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!
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!
7 years into my career, I’ve identified some keys factors that contribute to career longevity:
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.
Make a plan. Don’t put your head in the sand.
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.
…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.
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!
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.
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!
GOT QUESTIONS? Email me at email@example.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?
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 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.
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.
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.
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!
This post is inspired by a post on Twitter from an “M0” pre-med student. She asked #MedTwitter: “What specialty or you in/ interested in, and why? Here’s my answer. It’s easy to love interventional radiology.
There isn’t an easy way to substitute the feeling of working with your hands, and in interventional radiology (IR), and specialties like it, you can do just that. Did you like crafting, making bracelets, or perhaps video games when you were younger? These are all gateway activities to becoming a proceduralist or surgeon. And to be honest, my day to day manipulation of catheter and wire come pretty close to video games.
Using minimally invasive techniques means that in my field, we use the lowest impact access known to do the work, get in and get out! That often means a quicker recovery, less pain, and less cost for the patient (and the system)!
Is there a lymphatic leak with a refractory chylous effusion? Thoracic trauma or surgery can cause these, and we can often fix them in the interventional suite.
Got gastric varices? Gastroenterology can do a lot, but they can’t reach varies in the fundus. Interventional radiologists can help by placing a TIPS, a trans jugular intrahepatic portosystemic shunt. Or, a coil or plug assisted transvenous obliteration of varices (CARTO or PARTO) might suit the patient better. Better call an IR!
When there are bleeding vessels in the pelvis which are hard to reach or too small to see at surgery, surgeons send them to angio. IR can help.
If you call me at 2 a.m., I’ll engage. Whether it’s a pelvic crush injury or a splenic bleed, I can save a life. With IR’s endovascular techniques, we can watch the patient’s vitals switch from tenuous to robust in a matter of minutes.
The “territory” I work in spans from the neck to the toes. How amazing is that? Because of this fact, you can be the belle of the ball in the doctors’ lounge. My friends and collaborators range from hospitalists to oncologists, surgeons to pathologists… the list goes on!
When you are part of such a young, nimble specialty, you can almost watch it evolve in real time. You can witness as advances are made, and even be in a position to invent a new procedure or device yourself!
I’ll end with quote from Ziv Haskal, the outgoing and ultra-successful Editor of the Journal of Vascular & Interventional Radiology:
“IR began as—and still is—the coolest specialty in medicine. It focuses on extraordinary things never done before that astonish, and ideally, gradually become routine and mundane, offered to all.”Dr. Ziv Haskal
Dr. Haskal and my colleagues in medicine know, it’s a point of pride and a pleasure to bring these minimally invasive treatments to the masses.
You can see why it’s easy to love interventional radiology. What other specialties are you considering alongside IR?
Women in male-dominated fields can feel isolated. As an interventional radiologist, there have been countless times I was the only female physician in the room. And the demographics in orthopaedic surgery are even more skewed! This spurred Dr. Nancy Yen Shipley, the subject of this post, to start her podcast. She named it for the tiny proportion of women in orthopaedics: she called it The 6%. On her podcast, she interviews successful women across the spectrum of male-dominated industries, from sports trainers to film directors, CEOs to mechanics. And of course, her fellow physicians. It’s a multidisciplinary approach to the subject, and I think it’s brilliant! Because in my opinion, women in fields like ours have a lot to share across disciplines.
Dr. Yen Shipley and I connected on Twitter when I randomly saw her Tweet announcing her new project– this idea for the podcast she’d been harboring for some time. As her ortho practice slowed down during COVID-19, she decided that it was as good a time as any to get the podcast out into the world!
When I saw her announcement, I had to meet her, and DM’ed her immediately. That’s how I came to be a guest on The 6% (Season 2, Episode 5). In our conversation, we talk about “Leading Differently as Women.” In our episode, you’ll hear more about my back story, and factors that propelled me into the field that I love so much! We chat about how nerdy (yet gratifying) it is to read about leadership in your spare time, and how women can navigate the different expectations placed on them as leaders, especially in male-dominated fields.
And here’s the episode page where you can see an outline and take a listen.
Dr. Yen Shipley, a.k.a. “NancyMD,” is an example of a real-life superheroine in the world of orthopaedics. Once I’d met her, I had to interview her for my book, Save Lives, Enjoy Your Own: Finding Your Place in Medicine. In case you gotten your copy yet, the book contains soundbites from women across the surgically-oriented fields, from OB to ortho, and of course, IR.
As I mention on the podcast, and as I blog about here— empowering ourselves as female physicians isn’t just about being treated fairly in our careers. It’s about empowering ourselves financially as well. NancyMD, like me, is a female breadwinner and mother.
Here’s a little more about her:
Well you can! On Thursday, 11/19 at 8 p.m. Eastern/ 5 p.m. Pacific Time, she’ll be presenting a live virtual event in partnership with the digital lending platform, Laurel Road. She’ll speak on her journey to becoming an orthopaedic surgeon, and how she’s learned to manage her finances along the way. The event will aim to inspire those entering and establishing themselves in medicine to take control of their own finances.
