The Medscape National Physician Burnout Report for 2020 surveyed over 15,000 doctors. Results showed:

  • Urologists, neurologists and nephrologists experienced the highest level of burnout.
  • Women were 11% more likely to experience burnout than men. 
  • Bureaucratic tasks, hours at work and lack of respect from administration topped the list of reasons that contributed to burnout. 

The report also found that reported coping mechanisms ranged from constructive to destructive. The strategy most used was isolation, which can perpetuate burnout. However, the second most used strategy was exercise, which is a constructive method of reducing stress.  

Slightly more than 50% of women were willing to take a pay cut to have a better work life balance. But, isn’t there a better option?

Consequences of Physician Burnout

According to Dr. Dike Drummond, author, speaker and consultant on physician burnout, “There is an epidemic of physician burnout in the United States, and it has a pervasive negative effect on all aspects of medical care, including career satisfaction.”  

Burnout is directly linked to striking number of consequences:

  • Post-Traumatic Stress Disorder 
  • Depression
  • Lower patient satisfaction
  • Lower quality of care
  • Higher number of medical errors
  • High turnover
  • Increased risk of malpractice
  • Physician substance abuse
  • Physician suicide 

A survey of doctors in 2014 found that 54.3% had symptoms of fatigue. 32.8% reported excessive fatigue, and 10.5% reported a significant medical error in the last three months. It’s no wonder we are afraid of burning out. The price paid by physicians and society is steep.

Contributing Factors

After completing hours of one-on-one coaching with physicians who experienced burnout, Drummond determined that the five biggest causes are: 

  • Interacting with people who are sick, scared and dying. 
  • The stresses of on-call rotations, hospital politics, and personality clashes at work.
  • Inability to balance one’s personal and professional life.
  • Character traits such as being a workaholic, superhero, or perfectionist.
  • Poor-quality leadership.

Like factors named by Gagné and Deci, who study intrinsic motivation in the workplace, these factors increase a doctor’s risk of burning out. The pillars of intrinsic motivation are autonomy, competence and relatedness. Each has suffered as a result of healthcare restructuring.

Physicians experience a lack of control over their time, contributing to burnout. They are forced to check off boxes to meet billing standards, leaving them less time to develop therapeutic relationships with their patients. These factors are related to the three top contributors to burnout found in the Medscape 2020 report: bureaucratic tasks, hours at work and sensing a lack of respect from administration.

Treating Burnout

While work-life balance may not have been stressed during medical education, it’s critical to foster a personal balance as a physician. The characteristics that supported great grades during medical school should also be channeled toward personal wellness. Finding balance starts with identifying physical and emotional areas that may have been overlooked in the pursuit of a rewarding yet often demanding career.

Self-care basics: exercise, nutrition and sleep. Under the stress of work, maintaining relationships, and growing a family, basic self-care can fall to the wayside. However, prioritizing physical and emotional health is key to avoiding burnout in the long term. This means adequate exercise, healthy eating  and getting 7 to 8 hours of quality sleep each night. These basic strategies improve a physician’s ability to withstand external stressors.

Set boundaries. Doctors who don’t uphold personal boundaries may be at increased risk of burning out. A lack of boundaries between work expectations and down time can create tension and stress, in turn raising the risk of burnout. It is vital to deliberately set boundaries and then protect them as a physician.

Knowing and practicing these simple strategies may help you reduce the potential for burning out in the future.

Career Alternatives for Physicians Who are Burning Out

The skills gained during medical education and practice are remarkably transferable to different career options. Yet a physician’s education is highly specialized. Here are several alternative options that may allow a physician to return to clinical practice later if they are burning out.

Clinical Practice Outside the Specialty

Physicians may not consider clinical practice outside their specialty but it is a viable option. Physicians from a variety of specialties find wound care challenging and rewarding. The subspecialty has less stress, a predictable environment, a competitive salary and keeps physicians clinically and procedurally active. Family practice, plastic surgery, internal medicine and vascular and general surgery are just some of the specialties that involve skills that transfer into wound care.

