Grad student loans: a three decade commitment

If you want to have student loans for thirty years, you can! If, on the other hand, you’re curious about the benefits of paying them off sooner, consider this run-down from The White Coat Investor. In this article I’ll share some ways to minimize your student debt to begin with. Jump in wherever you are in your own educational journey, by skimming for headings. If you minimize the loans you take out, it’ll be the much easier to slay them later!

There are countless resources available for each individual’s repayment scenario, from the best place to refinance, to the mechanics of public service loan forgiveness.  Your journey won’t look exactly like mine. My hope is to inspire you to adopt this financial goal, if you haven’t already. The following is a victory lap, er, recounting of how I did it, including the mistakes and wins along the way.  

1. Do what you can to minimize undergraduate debt.

Tuition at many private institutions now tops $50-60 thousand per year. Before signing up, reconsider your options. My mom and aunt attended Rutgers, the State University of New Jersey, so as a soon-to-be high school graduate, I thought I wanted to go somewhere more exciting, farther from home. I looked at Ithaca College, a private school in upstate New York, and Lehigh University in Pennsylvania.

Then I visited Cook College, next to my mom’s alma mater, Douglas, and really liked it. I could earn a science degree among Food Science and Animal Science majors! Cheese Wiz was invented here! With campus located an hour and a half from home, I’d still be able to test my independence.  Enticingly, Rutgers automatically slashed tuition according to a student’s high school class rank and SAT score. This was free money. With the help of a part-time job and a small stash of leftover child support, I left college debt free.

2. Choosing a Graduate Program

At the age of three, I told my Aunt Marie I wanted to be a surgeon.  In high school, volunteering in a local emergency room, I wanted to be a physician’s assistant or physical therapist, as I saw people who looked like me (women) working in those roles.  By sophomore year of college, I realized I was smart and motivated enough to become a medical doctor. I applied to a joint BA/MD program with UMDNJ, the University of Medicine and Dentistry, across the river from Cook College. I was selected, and thus had the privilege of taking first year med school coursework during my junior and senior years of college, helping to minimize my future student debt.

The campus bus shuttled me back and forth between college and medical school. Some courses even counted toward both degrees.  I took the first year medical biochemistry course, and passed by the skin of my teeth. Toiling to improve my performance paid off. I could matriculate as a true second year medical student upon graduating from college. In addition to pushing my academic limits and introducing me to my older, more sophisticated new peers, entering the BA/MD program saved me at least twenty thousand dollars and a year’s time.

3. Grad School Admission Savings

The MCAT, the medical college admissions test, was not required to apply to the BA/MD program, so I was spared having to prepare for or take it. This saved time and money. Instead of paying application fees and traveling around the country to many medical schools, I applied to one.  Some students with early or strong applications could consider conserving resources in this way.

Before embarking on a prospective career path, compare the ratio of the anticipated educational debt to the expected yearly income. On The White Coat Investor Podcast, Dr. Dahle explains this concept, in the context of a orthodontist whose student debt grew to surpass a million dollars. Episode 59 of the podcast, entitled “Is Dr. Mike Meru Crazy?” expounds on the utility of this analysis.  Improve the debt side of the ratio by attending the highest quality, least expensive schools available. Having an idea of this ratio will help to determine how quickly you’ll ultimately be able to repay your loans.

4. Think of student loans as a mortgage on the mind

Two brilliant students got full scholarships to Robert Wood Johnson Medical School each year, and some students were financed by family. I was not in either camp. With the benefit of the BA/MD program, however, my final debt landed at the class median that year. By taking steps to minimize my student debt along the way, I got my Medical Doctorate owing one hundred thirty-six thousand dollars.

5. What about your own healthcare?  

Before the days of remaining on a parent’s health plan into one’s late twenties, I had a catastrophic insurance policy. This would cover fifty thousand dollars of care, should I land in the hospital from too much Jungle Juice. For health maintenance, I utilized the college’s student health center. It was free. Later, I got exams at Planned Parenthood. I continued to use their services through residency, benefiting from their sliding scale payment model. Since a graduate student in 2018 is likely to age out of their parent’s health plan, a contemporary approach to healthcare coverage during this stage may include a heavily subsidized health plan on a public exchange, or a high deductible health plan with a health savings account.    

6. Weigh the cost of being a resident in an expensive city.

I interviewed at many programs in and around New York City, but  worried about the high cost of living. It would be exciting to live there, but not as a poor resident. There would be limited time and money for experiencing the city anyway. So I ranked the best training programs on my list, which were located in lower cost of living areas, to help minimize my debt burden and maximize my chance of getting ahead financially. 

7. Don’t fall for forbearance.

A couple of years into residency, my loan servicer notified me I would soon enter repayment. I had hoped the balance would sit there until the end of training, like a sacred offering to the education gods. But given the choices I’d made so far, I had some extra money, and I started paying. I rented a drafty apartment in a historic building. Furnished with a couple new things and Craigslist finds, it was comfortable, and within my means.

A co-resident, on the other hand, lived in a polished apartment with matching furniture, in a trendy building nearby. So I was surprised when I found out his student loans were in forbearance. He felt unable to start repaying his loans during residency. Some residents don’t realize that in forbearance, interest continues to accrue and compound. It may seem the lender is granting a temporary forgiveness with forbearance- but it doesn’t come for free. It is a trap which leads borrowers to pay a greater amount interest over time. If you can start paying your loans during residency, I recommend it. 

Confused about your loan repayment strategy? Use the free calculators, or book a consultation with Student Loan Planner. 

8. Avoid consumer debt.  

Between intern year and the start of residency, I had one week to move across the country. Sadly, this meant letting go of my first car, a trusty ’96 Honda Accord. I sold it on Craigslist to an elated teen boy. Meanwhile, on the East Coast, my mom found me a lightly used Mazda for twenty thousand dollars. Could I have purchased a cheaper vehicle? Probably. Mom’s influence meant I got one nearly new, and fully loaded, to match her “you deserve it” mentality. Owning the Mazda outright became one of my earliest financial goals. I paid it off as fast as I could, and drive it to this day, 10 years later.     

Technology has brought about wonderful opportunities to save on expenses like transportation. Today, even someone with limited time or in a remote area could peruse countless used vehicles on the internet. Development of ride share services, available within minutes via the ubiquitous smart phone, make owning a personal vehicle unnecessary in some places. If I found myself in a small city like Providence again, I could get rid of my car, and rely on a combination of bicycle, Uber and Amtrak.   

9. Scale Debt Mountain. Slay the debt dragon.

Interest rates from the first half of medical school in 2005-2006 were consolidated at 2.5%. Loans from the clinical years were fixed at 4.5%. A private loan for residency interview expenses topped 7%. Sadly, today’s higher education loans can reflect an interest rate closer to that of my private loan. It’s no fun to look at these enormous balances, which barely seem to budge in the face of regular payments. I plodded forward, initially paying mostly interest, and throwing extra funds toward the principal balance when I could.

I attacked the highest interest rate, while paying the required minimum amount on each of the remaining loans. By focusing on the most expensive loan, it became satisfying to see the balance decrease with my successive overpayments. When the private loan was eliminated, I took a breath, and set my sights on the federal loan bearing the next highest interest rate.

10. Find money on a resident’s salary.

The average resident now earns $59,300 per year, according to Medscape’s 2018 Residents Salary and Debt Report. This is close to the median US household income of sixty-one thousand per year. Yet some residents struggle to repay their loans. I can tell you some of the things I did to squeeze that resident salary, and minimize the effect of capitalized interest on my student loans.

We got a small meal card allowance for the hospital cafeteria each month. Once it was used up, I ate whole wheat peanut butter and jelly sandwiches for lunch. It was cheap, easy way to fuel me. After stacking multiple sandwiches in the freezer, I grabbed one on my way out each morning, and it thawed in my bag by lunchtime. Occasionally I splurged on lunch at Au Bon Pain, but my default lunch was PB&J for two years.  

How did I minimize my expenses in training? I did not have a gym membership; I exercised outside. Living in downtown Providence, I was located about 4 miles from the hospital. Therefore, I walked or biked many places instead of driving. I was close enough to the train station to walk with luggage for a weekend get away. I did not subscribe to satellite radio, or have a TV. Therefore, I had no radio, cable, Tivo bills. A friend of mine, also a resident, struggled with Tivo addiction. It saved her time, she said, not having to watch commercials. I did not start a family. I bought no property. Abstaining from these activities helped me accumulate cash so that I could hit my loans again and again.

Getting out of my apartment

I read a lot in residency, and was often more productive when I left my apartment. I realized I could use the library at the Rhode Island School of Design because of my affiliation with Brown University. This cavernous space, formerly a grand bank building, was located just a few blocks from where I lived. There, I could study with a city view through beautiful domed windows, in a gorgeous space funded by other people’s tuition money.  

Latte factor

I never developed an espresso habit, at four bucks a drink. When I went to a coffee shop for a change of scenery, I’d buy a drip coffee or tea as the price of admission, and loiter for hours. I imagined myself a sort of trainee-vagabond. Fortunately, my good friend and study buddy was a like-minded, frugal girl who didn’t peer pressure me to spend more, or to buy the sad, overpriced convenience food.   