Hospital Administration

This is a long-standing option that physicians have taken over decades. Physician administrators may be more apt to initiate change based on the challenges and frustrations experienced by clinical staff. Physician administrators often have the respect and goodwill of other doctors in the hospital, which improves their ability to be successful. Hospitals are seeking a balance of clinical and administrative skill to more fully integrate the needs of physicians with the demands of third-party payers. One hurdle some physicians face is a lack of business knowledge needed to run a hospital profitably. Some have completed an MBA to overcome this challenge.

Academics

Teaching offers physicians the option of continuing clinical work while engaging with medical students. Most academic positions are seeking physicians who have published in peer reviewed journals and prefer doctors who have specialized. This is an opportunity for physicians who prefer a daily routine and have the background and clinical practice to support an academic career.

Medical Journalism

Doctors who enjoy writing and translating complex medical concepts into language the general public can digest may consider this alternative career. Pharmaceutical companies, research studies, and editorials all offer venues for physicians to help propagate medical knowledge.

Telemedicine

This is an option that allows physicians to continue to interact with patients through clinical practice, while benefiting from predictable hours. Telemedicine is flexible, allowing for a part-time or full-time schedule. In an environment where more people are apt to stay at home, the global market for telemedicine is growing.

Telemedicine and in-home visits are a hot topic and area of study, even in interventional radiology! So if you are afraid of burning out, take comfort in all the options at your fingertips, from preventative strategies to career alternatives in the future.

Author: Gayle Morris is a freelance writer who has written on health and wellness for over ten years. She spent over 20 years as a certified nurse and nurse practitioner before hanging up her stethoscope and picking up the pen. 

To hear my personal take on early career burnout and some strategies I used to deal, check out my recorded talk on balance. You can access it by clicking here.

And let me know what you think about this post in the comments below! Share your experience, or your unanswered questions. Are you afraid of burning out?

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being nice as a boss lady
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Being nice as a boss lady

Career & Leadership

“Being feminine & a boss & nice: How do you do it?” 

One of my favorite residents asked me this as we talked on the phone recently. She wondered how she’d be able to balance all the expectations she herself and everyone else might place on her in the future. It’s a good question, and I’m sure I’ll only scratch the surface of this complex topic. But to be honest, my first reaction was, “Nice? That’s what she’s worried about?” As a physician, she’ll soon be in charge of getting things done, as efficiently and safely as possible. So how is she supposed to manage that degree of responsibility, manage people, and… be nice? Well, it might sound harsh, but being nice isn’t always my highest priority. These are my thoughts on being nice as a boss lady. 

Being nice: an expectation for certain doctors

While you want to be nice enough in any situation, I strive for polite. As a physician leader, I consider it a good day if my staff and I didn’t offend anyone. That’s because patients are so different, and they’re usually struggling with health issues when I see them. They’re not at their best. Add to that the family dynamics that enter our department, or the expectation that we answer for something that was said or a cancer that was not diagnosed by someone else, even if it was months or years ago. As physicians, we are expected to handle all these situations with as much patience and empathy as possible, at all times. Sometimes it’s relatively easy. Things go smoothly, and the patients are sweet, respectful, and grateful.

Other times, the interpersonal aspect of doctoring can be more demanding. You could find yourself repeating yourself, or rephrasing, hoping for another shot at understanding one another. The work of translating medicine for patients can involve drawing pictures. Or it might be followed by several phone calls to distant relatives around the country, as you realize your patient isn’t sure what you mean, and maybe never will be. This is all part of being nice as a doctor. It is what we do every day, and it’s really just part of the job. All of these personal touches are on top of the core work of actually diagnosing and treating your patients. And most doctors do this for between 50 and 100 hours per week. Compassion fatigue, anyone?

Is delegating nice? 

Because of the demands on doctors I mentioned above, it’s incumbent on you to get help from the people around you. It might not seem “nice” asking someone else to do things for you, but as a doctor, delegation isn’t optional- it’s a necessity. If you don’t delegate, you’ll scurry about, spending bandwidth on tasks that could’ve been handled by someone else. And you will still have the doctoring to do. No one can do that but you. There’s a reason they call it a healthcare “team,” and if you’re handling stuff the support staff could handle, there’s an opportunity cost to that.