Meals and entertainment

Another perk of residency, Brown paid for a meal out, if we signed up to accompany applicants to dinner during their interviews.  We could attend as many of these events as we wanted during interview season. We could order a drink, plenty of calamari, and a piece of fish or steak, without having to pay for any of it. Sometimes, the night devolved into a boozy comedy, resulting in a funny or embarrassing story to recount over the coming weeks. This was free entertainment.

When I traveled to New York to visit friends, I slept on their couches. I spent extra for the business class train ticket, as it was far quieter and more comfortable than a standard car.  This meant I could meaningfully study or catch some sleep on the ride. Since both were needed throughout my training, I spent the money with intention.  

11. Prepare for fellowship

After residency, my boyfriend and I drove to Los Angeles to embark on a fellowship year at UCLA. We needed housing in short order, and we pounded the pavement on a high pressure search. In a gentrified area of West Los Angeles, central to the three hospitals I would need to get to, we found a rent controlled flat in a concrete 1960s apartment block, for thirteen hundred fifty dollars a month. It was a steal.

We shared my car, meaning I biked to work each day, and Bob slogged through traffic, trying to build his business as a self- employed musician and music teacher. We often cooked at home. When we ate out, it was often at an inexpensive street vendor, or a noodle bar within biking distance. Since I worked forty to eighty hours per week, there was little opportunity to spend money, and we ended up saving money throughout the year.

12. Consolidate the loans & stay cheap.

By the time we relocated to the Southern California desert to begin my first “real job,” my pay was set to increase five-fold. I refinanced with a popular Bay Area servicer. With fifty-five thousand dollars left to go, I reduced my term from twenty-five years to five. My payments increased to north of eight hundred dollars monthly. I seized the variable rate of just under two percent. Knowing the rate could increase put my feet to the fire. I could have chosen a fixed rate around three percent, but I was hungry for the kill, and greedy for the lower rate. After a couple of years, even the five-year term began to drag on. I received regular notices of tiny incremental rate hikes. I hit my principal balance again, with five thousand dollars here, seven thousand dollars there.

Instant gratification

You can make paying your loans gratifying, by changing the way you think about it. Paula Pant, founder of Afford Anything, a financial freedom blog and podcast explains how, in her post, “17 Lessons to Improve Your Money & Your Life.”  Under heading #3, “Never Delay Gratification,” she describes how to reframe beneficial activities so they become inherently satisfying.  When making a payment on my loans, I thought of the instant “return” on my money, realized by reducing my principal balance, and thereby the amount of interest I would have to pay moving forward.  

Still paying your student loans? Eat free food!

Doctors eat for free where I work. It is easy to take advantage of this perk, given my long hours, and ample working weekends.  Some days, I eat three square meals in the cafeteria. This has saved me thousands of dollars per year, freeing up money to pay off student loans.   

Stay motivated to eliminate debt.

Catching up with an old roommate over the phone, I was flabbergasted to learn she had paid off her student loans, totaling over one hundred thousand dollars, just two years out of training!  I thought I was working hard on vanquishing my loans, while she had already reached the finish line. A competitive spark flashed within me, and I found myself re-energized to obliterate my balance.

Some months later, I was a new parent, and my loan balance had finally fallen to four figures. I decided to make the final payment. Feeling like confetti should have fallen from the sky, I paid the remaining balance.  The next screen noted a confirmation code, and that I’d receive a confirmation letter by mail. That was it. Three and a half years out of training, the mortgage on my brain was paid.

There were a thousand small financial decisions along the way.  I certainly benefited from the advantages of a middle class upbringing in a suburb with good public schools.  I stayed in-state for a low-cost, high quality secondary and graduate education. Given the advantages I had, what could I have done differently to better optimize my debt strategy?  

Mistakes I made in debt pay-off

I could have reduced the number of residency and internship interviews, thereby reducing the amount of private loan funds needed for the associated travel. Many were within driving distance, but some required a flight. Thirteen radiology residency interviews later, I could have gotten away with fewer. I was driven by the desire to experience living in different parts of the country while I was unattached. Should I have chosen to move around less during training, I could have saved money. I might still be driving that 1996 Accord!

During training, I bought several new pieces of furniture to help me feel rooted. I was putting a band-aid on my loneliness, trying to placate myself through the competitive years of residency. When the four years ended, my parents took some of the furniture to New Jersey, and I liquidated the rest on Craigslist. In the end, I valued exploring new locations over keeping my possessions. And I paid for it.

I lived alone in residency, and was not organized or motivated enough to optimize my housing costs. Monthly rental for a studio in a crummy neighborhood was eight hundred dollars. I later moved to a larger apartment in a safer location, paying twelve hundred fifty dollars per month. If instead, I’d bought a condo or small house, I could have paid my mortgage with the help of roommates. This idea has been dubbed “house-hacking.” Chad Carson is a master in real estate, who started by house-hacking with his wife. He describes his methods in Episode 16 of the ChooseFI Podcast, entitled, “House Hacking with Coach Carson.” Short of house-hacking, I could have gotten roommates to reduce expenses and minimize my student loans.

Lifesyle inflation

On relocating, we rented a condo in Palm Springs for two years.  I drooled over the beautiful homes around us. We found a house that checked all our boxes. It even had solar panels, to offset the cost of air-conditioning six months of the year.  Now, a couple years into homeownership, and with a recent plumbing disaster under our belt, I can say that owning is leagues more expensive than renting.  Between episodes of maintenance and repair, we truly enjoy it. We have friends over often, and even hosted a house concert. It is an enjoyable, though certainly not a frugal way to go.

My husband and I traveled to Europe twice before my loans were paid off. After fellowship, we took a three-week trip through Eastern Europe. We were housed and transported about by family in the Czech Republic for part of the trip, while we spent the rest on a sailboat in Croatia, island hopping with friends. We saved here, and splurged there. In the end, minimizing student debt was key to my success in paying it off.

I am sometimes haunted by my student debt.  

Recently, I had the startling realization that I hadn’t paid my student loan bill in a while… I momentarily panicked. Then I remembered that that bill was gone forever.

How will you feel when your student debt is history?

Now, take action: Make a plan for those Student loans!

Physicians, know your worth

Five years into practice as an attending radiologist, I have negotiated my first contract, multiple pay increases, call compensation, and independent contractor status.  I prepared by researching my market value and reading about negotiation strategy.  The following are some things I learned along the way.  As physicians, we must know our worth, and be able to leverage it in a negotiation.

If you negotiate in medicine, you may feel like the only one.

Over the years, some colleagues have confided that they have not received any pay increases.  Since I started at a lower salary, right out of training, I realized that knowing my worth and negotiating would be critical to increasing my salary over time. Not negotiating was not an option.

My first lesson in knowing my worth

In 2014, the depressed radiology market worried my co-fellows and I.  After sweating the job search for several months, we each received job offers with the same starting salary.  We were each able to increase on the starting offer by asking for more.  It is intimidating to ask for a pay increase, especially when making a first impression on a new employer. But the practice managers on the other side of the table see medicine as a business, and if you want to be properly compensated, you should too.  

Consider your options to counter an initial starting salary offer:

a)  Counter offer = (initial offer) * 1.05

b)  A number just below the one that will get you laughed out of the room.

c)  Something in between

Negotiation isn’t taught in medical training.

During residency and fellowship, salary is based on one’s “PGY,”  or post-graduate year level, with some geographic variation.  In this model, trainees don’t negotiate their salaries for three to six formative years!  They just accept what is given.  Then, when training is over, salary increases to a junior attending level, and multiple variables are added to the salary equation.  Therefore, the new attending must know her worth, quickly learning to advocate for herself.

Know your worth, vis a vis:

• What’s the going rate for a shift?
• What do others receive for call compensation?  
• Is call pay included in a daily, weekly, or yearly rate?
• What is the most you can realistically hope to get?
• What is the least you need to feel adequately compensated?

Knowing these figures is key to avoiding a negotiation hangover.  

Renegotiating: it’s not a one time deal.

After a year at my attending job, I prepared to return to the negotiation “table,” albeit over the phone. I was working for a flat salary, and was often asked to work extra weekends for no additional pay.  At the time, I figured I was paying my dues. But after that year, there was no question that I had to negotiate for better terms. 

My approach was as follows: I considered the difference between average attending pay in my field and where I started.  I figured my salary should reach the higher figure in the first five years of practice, if not sooner.  Then, I divided the difference between the median and starting salary by five to calculate the yearly raises I’d aim for.  It helped to calculate these figures ahead of time. Being familiar with these figures was key to avoiding settling for too little.   

Yearly Raise =  (Dream salary – Starting Salary)/ Years to partner or peak earning potential

Break taboo & talk about compensation

To know your worth, you must talk about pay: with those around you, those you trained with, and colleagues at meetings.  Talking about pay helps foster transparency, and can help even the playing field. Women and minorities are particularly vulnerable when transparency is lacking. An analysis by Glassdoor.com in 2016 quantified the gender pay gaps in the US, Great Britain, and Australia, based on their crowd- sourced data.  Controlling for various factors, the authors revealed an “adjusted,” or unexplained gender pay gap across various industries, including medicine. Transparency helps women, minorities, and those early in their careers to bargain for optimal compensation.  