In a healthcare environment, it’s up to everyone to operate “at the top of their license.” And as the doctor on the team, it’s up to you to ensure everyone else is working in their scope, with an appropriate degree of autonomy. Most people thrive when they have a degree of ownership and independence in their work, and the ability to make their own decisions. When I give more responsibility to technologists, nurses, and schedulers, they’re often eager to learn and help me within their role. When you empower people to do what they’re trained to do, they end up more fulfilled. And, you’ll strengthen your skills as a leader at the same time!

As a byproduct, the more you delegate, the safer and better a doctor you can be. You have more time to double-check those pre-op labs, look up the next patient consult, or work on a hospital safety initiative. And when you delegate well, you’re more likely to have time to enjoy pleasantries with patients and staff, or even FaceTime with your family for a minute! In the end, a doctor who delegates is nicer. 

When to make small talk

People who take the time to engage in small talk are often seen as nice. But as a busy doctor, you have an agenda. Even if you grew up the person who cared about everyone and everything all the time, it’s hard to maintain that as you take on doctoring and all its accompanying responsibilities. And sometimes, people misunderstand and think you’re less nice when you need to move quickly or get to the point. But it’s not you, it’s the role its attendant responsibilities.

You are there to diagnose and treat, then move on to the next person who needs help. So when there’s less time for small talk, you might run the risk of coming across as less than “nice.” But don’t worry. If you can’t find extra time for hand-holding, sometimes a smile or solid eye contact is enough.

Shooting the breeze, with a purpose

When there’s time, it can be fun to chat with the people around you. This can make work more enjoyable. Side conversations are a great way to deepen rapport with your co-workers, as long as they don’t get in the way of patient care. For some people, it’s a fine line, and as the leader of the team, it can be your job to re-direct people, and remind them of their responsibilities. I might need to call for a dose of IV analgesia in the middle of someone else’s conversation. Is that nice? For the patient, it is.

In another way, in the procedure suite, small talk can be a useful tool. We call it “social anesthesia.” Since we do most of our work with local anesthesia and moderate sedation, a bit of social anesthesia can go a long way to ease a patient’s nerves. A bit of therapeutic distraction by the sedation nurse can help bridge the gap as the sedation takes effect. It can help redirect a patient’s attention from their fear to their happy place, usually some tropical paradise without fluorescent lights. In this way, small talk is a kind act of generosity. It often has a reciprocal effect, putting everyone else in the room at ease. The best nurses do this automatically, but as the boss lady, you can chime in or remind them, as in, “A bit of social anesthesia please!”  

When to put nice on the shelf

The problem with “nice” sometimes, is the expectation that it should always be a priority for women. But when you’re in a healthcare environment, or leading a team, being nice isn’t always the first priority, to be frank. At worst, trying to maintain this standard can be distracting, or even dangerous, when you’re a doctor. People’s health is in your hands, and that comes first. 

Long-term, the expectation of “nice” can trap you in an exhausting cycle of people-pleasing. And while pleasing people sounds good, you really can’t please everyone, so you definitely shouldn’t base your success on it. If you do, you’ll always fail somehow! My goals are more realistic. In my most challenging moments, I try to curse as quietly as possible, and I generally avoid anything that could get me fired.

Relationship building as a boss-lady

Because of societal expectations, women in power, including female physicians, are still expected to do things men aren’t. They have to bend over backward, manage relationships first, and pad their statements with niceties, or risk social backlash. But it’s too much to ask. And it holds us back, in my opinion. Over time, as people come to know you as a leader, it gets easier. Once you’ve built a track record of doing the right thing for patients every time, people will understand and trust your intentions. They’ll empathize with your frustrations, rather than demonizing you. And hopefully, they’ll understand when you bark an order, it’s to resuscitate a crashing patient, not because you’re a “B- word” (not boss… the other one).

What’s the opposite of being nice? 

Unfortunately, lady bosses can be called expletives for behavior that would be praise-worthy in a man. When we take charge or heaven forbid, correct someone, people misinterpret this as “she is upset.” I think “upset” is a booby trap for all female leaders. It minimizes and de-legitimizes concerns as emotional rather than rational. So sometimes it helps to clarify, “I wasn’t upset, but I needed to make sure you understood the dose wasn’t documented correctly,” or “I wanted you to call me prior to discharging that patient.”

So from my perspective, as a mid-career physician and department leader, I’d be careful with striving for “nice.” It can distract or deplete you with its demands. Personally, I don’t make it the top priority. Don’t get me wrong, being nice is pleasant… like a luxury. But it’s less likely to save your life than the lady who takes charge and knows her priorities.

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Lifestyle design for the aspiring doctor
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Lifestyle design for the aspiring doctor

Financial empowerment

As an aspiring or training doctor, you’re my hero(ine). Right now, as a student, you might be facing tuition bills of fifty thousand dollars per year or more. You’ve got stress, and you’ve got exams. Or, if you’re a resident, you’re facing some tumultuous times in medicine, and you might be freaking out a little. Either way, you’ve got some obstacles between you and your future life as a doctor. It’s hard to imagine what your life will look like after all the hard work you’re putting in right now. So I got to thinking about lifestyle design for the aspiring doctor. As a practicing physician for six years now, I’ve made the huge transition that you’ll be making yourself soon. Here’s a framework to start thinking about your future and what you’d like it to look like. When you think about lifestyle design as an aspiring doctor, you’ll have a better idea of where you want to go, so you can start steering in the right direction now. 

Design your career

Some physicians are outspoken, while others are go with the flow. I skew introvert personally, so it’s somewhat surprising I’ve wandered into multiple leadership roles. As you contemplate your medical career:

  • Do you aspire to be Chief, or Chair, or Medical Staff President? Even if you can’t imagine taking those roles, you’ll be leading a medical team. So consider the kind of leader you’d like to be. 
  • Your vision might improve the quality of care in your department or at your institution one day. 
  • Get to work on your interpersonal skills, and know they will also be honed on the job. Whatever your current challenges, don’t discount yourself as a potential leader.
  • Start working on foundational leadership skills. Pick up a book or listen to a podcast. Think about how you’d like to incorporate leadership into your career so you can start taking initial steps to make it a reality. 

Can your choose your hours as a doctor?

Some of the things you’ll need to think about as you transition from the student/ trainee mentality to an attending mentality will be your work-life balance. Generally, what do you expect, and what do you have control over? Having some idea will help you pick the right job when the time comes. 

Say you really like interventional radiology but don’t love waking up in the middle of the night- well you could choose to work at an outpatient vascular lab with no call, or you could work somewhere with a larger number of rads who share the call, and therefore take less of it. You could open your own outpatient based lab and focus on fibroids, varicose veins, or cosmetic IR. While none of these paths are easy or built overnight, they are all options. 

When I thought about my own lifestyle design, I considered my own drive to feel needed; it led me to practice in a smaller community that needed more interventional radiology coverage and expertise. I like being the one who knows how to stop the bleeding when no one else can. It’s been my choice to be on call at our trauma center two weeks out of each month, and it’ll be your choice too. 

Design your future finances while you’re still a trainee

When you look at your attendings, you’ll notice that some seem to spend a lot of money. They are sharply dressed, with a dry-cleaned wardrobe and a perfectly pressed white coat. They drive a BMW, and spend a quarter million dollars educating each child (before college!) at a private fancy school. So you might wonder, is that what doctors do? Is that what I should do? 

From the high overhead costs to practice medicine, to the educational debt we take on, many doctors get used to spending money they don’t have. But the cool thing is, you get to decide how you’ll manage your finances. So start learning about personal finance as soon as you can. Read about how people “survive” on $30k per year for some perspective- this has helped me. Learn about the concept of a savings-rate, so you can be prepared with a goal when you get that first attending paycheck. If you don’t have a plan, the money will sit in your bank account, looking like it’s there to be spent. It’s your choice how you manage your money, but the earlier you think about and get used to saving, the better. Your future self will thank you!

Design your personal life

  • Do you want to be the person who operates into their seventies, or would you rather plan for a second act, say, becoming a creative or a globe-trotting vagabond by your sixties? 
  • Do you want to fund your kids’ education at a public university? Will they attend private school? Or do you want them to enjoy an Ivy League education, debt free?
  • Wait, what kids? 

When you’ve had your nose to the grindstone studying medicine, it’s hard to remember you have a right to make all these decisions about your life, just like everybody else. At least that’s how I felt at the end of training!