Research your worth

The following are some online resources to help figure out your market value:

• Radworking.com has job descriptions including starting and potential compensation.
• Payscale.com shares anonymized information from other users regarding pay and benefits, when you create a profile on their site.
• Doximity.com has an interactive salary map populated with anonymous data from more than 18,000 physicians across the U.S.
• Job recruiters and industry representatives can serve as regional sources of information and opportunities.

Gauge your target audience

Are you negotiating with a peer, or someone of a different generation?   Are there cultural factors at play? I was negotiating with three men, and was the youngest physician in the practice. I was and remain the only female interventional radiologist in the group. These factors can contribute to how attempts at negotiation are perceived. Consider Sheryl Sandberg’s analysis of the “tightrope” women must walk in her best selling book, Lean In.

Put on your thick skin, just in case.  I was called “money hungry” for negotiating early in my career.  Going into the discussion, this was my worst fear: being criticized for advocating for myself and my family.  In the moment, I was non-reactive and business-like. Later, I received an apology.  It’s not greedy to negotiate for maximal compensation. It’s smart to know your worth.

Practice (finite) patience.  

After my first year as an attending, my contract negotiation was postponed for months. Decision makers in the group awaited the results of  hospital contract negotiations. It was a period of uncertainty, during which my Chief Operating Officer seemed to prepare me for a pay cut.  Finally, my contract was reviewed.  I was given an increase in call load, and a significant increase in compensation.  At that time, waiting for the group to secure its footing with the hospital was a key prerequisite to negotiating my first contract amendment.

Nurture relationships with decision makers

Demonstrate the ways in which you are an asset to your group or institution. “Toot your own horn,” as Debra Condren describes in her book, amBITCHous: (def.) A Woman Who: 1. Makes more money 2. has more power 3. gets the recognition she deserves 4. has the determination to go after her dreams. Share any accolades you receive with your boss. When a patient of mine sent a complimentary letter to our hospital CEO, lauding me and my team for providing excellent care, I received a thank you letter from hospital administration. I immediately forwarded the letter to my group’s CEO.  His reaction was to praise me as a “star.”  

Highlight any flexibility you offer: can you perform high-end interventional services one week and diagnostic services the next?  This allows for tremendous flexibility in physician scheduling. Are you the most up to date in a certain area, for example, just out of fellowship at a transplant center? Have you improved the practice through your leadership?  

Show your decision- makers evidence of increased referrals, improved departmental efficiency, excellent patient outcomes, or rave reviews from your referring physicians. Presenting yourself as a consistent asset to the group increases leverage at the time of negotiation.

Negotiate anything

Some institutions pay based on academic rank or other hierarchical factors.  If a higher salary is not possible, or even if it is, consider negotiating something else.  Like:

• Paid time off
• A new title
• Academic or administrative time
• An educational stipend
• Office space
• Access to assistant(s)

At the end of maternity leave, I negotiated an independent contractor agreement.  I now have greater control over my schedule, and aim for at least ten weeks off per year.   

Contract review

The contract serves as a framework for the working relationship.  It’s important to review it with an attorney, particularly one with experience negotiating physician contracts.  This is especially important if you are new to concepts like non-compete clauses, partnerships, buy-ins, or malpractice coverage.  

I was initially offered a standard contract used for diagnostic and interventional radiologists.  My attorney was able to help shape my agreement to reflect the combination of work I’d be doing as a hospital-based interventional radiologist, in-house diagnostic radiologist, and occasional remote reader.  For example, I initially received no call compensation, but negotiated a cap on the number of call weeks I would take that year. 

Tail coverage would not be covered by the practice, and was non-negotiable. My attorney helped me to understand the implications of this future cost, should I change jobs. The contract indicated a minimum number of studies to be read in an imaging shift.  We added language to protect me from docked pay in the case of factors beyond my control, like low hospital volume. 

I found my attorney using an online marketplace called UpCounsel.  The contract review included a phone consultation, follow-up emails, and a review of contract revisions.  A personal referral to an attorney, particularly in the geographic area you will be working in is ideal, if that is an option for you.  

See opportunities to negotiate

These strategies are not just for exceptional candidates or those with multiple offers. When you know your worth, you can earn the level of compensation you deserve. Variations of the negotiation game can be played in different settings, whether academic or private, diagnostic or interventional, city or countryside. 

What strategies have you found helpful in researching your worth, or succeeding at the negotiation table? 

I have some secrets to share. There are too many to list here, but I have to let you know. Even as a successful female attending, I don’t always feel that way. And in the past seven years, I have hit some bumps in the road. There’ve been moments where my reputation was in jeopardy, and my very job was at risk. This breaking-into-the-boy’s-club thing isn’t for the faint of heart, but I know you are strong enough to handle it. Here are some secrets of a successful female attending. (Shh!)

Some things I’m sure of, as a successful female attending: 

Women are not the “weaker sex.” Womanly strength has covered my local interventional service when other vulnerable people needed coverage. 

Here’s a secret: men are human too. They get sick, they break bones, they have heart attacks, and statistically, they don’t live as long! So I don’t agree when women are treated as second class citizens in the workplace. I.e., the pay gap. 

Super secret: women pull their weight. Did you know, when i went on a 10 week maternity leave, they needed to bring in multiple locum docs to cover me? It turns out I was working quite a lot, and the guys covering didn’t want to work that much.

Here’s a secret people have yet to catch onto… the benefit of living in modern times (aside from covid) include readily available childcare, house cleaners, even a spouse who works less than or more flexibly than you! I take advantage of every one of those things (don’t tell anyone). 

You know what shouldn’t be a secret anymore? 

That not all women thrive as stay at home moms. That many women are tremendously talented and driven beyond the walls of the home. It’s not 1970 anymore. Women are literally half of the talent pool. It’s no secret I’m tired of hearing about women working twice as hard for half the recognition.   

You know what’s still a secret to some? Negotiating isn’t greedy when you’re a woman. It’s a requirement. When I renegotiated my salary for the first time, I was called the G-word. Greedy. I’m serious. I survived, and so will you (if it happens, though it shouldn’t, ever).

And while I’m sharing… here are some mistakes I see y’all making.

Be honest with yourself. Do you:

1. Discount, dismiss, or forget the accolades you’ve received? (Write ‘em down!) 
2. Make yourself small for the ‘benefit’ of others?
3. Ruminate on criticism, fear, imposter syndrome, or all of the above?
4. Listen to other people’s limiting beliefs about you?
5. Think money is dirty, or something for other people to take care of? 
6. Internalize misogyny or benevolent sexism? (I have, and probably still do)
7. Overthink a lot of things?
8. Think you lack what it takes to address inequities you face? 
9. Lack self-compassion? 
10. Deny the agency that’s available to you, now and in the future?

There ya have it. These don’t need to be secrets or liabilities anymore. 

Consider this chat like the moment of “real talk” reserved for the ladies’ locker room. 

I’ve worked through some of these obstacles, and I can tell you, life is better when you do. And it can be incremental, like a work in progress. 

In the coming weeks, I’m going to introduce a brand new course offering. It’s all about building your career capital so you can build your empire. It’s a mix of career coaching and personal finance, from the perspective of a breadwinning boss. I have learned to save lives and enjoy my own, and I want that for you, too. In many ways, I’ve told you “what” you can do to empower yourself as a female physician. Now, I’ll show you how. If you’re not on my mailing list and want to be updated, be sure to jump on it by clicking here.

Stay tuned!

Hi Friend. Every few blog posts will now be dedicated to catching you up on the podcast I’ve been working on. These are short little episodes, 5-15 minutes. You can listen on the go and get a dose of divine feminine energy with me as you walk into your male-dominated space. Here are the new episodes, which relate to chapters 1 and 2 of Save Lives, Enjoy Your Own, the book!

It’s so interesting to think about finding your people. What does that mean? I explain what I mean by it in the book, and you’ll get a taste of it here. It’s easy to think, especially in the medical and STEM fields, that your people might look a certain way. In the male-dominated fields, we see a lot of stereotypes. In my field, a typical IR is male. They might be white, Asian, or South Asian, but they’re usually not female.

Over time, I’ve come to enjoy surprising people- by smashing their expectations. I exist in my department almost as an act of defiance. It’s been a while now that I’ve felt at home there- in my office, and in that interventional suite. It might take you some time to feel at home when you are finding your place in medicine. In the book, I talk about why this matters… why not just settle on something with more regular hours, so you can get home to your family? Because the meaning of your life is greater than that found inside the confines of your home. And how do you find your people when you feel like an outsider? I share some clues you might encounter that lead you toward your people.

Basically, these are people you can get nerdy with.

I hope you enjoy a listen, and let me know if you like this new medium!