You’re the heroine in your own adventure. And while you won’t always have control (over your fertility or the challenges life throws your way), a lot of this stuff is up to you. You can be a surgeon with four kids, and train other future surgeons! You can have four kids and Chair a Radiology department. Or you can opt to have fur babies, or a pet project instead. Lifestyle choices don’t dictate your career choices; you can do what you wish. Don’t let anyone tell you you can’t. 

Design your time outside the hospital

Would you believe I took 12 weeks off work last year? What did I do with all that time?

  • I attended not one, but two NON-medical conferences, in order to learn skills outside of medicine. 
  • I spent a week at a medical conference
  • We spend a couple weeks each year with family back east. 
  • My little family of 3 likes to travel, so normally we’d be planning a trip abroad… those plans are on hold for now. 
  • When I’m not galavanting to other locales, I’m stay-cationing at home, or playing stay-at-home mom. 

When I take a week off, I can actually go to therapy (during banker’s hours!), where I work out the mental and emotional kinks. Without the extra time off, my schedule simply wouldn’t allow for it. With the remaining time left, I can read with my kid, hang out in the pool, and manage my blog. 

Aside from self-care and family care, I’ve made a hobby of learning about investing venues like real estate. I’m learning to be a landlady, with the end goal of long-term passive income in mind.

Continuously tweaking my own lifestyle helps me get closer and closer to the ideal life for me. 

Lifestyle design for the aspiring doctor

You have a lot to think about as a student or trainee, and you are already super-human for what you’ve accomplished. But in a quiet moment, you might look up from your study guide and wonder, what does my future look like? 

Well, it’s up to you to design it. Use someone you identify with as a template, but don’t forget to add your own flourishes. It’s your life, after all. It’ll be built on your individual desires, preferences, and priorities.

These are some of the things you can consider as an aspiring or training doctor. You’ve worked hard to build this life- don’t forget to enjoy it!

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things to not worry about during a pandemic
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Some things NOT to worry about in a pandemic

Career & Leadership

I was talking to my mentee the other week, and it gave me a surprisingly different perspective on the pandemic. He’s a third year medical student, whose classes are suspended for the rest of the academic year. He’s been enjoying hikes each day, a refreshing change from some recent blistering rotations and lack of physical activity. But he’s also been fretting about his plans that the coronavirus cancelled. As a rising fourth year, he was looking forward to strategic away rotations, banking on them to help him get into a competitive residency. Now that away rotations are cancelled, he’s worried it’ll affect his applications. I reigned in my surprise and reassured him. This conversation inspired me to share some things I think you should NOT have to worry about in a pandemic. 

Your competitiveness

The pandemic canceled your away rotations. It’s a bummer, but no one in their right mind could penalize you for that. Plans will change, or go out the window entirely during these months, in order to save lives. As a student or trainee, it might be hard to maintain this perspective, when you feel like your future hangs in the balance. But trust me, decision-makers will understand that you didn’t travel for an away rotation in a pandemic. If they choose to take all internal candidates over your fabulous self, you don’t want to go to that program anyway. This doesn’t signal an end or a derailment of your career- it’s just a temporary hold. 

That you should be doing more

You’ve heard some of your classmates are out volunteering for the Red Cross? Or working at a soup kitchen? If you’re the type who can’t sit still, this could be a therapeutic option for you. But if you’re scared and overwhelmed like the rest of us, it’s OK to take care of yourself and just stay home. Really. 

You could even take a break from your regular programming to enroll in this free online course on The Science of Well-Being at Yale! I’m really liking it so far. It’s a way to work on yourself and your mindset if you really feel you should be doing more right now.

What everyone else is doing

Are you upset about people on spring break in Florida, ignoring social-distancing mandates? Or are you envious of your friend Tanya’s baking projects? Staying connected to others through social media can be a helpful antidote to loneliness, but at a certain point, it’s time to tune out.

Let me offer a helpful hint if you just lost an hour scrolling on your phone. Take this time to reflect on your own personal objectives, rather than what others are doing. Build some structure into your day, so you can accomplish the things that you want to do. Revisit why you’ve pursued medicine, to refresh your motivation and perspective. Now’s a great time to work through any challenges you’ve faced, when you were too busy to reflect on them.  

Your haircut or lack thereof

Did your roommate give you a terrible haircut? Or are you displaying gray hairs openly for the first time? Personally, I’ve shifted my emphasis from aesthetics to cleanliness. At work, my hair’s tucked away, flattened under a cap, and crimped by personal protective equipment. Goodbye, pretty curls. When I’m home, my hair is a freshly-shampooed mop, or pinned off my face. I have a new appreciation for my health each day, and my grooming routine centers around maintaining it.  

Worthwhile things to focus on now 

  • Taking care of your health
  • Studying
  • Reconnecting with family

When interviews arrive, if you’re asked to explain what you did during the pandemic, reasonable answers include self-isolation, study, and reconnecting with family. This is not a time to be a stand-out superstar, but a time to do your part to flatten the curve and support your community in whatever way you can, even if that means staying home.

Being a student or trainee is stressful. And the collective trauma inherent to Covid-19 is real, so your primary objective is to care for yourself and your mental health. Take this time to peek inside your heart, and patch the holes you didn’t have time to repair before. 

So go ahead, let go of these worries I listed. Watch TV for a few hours, play video games. Know that you deserve to decompress during this unimaginably stressful time. I won’t tell anyone, promise. 

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living within your means as a superpower
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Living beneath your means as a superpower

Financial empowerment

When I was growing up, my parents split, and I faced the financial realities of divorce. For me, it meant a new school, new classmates, and living under a new roof with new rules. The change upended our lives for a few years. That’s probably why money has always meant security to me. It’s one of the reasons I was driven to pursue medicine, a stable profession with steady income. Deep down, I wanted to be able to take care of myself- and never have to rely on anyone else to do so. But later, I learned that even those with high incomes can struggle to pay the bills. No matter your income, it takes certain habits and a certain mindset to live on less than you make. You might even look at living beneath your means as a superpower. 

Money is freedom

It wasn’t so long ago I lived on disbursements of student loans, with the knowledge that every dollar I spent drove me further into debt. It was a harrowing time psychologically. I tried to focus on my studies, while I saw my loans grow to six figures. Sometimes, I’d lay in bed worrying about it. But as a student, you need to focus. And the only way to do that is to learn to live with the loans- to develop a tolerance for debt. Unfortunately, developing debt tolerance isn’t always helpful later on!

In residency, once I started making money, I started to think about how to22 tackle my debt. With time and patience, years later, I accumulated a cushion of funds. Once I could reliably pad our household account to around $10,000, we could stop wondering whether there would be enough in there to cover the next bill. I used to time my payments carefully to avoid an overdraft, but now, we could use auto-pay, freeing up precious mental bandwidth. This decreased financial clutter is just one of many reasons to live beneath your means. 

Tumultuous times in medicine

It’s disheartening to see, but with increasing corporatization of medicine, physicians are feeling more like commodities, as they get tossed about by administrators in large organizations. Medicine is still a great profession, but physicians aren’t being universally respected as they used to be. I see it at my own institution, and in the media.

In this pandemic in particular, it’s never been more important to live below your means. Some hospital systems, while cutting back on elective care, are cutting physician salaries at the same time. Worse, some systems are asking for docs to volunteer without pay, despite the risk to themselves and their families. Some facilities lack adequate personal protective equipment, and when one physician spoke out, he was fired. In times like these, there’s never been a better time to have a stash of “F- you money,” a favorite term of J.L. Collins, the author of The Simple Path to Wealth

My career was upended at the same time

Just as the pandemic was mounting state-side, my radiology group dissolved. As an independent contractor, I was left wondering when I’d get paid for the work I’d done, and whether I’d be working the next week! I knew I was needed at my hospital, but would some new radiology practice or corporation come in and try to undercut my pay? Would the hospital support us radiologists who’ve provided service all these years?  

In this vulnerable situation, I’m so glad we’ve lived beneath our means. If I was offered a low-ball salary, I could’ve walked away. If we were living paycheck to paycheck, I’d be under duress to accept whatever the new vendor offered. They didn’t know my financials, but could’ve speculated about how rooted we were in the community, and whether we could afford to walk away. If we didn’t have savings, I’d have less leverage to negotiate. Without a stash of “F- you money,” I’d have less ability to advocate for my family. At worst, a new company could’ve taken advantage of that.