This week, in honor of National Women Physicians Day, I bring you part two of my pregnancy journey. In case you missed part one, you can read it here. As I gestated month after month, I had to figure out how maternity leave worked, and who (aside from my husband) would care for my child when I went back to work. Looking back, it’s a blessing we got through that period of change. I’m grateful that in the end, I survived human resources (HR) and natural childbirth.

Unanswerable questions like: will I retain my health insurance coverage?

I say survive because it was not a seamless experience. Please note, this is my experience with a former radiology company that no longer exists. While I was on leave, I wanted to confirm my health benefits would remain intact. Seems like an obvious “yes” over a 2-minute phone call, right? Nope. My HR contact, the head of the HR, in fact, and a mother of three herself, could not give me a straight answer. It was pretty stressful. To make matters worse, she repeatedly used the word “terminated” to refer to my employment as I transitioned to leave. “I’m not quitting,” I assured her. “I’m the breadwinner of the family. There’s no question about whether I’m coming back.” I clarified this point, hoping she’d stop talking about my termination.

But on she went. “Are you f@#&-ng kidding me, lady?” I wanted to yell at her. But she was so nice… just oblivious. She seemed to be well-meaning but some of the terms she used were just tone-deaf. She droned on about how I might need to pay for COBRA, depending on the length of my leave, though I told her the amount of time I intended to take. It was bewildering. And not comforting. My husband and my new baby would be relying on that health coverage. Not to mention me, the pregnant person, staring down the largest medical event of her life thus far. In the end, there was no interruption of my health insurance, and no need to buy expensive COBRA coverage. But there was uncertainty. 

Uncertainty meets frustration with human resources

As I prepared for my medical leave, I felt confident in my place as a valued and respected doctor in the practice. I’d pulled more than my weight in the years leading up to my pregnancy. So I was not bashful about asking, “Is there a maternity leave policy?” No. There wasn’t. A nationwide radiology practice had no parental leave policy. And I’m not talking about paid maternity leave. They didn’t have any written policy on how it would work, whether a pregnancy worker would retain her health insurance coverage during leave, for example. Apparently, I had 5 sick days to use before my state disability went into effect. I didn’t realize we even had sick days up to that moment (apparently, they are required by law). I had to figure these logistics out as I went, getting mealy-mouthed answers along the way. 

Lame excuses from human resources…

States have different pregnancy laws, and this was my former group’s excuse for not having a parental leave policy. So despite my intimations that they should create one for the next individual affected, they never bothered. As I mentioned, this company I speak of no longer exists. Maybe it wasn’t forward-thinking enough. One thing I’m sure of is that in 2021, companies are operating in a world where more women are breadwinning than ever. They must have these policies in place. And FMLA is not enough. 

FMLA is a loosely constructed federal protection, which holds a woman’s job for 12 weeks if she and her employer meet certain criteria. A company must have a certain number of employees and a worker must have worked at that company for at least a year. Well, since my radiology company had taken over from my last employer less than a year prior, I wasn’t even technically protected by FMLA. 

Thankfully (?) it’s a huge cost and pain to recruit doctors, and my job was not in jeopardy. In fact, they needed multiple locum docs to cover what I’d previously done. I’m certain that coverage cost a pretty penny. Let’s just say everyone was eager to welcome me back. 

A pleasant surprise following maternity leave

Prior to becoming a parent, I’d worried that my becoming pregnant might be a liability to my career, how I was perceived, or how I was valued. But I must say, it had a paradoxical effect. As I prepared to return from leave, my Department Chair asked me to step into a new leadership role. I became Chief of Interventional Radiology.

It goes to show that there are places that value the contributions of women, even if they don’t do everything right. This felt truly deserved, as I’d been largely leading the section through my early career. Despite that, it was certainly the largest title I’d held up to that point. So I became “mama” and “chief” in the same season. 

One thing I want to share, in case you’re planning a future pregnancy, is the concept of short term disability. If you work in certain states as an employee, you’ll automatically pay into a state disability fund. But if you don’t live in one of those states, and you’re planning a pregnancy, you should buy your own SDI policy.  

Disability Insurance

Calling pregnancy a “disability” may be objectionable to some, but it is the current manner in which pregnant workers may qualify for partial income replacement in the period surrounding pregnancy and childbirth. 

Two types of disability insurance are pertinent to the pregnant worker:  state disability insurance (SDI) and/ or a purchased short term disability insurance policy.  

No federal disability insurance or benefit is available to those giving birth or adopting at this time. 

State Disability Insurance (SDI)

Employees working in California, Hawaii, New Jersey, New York, Rhode Island, and the Commonwealth of Puerto Rico may be eligible for state disability benefits related to pregnancy and birth. In some states, this benefit is called temporary disability insurance or “TDI.” Workers in these states contribute to the state disability fund during each pay period. 

To qualify for SDI, short term disability benefits, a medical practitioner must certify a disability is present.  A pregnant worker or new mother must meet an income threshold in the year prior to qualify for state disability payments. The monetary benefit she receives will reflect a percentage of weekly pay, based on a sample period during the previous year, with a ceiling. For example, in California, the maximum weekly benefit in 2018 was approximately $1170.  There is a waiting period of 7 days before one may claim SDI benefits. Refer to your own state’s department of labor webpage for further details. 

A warning about approaching human resources!

An employer may have their own requirements for initiation of a medical leave (like taking sick days before leave is initiated).  Ideally, parental leave parameters should be outlined in the employment contract.  If not clarified at the time of contract negotiation, this kind of inquiry may be perceived as an announcement of a pregnancy.  Be prepared to clarify this point.  

Short Term Disability Policies

If a worker does not qualify for a state disability benefit, or if this benefit is insufficient, short term disability insurance may be purchased.  An employee or self-employed individual may purchase short term disability insurance for this purpose only before she becomes pregnant.  The option to purchase such a policy will usually occur during the enrollment period for other employee benefits, such as medical, dental, and life insurance plans. Speak to your benefits coordinator or human resources department to find out more about the options available.  Short term disabilities start after different amounts of time which is important to consider when purchasing if one is planning on using this for maternity leave.

For more pregnancy and post-partum resources, head to the SIR’s Pregnancy Toolkit, where you’ll find information about radiation safety, general tips and tricks from those who have been there, and other resources. 

And about the birth. More surprises!

Oh, and I mentioned that I almost had an accidental home birth! It’s true. After a week of riding waves of nausea and misery, I was feeling pretty good one night, when I had a late-night snack. I wolfed down a tuna sandwich and Sun Chips, and within the hour, they were back again. I was in labor. Specifically, a stage of labor called transition. Most women transition in the hospital. I was transitioning at home.

I could hardly speak. “Call. Thunga.” That’s all I could utter, one staccato word at a time. My husband had no clue what I was saying. I was asking him to call my colleague in anesthesia. I needed an epidural, now. A freight train was moving through me, every few minutes. I’d been trained to record the interval between contractions, but I could hardly manage this myself. My husband quickly packed the car. It was the middle of the night, and it was time. 

These were telltale signs of the onset of active labor. We made it just in time to be leisurely greeted by the staff on L&D. I was a primipara, a first-time mom, so they didn’t take me too seriously. I began bleeding as I changed into my hospital gown for the nurse to check my dilatation. My cervix was fully dilated, and they rushed me to the delivery room. My water burst with a strong contraction, as though someone had pelted me with a water balloon. It was 2 am, and I was relieved my OB made it in time to catch the birth. 

Like a force of nature

I’d hoped for a natural birth, or natural-ish. Epidurals could slow labor, I’d heard, and I didn’t want to be in labor for days. As it turns out, I was way too late for an epidural. I’d planned to bounce on an exercise ball to pass the hours. But our suitcases never made it out of the car. The power of unmedicated birth felt like a freight train. It’s a power I’ll never forget.

I’d survived human resources… and natural childbirth. 

I’m 37 years and 10 months old– an age at which I can no longer take my fertility for granted. As my three-year-old blossoms into a chatty delight, and even when he challenges me, I’m beyond grateful for him. In the first couple of years of my parenting journey, I couldn’t fathom having another child (though it seemed like anyone and everyone felt free to ask about my plans for a second kid!). I was still learning to mother the first. But lately, I want my boy to have a sibling. I’ve been thinking about my own pregnancy journey, as I contemplate going through it again. Pregnancy is not for the faint of heart!

Are you ready? 

Before we made a decision to proceed, I’d ask my husband this question: “Are you ready?” He would nervously laugh and say no. It’s not that we didn’t want to go ahead, but the thought of opening ourselves to the possibility of a pregnancy felt like jumping off a cliff. It would change everything– and are you ever really ready for that? So even though I knew he wanted a kid/ kids too, he would nervously laugh and say no, whenever I’d ask. Finally, we were as ready as we were ever going to be.

It started with a miscarriage… sort of

The first time I got pregnant, I felt pregnant. The hormones circulating in the ether weren’t quite mine. It was the feeling of progesterone. I’d felt something similar on oral contraceptives before. It was a bit of a dulled feeling, which left me just a little calmer, compared to my usual energy. My close friend who’d given birth the year prior suffered bleeding throughout her otherwise healthy pregnancy. So when I didn’t suffer any bleeding myself, I assumed we were doing well. I figured I was having a normal pregnancy. I even scanned myself at work, glimpsing the flutter of the baby’s tiny heart. Or so I thought. 

When it came to the first official ultrasound a few weeks later, all we saw was a sac with some membranes. It looked like cobwebs. The image, projected on a large flat-screen TV on the wall surprised me, and I began to cry. 

When my beta HCG didn’t fall to zero, it raised the alarm bells that something else might be going on, like a molar pregnancy. I underwent a D&C to make sure there was no retained tissue or other abnormality. In the end, there was no evidence of mole, and we chalked it up to a blighted ovum.

Pregnant again

Months later, I became pregnant again, and this time, it was smooth sailing. There was nausea but no vomiting. I was able to work pretty normally. I used an acupressure band on my wrist and chewed anti-nausea tabs. To mitigate my symptoms, I’d sit during procedures when I could, like for thyroid biopsies, as an example.

For fluoro-guided interventions, I added an extra piece of lead around my waist to double down on radiation protection. Confidentially, I got a fetal dosimeter. After the first pregnancy misfire, I wasn’t ready to announce my pregnancy to everyone just yet. 

More unexpected news: pregnancy is not for the faint of heart.

At an early ultrasound for nuchal translucency, the technologist noticed that my cervix looked short. Even as a radiologist, I didn’t realize we could catch a short cervix so early in pregnancy. And so began my high-risk pregnancy. From then on, I reported to the local high-risk OB for frequent cervical measurements, in addition to my usual prenatal appointments. I felt cared for, but concerned. Why did this happen? I had no risk factors for this condition. Would I have a pre-term baby? The thought was terrifying. 

Meanwhile, my husband had seized a golden opportunity: he signed on with a traveling jazz ensemble called Postmodern Jukebox. He would be away for 4-8 weeks at a time, for three tours during that year. It was a scary time, and I tried not to dwell on the thought that I might suddenly need an ambulance while he was on the road. Thankfully, that horrid vision never became a reality. 

High-risk pregnancy and my life

In order to reduce the risk of pre-term birth, I was placed on bed rest. I could get up and make myself a sandwich, but I was not to walk around the block. This severely restricted my activities, and I became essentially housebound.

To make matters worse, the summer in the Southwest is scorching. I’d be homebound while the temperatures soared into the one-teens, occasionally hitting 120 degrees in August. I floated in my pool, whose waters rose to over 90 degrees. I was floating in water nearly the temperature of amniotic fluid. For hours, I floated there, reading about birth and baby care. 

High-risk pregnancy and my career

Thankfully, I did not have to go on disability. At the time, I was already doing a week of teleradiology here and there. That became my gig for five months. I sat at home, reading diagnostic images. My doctors would not allow me to work in the hospital, with its long hallways, barium studies, and other procedures that would keep me on my feet. It was no longer safe.

I was so grateful to be able to continue working, as I’m not sure how I’d have managed otherwise, mentally and emotionally. The structure work made me feel I was still contributing to the practice, rather than a burden on anyone. Who knows who I’d be a burden on, but I think it’s just human nature or doctor-nature to think that way. 

As I dictated hour after hour, I imagined my little baby was listening to me, getting smarter, or at least learning the sound of my voice. While other women fretted about going into labor in the operating room or in front of a patient, here I was, sitting at home at a pretty early stage of pregnancy. For someone so used to living at the hospital much of the time, it felt strange! 

Supporting pregnant employees is probably not for the faint of heart either

I will say, everyone at my (former) company was extremely supportive of the high-risk nature of the pregnancy. They had no maternity leave policy, but that’s a story for another day. 

I’m so thankful I was able to keep working in a telehealth capacity. If I’d needed to take a longer period of disability, I suppose my long-term disability insurance may have kicked in. I’m not sure. 

In the end, I got steroid shots just in case baby was premature. I was elated to make it out of the 20-29 week stage and into the thirties, where baby would have a fighting chance. Doing what I was told, with medications and precautions, we made it to 38 weeks and zero days. He was perfect, and I got my greatest wish: avoiding the NICU. 

Pregnancy is not for the faint of heart

That last week of pregnancy was tough. I suffered waves of severe nausea so strong, I presented to my OB and broke down crying. Previously wanting to try natural childbirth methods, I sobbed, “If this is what birth is like, please put me OUT. I can’t take it!” 

She sweetly smiled with a glimmer in her eye and told me, “That means he’s coming soon.” 

I worked from home through that week, taking an hour off here or there as needed. 

The pregnancy experience is really what you make of it. In many ways, I was tremendously supported, and other times, I was disappointed by my experience. It was anxiety-provoking and lonely. I was a prisoner on house arrest, in my gilded cage. But would I do it again??

Tune in for part 2, and I’ll share how I nearly gave birth at home. By accident. 

Is that TMI? Maybe. But I’m betting some of you might wonder what the gestating journey can look like in a surgically-oriented field like IR. No matter who you are or what you do for a living, pregnancy is not for the faint of heart!

xo

By the way, if you want to hear from me weekly, make sure to jump on my mailing list. I’ll share all the gems I’ve learned in my first 7 years in practice, and show you how to slay in a male-dominated field.

This post is inspired by Twitter and the silly threads you’ll see there featuring “wrong answers only.” This kind of thread is often inspired by a funny picture… or one that could have many possible explanations. If you’re not on Twitter yet, head over there to see what I mean, and get a dose of humor. It’s true, some use Twitter like a living curriculum vitae (CV). That’s certainly the case in my field of interventional radiology. The platform lends itself to sharing interesting cases and learning points, especially image-based ones. Even if you’re in a less image-oriented field, there is plenty of #MedEd to be had. Physicians and other healthcare workers post about thought-provoking patient encounters, dealing with difficult situations, and all kinds of advocacy. To be honest, it can be a lot to take in. It’s a cacophony of voices. But those are a couple of reasons Twitter keeps me engaged from time to time, and why you might want to jump on that bird app yourself. And as promised, here are some reasons why I’m successful at work (wrong answers only).

Why I’m successful (not!)

I never have a complication (they happen).

I never miss a diagnosis (we all do).

My perfect hair (it has a different personality each day, and I don’t spend a lot of time fighting it).

My people skills (I try, but I’m still learning).

I smile at staff for no reason (I can’t smile my way through life. It’s not naturally me.)

I floss my teeth at work (…it has to be done, but I try not to get caught)!

You’ll never see me lose my cool. (Um, have you heard practicing medicine can come with some inherent frustrations?)

Everyone likes me (really, some just tolerate me).

I get along with everyone. (I try to find some way to make some small connection with those on my team.)

I’m kind and patient in the IR suite. (In reality, everything is time-sensitive. And you just kinked my wire again, newbie…)

Gender bias is a thing of the past (…sadly, it’s alive and well, but I don’t let it stifle me anymore).

Here’s some radical honesty about being successful.

So the next time you think you need to be perfect to succeed in medicine, think of me! I’m proof there’s no need for perfection. We are succeeding when we’re doing the best we can each day (truly). If you need a reminder, make sure you listen to my recording, 7 things to keep you going strong on the path to becoming a doctor. I share some secrets and foibles there. 

Hungry for more encouragement and connection? That’s the aim of my new podcast, Save Lives, Enjoy Your Own, which you can consume anywhere you get your podcasts! I’m a fan of the Overcast app, but I’ve used the Apple podcasts app as well. It’s even on Spotify, so now, you can instruct Alexa to fire up an episode of “Save Lives, Enjoy Your Own!”

Please take a moment to drop a comment below, about why you’re successful at work. Wrong answers optional!

You can leave a comment by clicking “hide/show comments” below this post. I love hearing your reactions, thoughts and experiences.

‘Till next time, keep thriving!

What is someone like me, a full-time interventional radiologist, mom, and blogger– what am I doing starting a podcast?? I never thought I would do start one, even when my friends told me I should. A podcast is so much more accessible than a blog because you can listen on the go, they told me. I knew they were right, but to be honest, I was intimidated by the learning curve. And the extra work. But here’s the thing. Hearing the sound of someone else’s trusted voice has helped ME at times when I’ve felt so lonely. And listening to podcasters and leaders has made me feel so connected to others. It’s a powerful medium. And we need connection now more than ever. So I started a podcast. According to my personal mantra, it’s called Save Lives, Enjoy Your Own.

Another driver behind the podcast is that I see LONELINESS in training as a problem. I think this is particularly true for those aspiring to competitive fields, and/ or fields in which there is a prevalent “bro” culture. If you’re a woman, you might feel left out in that kind of environment. That’s why I think projects designed to stamp out loneliness and isolation are the key to thriving in medicine. As an example, check out the Stanford Story Rounds. It’s a regular meeting on campus for students, trainees, and attendings to tell their stories, as a way to build community and support each other. That is what I’m trying to accomplish here, in a way. I think this platform can support women in the traditionally male-dominated fields of medicine. 

The why behind my new podcast. 