If they’d low-balled me, my family would’ve been OK. I could’ve declined, and taken some time off. I’d have looked into other job opportunities or locums assignments. In the meantime, I’d be a stay-at-home-mom who blogs on the side. This blog nets a few dollars per day, and wouldn’t support the family. The reason we’d survive is because we live beneath our means. 

Who’s covering my tail?

As my company dissolved, so did my malpractice coverage and hospital privileges. It was surreal.

Tail coverage is the malpractice coverage for “prior acts:” work I’ve done over the past 6 years. My last company had this covered, until they dissolved and stopped paying the premium. Now, I’ll pay for it out of pocket. Tail coverage will cost me five figures, and it’s just one example of the costs physicians shoulder to practice medicine. That’s why I’m appalled that while other healthcare workers are receiving hazard pay to fight Covid-19, doctors are being asked to work for free. I don’t get it. Who could afford to?

These blunders highlight the importance of living beneath your means. Even during good times (like a couple months ago), we must plan for surprises. When you live on less than you make, you can absorb the financial challenges that come your way. If you’re ever fired, abused, or suddenly under-employed, you’ll need enough savings to absorb the blow, and pivot to your next move. Beyond an emergency fund, consider having a disaster fund. It might save you when you really need it someday.

What got you here won’t necessarily get you there

Since accomplishing my first big financial goal, my peak net worth, we’ve all encountered a new reality of a global pandemic and the associated economic downturn. I have been so laser focused on that net worth goal, but now, I must shift my focus. The most important objectives now are protecting our health and conserving resources. And mentally preparing for that net worth to fall.

I’m also making moves to increase our financial margin of error. I’m refinancing our rental property, so that it becomes more cash-flow positive. This will decrease my monthly expenses as a landlady, in case one of my tenants can’t pay their rent.

Living within your means

If you’re a student, class is out. This might mean enjoying some time outdoors, independent study, and reconnecting with family. If you’re a resident, it might mean repurposing yourself as a phlebotomist or front-line physician. With social distancing and closing of non-essential business, some opportunities to spend have disappeared for the moment. It’s an instructive moment in living within our means, in a way.

At work, I plan to show up as long as I’m well. I’m sharing preparedness resources with administration, I’m doing what I can to keep my team safe. When I return home, whether I’m helping building a lego tower or cleaning up spills, it’s all part of mothering in a pandemic. These simple acts have a new significance, and I’m grateful we are still well enough to do them.

These days, the pretense of society falls away. I load my leather work bag with medicine and supplies. I take my toddler for a walk in any t-shirt I’m wearing around the house. There aren’t many people around to judge. With nothing to do but stay home between shifts, it’s easier than usual to live within our means. We’re focusing on the simple pleasures in the meantime: cooking at home, potty training, and Netflix.

How to live beneath your means

It’s times like these I’m glad we are used to living beneath our means. If you haven’t done so up to this point, or aren’t sure what that could look like for you, here are some ways you might consider trying.

  • Rent your living space until you have a large amount of savings. Owning a home is almost always more expensive.
  • Choose the cheaper version. For example, I don’t mind cheap coffee or ugly produce: they keep me in the habit of saving. One day I realized I could save money by switching to bar soap. There are always more ways to go cheap, even while living the good life.
  • Avoid waste. I save any bit of food I can. When my husband candied walnuts the other day (yeah, I was impressed), and I couldn’t finish the last few, I saved them. They’re in a tiny container, and will make an awesome snack later. I saw no reason to chuck them. Basically, avoid waste if you want a rich life.
  • Rethink your clothing. Do you really need so much of it? I like the idea of a capsule wardrobe, and have a small rotating wardrobe myself. It includes relics from years, even decades ago. I am currently writing in shorts from college (which are old enough to vote). And I’ve stopped shopping for sport.
  • Look at bad habits: I was in denial about how much money we spent on wine! I’d have a couple of glasses each night, and between me and my husband, we could blow 10-15 bucks per night. Then I thought about the yearly cost of this habit- $3000 a year! For financial & health reasons, I’m glad we cut back. Are there bad habits that are costing you money?
  • Hide the funds. I described this approach in 5 Steps to Reverse Your Budget. In short, you can intentionally constrain your budget to help you save more. This approach leaves you free to spend what’s left without stress.