One day, pre-COVID, I was asked to present a talk at the Medical Students’ Scholars Dinner at the annual meeting of the Society of Interventional Radiology. I was so excited to address some of my future colleagues in this forum. But it was in Seattle, in March of 2020. Let’s just say I was relieved when the meeting was canceled. I didn’t want to risk getting sick, or worse, bringing back the virus to my elderly and infirm patients in Southern California.

So I recorded that talk (here). It featured some of my most awkward failures, and what they taught me. And the feedback from that recording touched me. One medical student, an aspiring plastic surgeon, told me how she listened to my talk again and again, even as she fell asleep. I do that too… sometimes with guided meditation, other times with an audiobook. Often, I drift off to the voice of someone I admire. And it’s an honor to be able to play that role in your life: to be one of your guides as you traverse your own heroine’s tale. 

What to expect from the Save Lives, Enjoy Your Own Podcast

This podcast will provide a backstage pass to my book. Every other week, I will work my way through the book, introducing each chapter and a personal story around it. I’ll share excerpts of the book, and my own answers to the Spill Your Guts exercises at the end of each chapter. My aim is to remind you, through the sound of my voice, that women not only exist but can thrive in their chosen specialties, even those traditionally known to be boys’ clubs.

The podcast is unedited. It’s real talk. And for now, it’s just me. 

Check it out here!

If you like what you hear, please share with a friend, subscribe, and leave a 5-star review! 

I hope you enjoy your own.

Let me know how you aim to do that this week in the comments below!

How many awkward comments will you receive, and how many awkward questions will you endure as a woman in a male-dominated field? So many. And sometimes they’ll be prefaced with the cringe-worthy, “I’m not trying to be sexist but…” How do you field them gracefully, so as not to alienate those around you?

The latter question adds insult to injury, doesn’t it? The biased and even blatantly sexist remarks women face in the workplace can be compounded by the backlash they can receive when they (you) respond. Being in an attending role, I’m asked how to handle these kinds of incidents. Here’s a recent example, from a mentee, a medical student traversing her clinical rotations.

A chat with a vascular surgeon gone sideways

She reported: “I’ve enjoyed vascular surgery so far, and they’ve involved me in a lot of procedures! I got to cut a metatarsal this week! I’ve also seen several IR procedures this week, like thrombolysis and an EVAR. It’s been interesting to see how we think through the decision to approach a case at surgery versus in interventional radiology (IR). I mentioned to one of the vascular surgeons that I was interested in IR. He replied “I’m not trying to be sexist but…” then proceeded to tell me that as a woman I shouldn’t choose a surgical specialty and asked how I’d be able to have kids if I pursued IR…”

My response initially was…

That’s why I wrote this book…

And basically… I don’t know if you can change him, or if it’s worth your time.

But (I’m sad to say,) I’d expect to hear more comments like that in the future.

You could reply or try to stand up for womankind, but depending on how it’s received, you could face backlash, like a lackluster grade on that rotation. 

Here are some possible responses. I’ll leave it up to you whether you say them in your head or out loud. 

When you’re fielding blatant sexism, try:

1. “Anything preceded by ‘I’m not trying to be sexist but…’ is nearly guaranteed to be sexist, and doesn’t excuse you from saying it.”  
2. “Who determines who ‘should’ pursue a certain career path?” (The individual in question, or the crusty, outdated notions in your little head?)
3. “What year do you think this is?”
4. Define mansplaining to the perpetrator. Suggest that if he (or she) hasn’t actually been a mother in said field, he probably shouldn’t advise on it. Or, cite numerous examples of inspiring and successful women in the said field. 

Approach with curiosity

5. “Do you think that comment is helpful?”
6. “Why did you choose a surgical specialty? Did you ever consider that women may have the same motivations, aspirations, and skills? Did you ever consider that to deny someone’s potential because of their gender is an idea not fit for this century?” 
7. Ask, “Do you have kids? Who is fathering them when you’re operating and seeing patients?” 
8. Ask, “Does your wife work outside the home?”
9. “Do you realize that women comprise more than half of the talent pool entering medicine these days?” 
10. “Do you realize that because of systemic biases, women have to work harder and be objectively better than their male peers to be noticed, respected, and trusted?”

Judging them… and prompting them to judge themselves

11. “Sorry, can you repeat that?” (With an incredulous tone, and a quizzical look)
12. Make a face… “Why would you say/ think that?” 
13. “Would your mother approve of that attitude toward women?”
14. “Do you find gross overgeneralizations helpful… in general?”
15. Did you know women comprise more than half of med students these days? You’d better hope they do become surgeons so there will be one to take care of you when YOU need one. 
16. Would you want your own daughter to make career decisions based on her reproductive equipment, or based on the fact that she’s a person with the brains, heart and soul of a doctor? 

Dripping with sarcasm, if regionally appropriate

17. “Did you know they actually allow women to be surgeons now?! It’s wild…”
18. Women physicians have been shown to have superior outcomes. So… perhaps men shouldn’t be allowed to be surgeons.  
19. “Do you have kids?” (Yes, I have two, they’re great, blah blah…) “How did you expect to do that and be a surgeon?” 

Responding to, “Women shouldn’t choose a surgical specialty. How will you have kids if you do?”

20. “Whether or not I choose to procreate is independent of my career choice, actually.”
21. “I have a partner who believes men and women should both be involved parents.” 
22. “Have you ever given birth or been a mother in medicine? Then how do you know what it’s like or whether it ‘should’ be done?”
23. “Have you heard of benevolent sexism? It’s the idea that men know better than women, simply because they are men. I suggest you read about that tonight.”  

If all else fails… and he wasn’t trying to be sexist… he was just trying to help

24. Did you know that sexist comments like that are damaging to the environment and to future physicians’ careers?
25. Did you know it’s not 1970 anymore? 
26. Hand him a copy of my book and suggest he donate a copy for every member of the nearest medical school, so he can help the student body to learn not to perpetuate these disempowering notions.
27. Hand him my website so he knows sexism is a problem in medicine, and not to be a part of it. 

Don’t get fired reacting to sexist comments

But don’t let them derail your dreams either. That’s the tightrope you’ll walk as a woman in training. You can do it. You can probably do it backward in high heels, like Ginger Rogers, or in awkward clogs on 3 hours of sleep. Despite these sexist comments that fly at you, you are strong, and you are worthy. It’s these comments that are all wrong. They’re trash; a product of lazy thinking.

How you choose to respond to sexist behavior is up to you. You don’t have to die on this hill, and you don’t have to verbally slap anyone across the face. But in the right moment, if you find a receptive ear, you might just find an opportunity to examine the bias you find and stomp it out. 

attending: so what are you interested in?
me: surgery
attending: you’re a tiny little thing, you think you can do that? maybe ophthalmology

???????

— livv (@inbedmd) December 31, 2020

Is it hopeless? No. If I thought it was, I wouldn’t spend all my free time here writing about how you all should join me in male-dominated fields. I think once we as women, (minorities, and non-binary identity folks) reach a critical mass, our presence will become the new normal, and things will continue to slowly change.

It’s not your job to fix anyone. You already have the burden of doing your best every day and learning as much as you possibly can. In the end, it doesn’t matter what some guy (who is wrong) thinks. It’s your plan! They’re your dreams!

I’m not trying to be sexist but… I think women are often better than the guys, because they’re required to work harder for the same level of respect. And when I need a surgeon or specialist one day, I’ll be praying it’s a lady. 

Sometimes, I hear from one of you, and it reaffirms what I’ve suspected all along. That you’re still hearing the same old ridiculous garbage comments and advice, as you chase down your dreams in medicine. I got permission to share a recent exchange with a rising star, a fourth-year medical student at the University of North Carolina. Ms. Ainsley Bloomer plans to become an orthopaedic surgeon. Here’s our exchange. Incidents like these leave me thinking, “Seriously, can you believe this guy?!” This is not to say there aren’t a lot of great male advocates out there… but we still have a long way to go to reach gender equity, especially in the male-dominated fields of medicine.

She writes:

Dr. Hamilton, 

Thank you so much for sharing your passion for your job and your family with the internet. I think it would be super helpful to hear about how one should handle difficult professional situations as a woman in a male-dominated field. If you feel comfortable sharing anecdotes along with tip/tricks for handling tricky to navigate situations, that is a topic I cannot hear enough about. It is great to be able to learn from someone else’s experience.

Best,

Ainsley Bloomer

I responded, intrigued

Hi Ainsley!

Thank you for that idea.

Can you tell me more? 

What’s a difficult situation you’ve witnessed or experienced yourself?

I recently heard from a mentee that a vascular surgeon told her women shouldn’t do IR, so I planned to respond to that encounter in the form of a post. 

If there’s a difficult situation I don’t feel qualified to speak to, maybe I can find a guest to write one.

What stage are you at by the way? Student, resident?

Have a great weekend!

BH

Future orthopaedist receives discouraging messages from various unnamed offenders… can you believe these guys?

Absolutely! This is something I have thought A LOT about as I hope to one day be a mentor for others as we work to improve our current medical atmosphere. I apologize if this is a lengthy response. But I feel this is something I don’t quite yet have the right words to express. I can provide examples, and I would guess you have a list of your own experiences to share, too. 

I am a 4th year medical student at UNC SOM applying into orthopaedics. 

Some examples of comments I have received include:

“You’re not strong/big/tall enough to be an orthopaedic surgeon.”

“Do you know all orthopaedics surgeons are men?”

“Why would you want to do that? It’s so labor-intensive and you have to physically work so hard.”

“Do you know it’s really competitive to become an orthopaedic surgeon?” 

“Do you think you’re qualified?”

“You’re going to do hand or peds, right? That’s what all the women do.”

Truthfully, these types of comments motivate me more than deter me, especially when I consider the source. I think it’s important to respond in a calm tone and in a leisurely and relaxed way. I think it’s also important to be subtly assertive in your commitment to your field of interest. It’s my hope that over time, we can eliminate discouraging medical stereotypes and open these pathways so that others don’t have to go through the same obstacles in the future. 

Supporting each other through gender bias

I think this conversation is so important. There is a theory of learning termed “fire walking” where trainees can learn from the mistakes or experiences of their teachers so they themselves do not have to go through the experience to gain the knowledge. Although there are certain aspects of education we have to work through on our own, some knowledge can be passed down verbally. It really helps to hear an attending level perspective on handling situations whether from a “what I would do” or a “what I wish I would have done” point of view.

The other thing I anticipate hearing in my future career are questions about kids and having a family. I also have seen and experienced some of the tension that can occur between female nurses and female medical students/residents/attendings. This is also something I think would be such a helpful topic to hear about from attendings as to the best way to calm any hostility from the get-go. I aim to be a team player and respectful in every interaction, but sometimes things go sideways, and it is helpful to have the skills to recover from these interactions so we can go back to being productive. 

I look forward to hearing more bits of wisdom!

Best,

AB

This is why I love hearing your truth…

This is great, thank you so much! I have to chew on this a bit, and I’d love to hear your take. 

How have you responded to these comments, if at all? 

I have a blog post which is specific to interventional radiology in some ways, but covers some overlapping stereotypes. It’s called myths in interventional radiology. I meant it as a myth-buster so people wouldn’t see these discouraging comments or stereotypes as real. I wanted to dismantle them and show their ignorance!

But the post doesn’t deal with how to respond. 

I think so often, especially with the power differential as you come up the ranks in medicine, it’s not always possible to give a response. And if the comment hits a nerve, it’s not always possible to give a composed response on the spot. In my experience, that is very hard! 

That’s why I think so much of this is internal. What I mean is, women are doing internal workarounds to deal with the biases and put-downs that come their way. And community can be a salve. We need each other just to validate the struggles we face, and support each other, whether in person or virtually. I wonder what you think…

Do you think it’s your responsibility to make the road smoother for everyone who comes after you, by correcting those who make these comments? It’s a noble thing to do, but it’s not required. 

And in my opinion, just you being where you are, and doing what you are doing is giving other women permission to do the same. It’s teaching old school and narrow-minded people that it’s not only possible for women to do these things and have these roles, but that it’s going to become the new normal. 

BH

I have responded to some of the comments. She continues:

Sometimes, others have stood up for me, and that has been a really amazing experience. People who didn’t even know me well have “stood up” on my behalf, and it’s something I will never forget. I hope to be able to do that for others. Sometimes we feel strong and resilient, and sometimes we just don’t. You never know what someone else is going through and what could be their breaking point. 

Your point about the rank/ power differential hits the nail on the head. 

As to your question, I do not think it is my responsibility to fix others. It’s definitely not my place to correct the person, as I don’t want them to become defensive. I hope that by answering in a relaxed and confident manner, a well-intentioned person might refrain from repeating these discouraging or biased comments to the next person. 

In medicine, it seems like we often try to reinvent the wheel, when really, our energy and ability to innovate should move the needle toward progress. There are so many patients to treat, pathophysiologies to explain, and treatments to create, that it feels like such a waste of time to have to defend my career choice and my reason for being here. 

Also, I think there is a tendency for those with “softer” personalities, for lack of a better term, who might have been fantastic in a specific career but were pushed into another field because they did not fit the stereotype. Perhaps those of higher rank told them they would not make a “good surgeon/ interventionist/ orthopod,” etc. Maybe all they needed to succeed was a little support, and some experience to buttress their confidence. 

I think too for those that don’t fit the stereotype, there is a tendency to feel the need to go above and beyond to prove they deserve to be there. 

Sorry… I have a lot of thoughts on this topic, and I can see it from a variety of different angles. My eternal New Year’s resolution is to be more concise.

-AB

Can you believe this guy?

There’s nothing wrong with your response- it’s a complex topic, and your insights are valuable!

I appreciate your willingness to share because I don’t want it to be me “having the answer” as if I’m speaking from on high- because I don’t have all the answers. 

But what you said about people who don’t fit the stereotype being great and missing the chance to be who they were meant to be- that is how I see my former self. I narrowly missed settling for something else, because it’s easy to ‘trust’ people who ‘know more than you’ in medicine. And I think it’s important, as much as you take feedback and examine it, to listen to an inner voice. Clearly, you know what you want to do, and I’m grateful for that! These voices haven’t made your foundation shake. 

BH

What do you think? Can you believe this guy?

What do you do, and how do you feel when you’re on the receiving end of comments like this? Share with us in the comments below.

And don’t forget to sign up for your continuing financial education with the Annual White Coat Investor Physician Wellness & Financial Literacy Conference in March! Sign up by January 11th for a special WCI Swag Bag (valued at $100) and a Bonus Bundle from me (valued at $499). To read about my upcoming talk, check out last week’s post by clicking here.

Hey there, and Happy Holidays! If you are looking for the perfect gift for the doctor in your life, whether that’s YOU or someone else… read on! I’m excited to announce I’ll be speaking at the annual White Coat Investor’s Physician Wellness & Financial Literacy Conference on March 4th-6th. Network and learn from the comfort and safety of your couch. I’ll be speaking about creating money momentum as an early career doc. I have tackled my early career finances in such a way that, despite living in a medium/ high cost of living area in California, I’ve managed to amass some wealth. In my talk, I’ll share some of my money philosophy, mistakes, and moves that have helped get me here. This is a sneak peak into the talk I’m planning for March!

WHY bother gaining financial momentum? 

Won’t I be fine with a doctor’s salary? You might wonder. It was a pretty steep learning curve, and a bit of a smack in the face to learn the stark difference between gross and net pay. That big number you’re working for? It won’t all be yours after the tax bite, so don’t plan to spend it all. 

My wakeup call happened as I exited fellowship, and my husband and I planned for a jump in salary from 70k to more than quadruple that. It was up to me to figure out what to do with it. How could we take care of this money? How would we discipline ourselves so we weren’t tempted to spend it? We sat down with a financial advisor to make a money plan. It takes discipline and an education to take care of your new-found and long-awaited earnings!

Mind your career longevity:

7 years into my career, I’ve identified some keys factors that contribute to career longevity:

• Picking the right career to begin with
• Switching gears from the pace of training to the pace of attending life
• Learning to be mindful and take care of your money-maker (that’s you)

The primary residence: should you buy a home??

According to recruiters, as many as 70% of physicians across all specialties change jobs within their first two years out of training. Even if you plan to stay where you are, you might benefit from renting first while you learn the area.

The bottom line is, maintaining a home generally costs more than renting. Often, it’s a lot more. So if you still have student debt and aren’t on solid financial footing, consider renting until you are. If you’re still itching to buy a house, read this first.  

How can you gain money momentum with all those student loans dragging you down?

Make a plan. Don’t put your head in the sand. 

Lifestyle creep: good or bad?

Incremental creep is okay. But on the other side is hedonic adaptation. When I was a kid, if we were going anywhere with a pool, I wanted to plan my whole day around enjoying that pool. Now, I have one in my backyard. It’s part of everyday life, and it’s hardly exhilarating. Sometimes it’s really nice to soak in the hot tub, while other times, I don’t go in for months, and it’s just another expense to maintain it. The pool is a great example of hedonic adaptation. You can get used to all kinds of lifestyle upgrades, and go broke doing it. So if you’re aware of this dynamic and plan for it, you can decide how you’ll handle it before you go broke on the hedonic treadmill.

Being selectively cheap can power your financial momentum. Last week, I was chatting about cars with my support staff, in the context of my looking at an electric or plugin-hybrid. When they heard what I was driving, they actually laughed in surprise. They all have newer cars than me. Instead of feeling embarrassed, I felt a little proud. Because it’s my choice. I still enjoy the car I have, and I haven’t had a car payment in years. If you have an area in which you can cut costs, it can help supercharge your financial trajectory.

Money momentum can empower you

…but it’s not everything. 

In my view, money can buy freedom. Having an accessible pile of money, like a sizable emergency fund, can give you the flexibility and peace of mind we all crave. In The Simple Path to Wealth, J.L.Collins called this extra money, “F-you money.” That’s because it allows you the financial cushion you’d need to make a big move for the sake of your goals or happiness, like walking away from a toxic job or situation. In this era of decreased autonomy, decreased reimbursement, and increased job uncertainty, there’s never been a better time to have F-you money, just in case. 