Can you really afford it?

When you’re considering an expenditure, ignore your monthly income. If you’re a physician or high-income professional, your income could bias you towards thinking you can afford it, even if you can’t. I think some students and residents think a big attending salary will absolve them of all their financial sins, but it’s not necessarily true.

The reality is, once you’re a six-figure earner, you’re paying a load of taxes: think a fifth to a third of your gross or more. So basing spending decisions on your gross salary is a mistake. Doing so ignores the fact that that money isn’t all yours. A huge chunk of your gross belongs to the public in the form of income (and other) taxes you’ll pay. So be real with yourself.

You want a new car, and think you can afford it based on gross income? The question you should ask is whether can you afford it on your net income. Also known as your “take home pay,” it’s the money that’s actually yours to spend (and save) after the tax bite. To be honest, when I’m making a purchase, I ignore those numbers too. Because the less you spend, the more room you’ll have in the budget.

Another money trap

As a big earner, you don’t just pay all the taxes- you may still grapple with student loans. For many docs, student loan payments can cost $10,000- $17,000 per year or more. The larger figure is for someone paying back $500k in principal and interest over 30 years. Take a look at your loan amortization schedule to see how much you’ll actually pay for your original student loan balance. It might surprise you how much interest you could save by refinancing and/ or pre-paying like I did (note: now is NOT the time to refi if you’re paying toward PSLF).

One of the reasons I wanted to eliminate my loans was to live below my means more quickly. The loans were a large fixed expense, and I didn’t want them hanging over my head. At our income bracket, there was no benefit to keeping them, since we couldn’t deduct any student loan interest. With that monthly payment, there was less margin between my salary and total fixed expenses. I wanted it gone.

In the short term, with the lump sums I made toward my student loan principal, we had less disposable income. I stretched myself to overpay them. But in the long term, I was claiming my authority over my debt, and belittling it every month. Now that my student debt is paid, our monthly expenses are lower, and it’s easier to live beneath our means.

You are who you hang out with

Another way to live beneath your means is to be around like-minded people who live beneath theirs. Personally, marrying a practical person who doesn’t get starry-eyed about lifestyle purchases is super helpful. Sure, shrimp and lamb are among his favorite foods, but so is frozen pizza. He drives a Subaru, and probably will for life. It would be harder to reach any financial goals if my spouse was a spender.

The way you socialize can determine whether or not your budget is balanced. I once befriended a group of doctors and professionals who liked to go out to expensive restaurants and order everything on the menu. No matter what you ordered or consumed, everyone split the bill evenly. Doing this on a regular basis would be a handicap to wealth accumulation, and it made me feel helpless. I just couldn’t hang with them regularly. Their values didn’t align with mine. 

Great minds think alike

Now I gravitate toward those who have a similar lifestyle to mine. A new friend, a pediatrician, is also the breadwinner of her family. As the one driving the finances, she has a similar mindset to mine. Another friend is a real estate investor, who focuses on investing over spending. Compared to other high-income earners we know, she is frugal. She knows that any money she saves could turn into a rental property. That’s why, even as a doctor’s wife, you won’t find her sporting status symbols. Hanging with these ladies is more fun because we are on the same page.

There’s a physician in my area who died in debt with no estate plan. He left behind a complex family structure, and a mess for his family to sort through. To settle his debts, his mansion sold at a bargain basement price. His widow gets by in a condo, while her fragmented family struggles with legal fees and child support. It’s heartbreaking stuff. We can all do better by our families than this- and the first step is living on less than you make. 

Everybody needs a backup plan

When it comes to inevitable disaster, like a market crash, a pandemic, or both, living beneath your means will keep you sailing through when others struggle. It could even put you in a position to help others.

I’m so used to living on less, that the thought of living above our means feels vulnerable. Planning for financial contingencies makes for a far more comfortable life. In fact, building in financial leeway is a cornerstone of my work-life balance. And in stressful times like Covid-19, we could all use a bit of balance.

What steps could you take to live below your means? Would you like to make more money? Cut expenses? Maybe both? Or maybe this all sounds too restrictive for you.

If I’m a patient tomorrow, gasping for air, will I regret living beneath my means? I don’t think so. One day, after my last breath, my family and my community will thank me for doing just that. 

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