Sometimes, even before you’ve reached a net worth of zero, dropping a few thousand on a special trip or experience can keep you feeling like you’re living for the now, not just the future. When I had a five week stretch off after fellowship, my then-boyfriend, now-husband and I had the chance to backpack around Europe. It was well worth the spend.

Will you join us?

The goal of WCICon is to help improve the financial literacy and overall wellness of physicians, dentists, and other high-income professionals. We (WCI and I wholeheartedly) believe that increasing the financial security and overall wellness of doctors enables them to be better partners, parents, and doctors along with reducing burnout, decreasing suicide risk, and improving patient care.

If you join us, you’ll get to hear not just my fabulous talk, but over 50 hours of educational material that you can access on demand. CME credit is available; use your CME funds to learn about wellness and personal finance, including my approach to gaining some money momentum early on!

CME details: let your employer pay!

Continuing medical education credit for physicians, medical professionals, and CE for dentists will be available. This activity will include up to 17 AMA PRA Category 1 Credit(s)™ and dental CE credits. That may allow you to use your employer-reserved CME funds to pay for it, and/or write it off as a business expense. Considering how many conferences were canceled this year, many of you are still sitting on unspent CME funds. This is a terrific use for them.

Registration & TSH Bonuses!

Register HERE, and you’ll benefit the mission of the TiredSuperheroine platform at no additional cost to you. In fact, I’ll throw in a bonus bundle to say thanks! It includes:

• A 1:1 coaching call with me. 40 minutes to work through your money or balance quandary. If you’re already thriving, we can talk about strategy to reach the next level!
• Your choice of a 6 month membership to Audible (including 6 audiobook credits) & the Plus Catalog or a bundle of TiredSuperheroine favorite books in physical form.

Swag bags!

Register early (by 1/5) and get a swag bag too! This year goodybags include books written by each of the keynote speakers, a WCI t-shirt and swag, and items from conference sponsors (approximately $100 value). If you sign up by January 5th, WCI will ship these to you so that you can have them in hand when the conference begins.

Note: it looks like they’ve extended early registration through 1/11/21, but if I knew I was going to register, I’d do it now, to claim that swag!!

Check out this lineup, which includes more women than ever before!

The Money Mindset Transformation Class You Wish You Had in Training -Latifat Akintade MD

Successful Budgeting: The First Step on the Pathway to Wealth -Disha Spath MD

How to Nail Your Next Negotiation in 3 Simple Steps -Linda Street MD

Changing Your Life One Line at a Time -Jennifer G. Christner, MD

The Biggest Investment You Will EVER Make -Kate Louise Mangona, MD

Financial Freedom Means Changing (Some) Behaviors -Jess Thompson, MD

When Life Gives You Lemons: Wisdom from a Young Physician -Audrey Jean Roberts Ludwig, MD

How First-Generation College Graduates Can Reach Financial Independence -Dewan K. Farhana, MD

You’re Burned Out…Now What? -Dawn Baker, MD

How to Build Another Source of Income by Investing in Real Estate -Letizia Alto, MD

How to Raise Financially Fit Kids -Sanghamitra Sadhu, MD

And a ton more topics, which you can check out on the conference website here!

Here’s the timeline:

BEST DEAL* Now through January 5th, 2021: Early registration with swag bag ($100+ value) is $899

January 5th through March 6th: Regular Registration (no swag bag) is $899

March 4-6th, 2021- Conference is live!

GOT QUESTIONS? Email me at tiredsuperheroine@gmail.com

Happy Holidays! Wishing you health, wealth, and money momentum in 2021!

There are a lot of fields in medicine to choose from. How do you find the right place for you? It’s quite the task to figure out where you belong in the medical field, as complex and varied as it is. Even when you find a specialty that lights your fire– one that makes your hair stand on end and that makes all your neurons fire in the best way– how do you know if you really belong there? It’s a pretty high-stakes decision, choosing the right career. No pressure… pick the right career, or else.

Despite women comprising more than half of medical school students, there are still many fields that seem to repel women. So if you’re interested in urology for instance, how do you keep from being repelled for the wrong reasons? 

Women are clustering in to pediatrics, OBGYN, and other *relatively* lower-paying specialties: think endocrinology. If you are truly driven to be in one of these specialties, then you’re following your true north, and the work itself can be part of the benefits package. But what if you choose in part because… well, it seems easier to work with some other female colleagues around? Or because some attending physicians ‘advise’ you to choose something ‘easier’ than the field you really like?

What are the consequences of picking the wrong career?

1. The gender pay gap no one talks about. 

I’ve noticed that no one talks about the gender pay gap- the huge, yawning gap that arises from women clustering in certain specialties. Take a look at this study. It says as women enter a field in increasing numbers, there is a tipping point at which it loses its alpha allure, men stop entering the field, and pay FALLS. This article made my head hurt. But it also reaffirmed the virtue of pursing the right field based on the work, not the demographics. If you choose a ‘woman-friendly’ field, beware of the pay cut that often comes along with it.

I talked about this article with Bonnie Koo on her podcast, WealthyMomMD. Check it out: 

The right career can help you duck burnout

2. Epidemic rates of burnout

The other reason I’m interested in career choice is because I think it behooves you to pick what fuels you most. Medicine is demanding, so you might as well choose the field that puts you in a time warp. The one where you forget that clocks exist, and you emerge from a case or interaction as if from a spell. That’s what happened to me recently, as I attended to a trauma patient who needed angiography of multiple body parts. He was a one-man code “triage,” and the surgeons and I masterminded minute to minute, in order to figure out what needed to be done next, as his blood pressure floated from the nineties to the seventies systolic. 

When administration makes a decision that makes my eyes roll, what keeps me going is knowing I’m doing some real good in my work. Knowing I’m using my skills and talents at the highest level to help patients is fulfilling, despite the difficulties in our current medical environment. Being the only one in the hospital who can help in a specific way, using my specific skillset, makes me feel like a critical part of the team. And no one can devalue that. 

This is what helps keep burnout at bay. It’s what makes going in at 10 pm for an emergency a duty, not a burden. 

I’m worried burnout, especially in women, though multifactorial, can come from settling. Settling on a career based on extrinsic, rather than intrinsic factors. That’s why the message of my book is to choose the field that fits you best, and ignites you the most. Settling seems a recipe for disengagement and burnout. 

Can you afford to pick the wrong career? 

3. Maybe, but it’ll cost you dearly. 

If you don’t like your job, it’ll cost in career satisfaction. That is a major bummer after all that time spent in school and training, not to mention those student loans!

If you need to change course and apply for a new residency, that’s okay. Lots of successful people have done it. It’s worth a year or three up front, if that pivot lands you where you truly belong. 

If you have an idea of the area of medicine you’d like to practice in, and you grow out of it or realize it’s not quite what you thought, it’s okay. 

If you think, “Why do a fellowship when it’ll cost me a year of attending salary?” I’d say the investment is worth it if fellowship gets you where you want to be. To do a fellowship, you’ll earn maybe $70k, maybe more with moonlighting, if that’s an option. You could be earning $200-300k as an attending though, so you’re “losing” $140k or more, right? NO! 

Not if that fellowship brings your earning potential higher! If fellowship garners you an extra $50k per year (say, on average, even if this is oversimplified), then over a 20 year career, that’s a million dollars in gross earnings. In these decisions, keep the long view in mind, or it’ll cost you!

That’s why I wrote Save Lives, Enjoy Your Own. To help guide you toward the right decision. It will help you sift through your talents to realize how much exploring you need to do. The book will prompt you to spill your guts (my journaling exercises) so you can dig beneath the surface, below other people’s expectations of you, to what you really desire in your career.

Career longevity in the right career

A key component of making a living and building the life you want will be career longevity. If you don’t love what you do, it won’t be long before everything else becomes more important… your partner’s career, your kids… and what will be left of your career? It’ll become low priority. It’ll get what’s left over. 

If you practice something you truly enjoy and can grow into, you’ll be poised for a career that’s as long as you want (and you need) it to be. If you keep working, especially as a primary breadwinner, your family can enjoy the financial security that comes from your ongoing ability to earn. 

Boredom in the wrong career

Getting bored is a thing, even in medicine. And if you stop feeling stimulated and engaged by your work, it can become a slog. So word to the wise, from someone who is entering her seventh year as an attending, go for a specialty that feels like a bit of a reach. Take a leap of faith into something that intimidates and stretches you a bit. Because that big, beautiful brain of yours might get bored of something if it loses its challenge. I’ve seen it in others.

Was I intimidated by all there was to learn in interventional radiology? Heck yeah, I was. There were the procedures, the equipment, radiation physics, not to mention the male-dominated side conversations I couldn’t relate to. Sometimes, it seemed like too much to learn. Still, I knew it was the right career for me, despite the added challenges I saw. It’s not always easy choosing the right career, but it sure is worth it. I did it, and you can too.

Let me know what you think by leaving a comment below.

‘Till next time!