NancyMD describes herself as a financial “late bloomer,” and I can’t wait to hear more about why she says that, and what she’s learned!
This virtual event is FREE, and the first 60 attendees will receive a thank you gift! Register now by clicking here.
The event is: “Jumping Into Your Financial Journey: Q+A with NancyMD”
On: Thursday, Nov. 19 at 8 pm Eastern/ 5 pm Pacific Time
The conversation will be geared toward medical students, but the event is open to all!
I’ll be there!
What money questions have you been pondering lately? Let me know if there are any topics you’d like me to dive into on the blog!
Leave a comment below, or email me at firstname.lastname@example.org
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.
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.
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.
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?
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.
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.
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!
I’m beyond pleased to tell you, I’ve completed my book giveaway as part of the launch of my new book, Save Lives, Enjoy Your Own. I’ve sent over 700 books around the globe, from the US to Switzerland, Nigeria to Saudi Arabia, and Hong Kong to Australia. This process involved a steep learning curve. Sometimes I fought with my email service provider, other times I was running to Staples for a critical roll of label tape. Sometimes I had a surge of energy, personalizing an inscription by first name, wishing them success in their career and beyond! Other times my signature looked like a middle school boy’s boxy scrawl, signaling the fatigue I didn’t realize was creeping in. All of this was actually a part of an ideal week for me. Why?
Because as I signed and packed each book, I knew it had the potential to change the course of someone’s future career. I knew each little package could contain just the encouragement the recipient needed to become the next superstar in medicine.
Once, a mentee asked me what an ideal week looked like for me, as an IR. It’s an interesting question, and it varies from week to week. Since I spend most of my work life at a level 2 trauma center in the community, I’ll describe my ideal week there. As to my ideal week off, that looks pretty different, so I’ll write about that next. It definitely deserves its own blog post.
My ideal week as an IR involves coming in each day at 8 am. I’m on call through the night, and the ideal week involves racing in once per week to rescue a bleeding trauma, whether from a pelvic crush injury or a liver laceration. The best weeks for me include a moment where I sweat: I race to fix the bleed as fast as I can.
Since I thrive on the variety of cases in private practice at my insitution, the ideal week also includes a uterine artery embolization with peri-procedural management and follow up. It involves a few image guided biopsies, where I can stretch my ultrasound skills a bit, and perhaps a thermal ablation of locoregional disease, like a liver metastasis. I love doing peripheral arterial work, and I recently had the pleasure of taking over a case from a colleague, where he thrombolysed, or dissolved clot in the popliteal artery harboring an underlying aneurysm. I was able to exclude the aneurysm with a well-positioned stent-graft.
My ideal week involves bread and butter cases like permcath & port placements, declots, bone biopsies, and abscess drainages. Every case is an opportunity to hone my techniques, with the goal of operating as painlessly and stealthily as possible. Routine cases also allow for time to teach my growing team about peri-procedural management for common procedures.
A typical week involves going home anywhere between 3 pm and 8 pm when I’m on call. At my hospital, one IR is responsible for all the work that comes in, so we leave when the work is done. There is a typical rhythm to each week: I stay a bit later on Mondays and Fridays, while the mid-week days are (a bit) more predictable. Even on call, I might meet a friend for dinner, as I did the other day.
When I’m not catching up with a friend, most nights I’m headed home. Thursday nights my husband teaches a music lesson, so sometimes I’m rushing home just in time to be with my little boy as my husband starts his lesson. We eat and play, this week, rolling a rubber ball around the living room. Wes takes a bath while I shower, then he demands a late night snack as I try to brush his teeth.
After our little sprite is down, my husband watches some of a movie, while I listen to a mindset recording. We prepare to get some rest!
Mornings involve a pot of coffee and a simple routine before I’m out the door. I have a blessedly short commute of less than 10 minutes to our local hospital, and I appreciate that every day. Side note: I highly recommend you take this into account as you choose a job and place to live, when the time comes. A shorter commute= a better quality of life!
At work, I supervise residents who are interested in learning simple procedures like paracentesis, catheter removal, and the like. They pop in and out of my procedures when they can, and they come to me with questions. Though I don’t have radiology or IR residents, I enjoy the teaching and interaction that occurs at my community teaching hospital with trainees of different stripes.
During room turnaround time, or during quiet moments, I might type up a blog post like this one, or edit, or format one. I might call a plumber or make an appointment to see my accountant on my next week off. There’s usually some space in the day to have a phone call with a colleague, answer some emails, or complete a task for my committee work with the Society of Interventional Radiology.
In summary, my ideal week at work involves some straightforward cases mixed with a breadth of challenging cases and consults. I truly enjoy my work, and generally don’t feel it encroaches too much on family or personal time. Even during busy weeks, there is plenty of time for sleep and basic self-care.
I always sit down for lunch, but the specific time varies, since I squeeze it in between cases. During my break, I chat with colleagues in the doctors’ lounge about our patients in common, hospital politics, and life. Each day, as long as I eat lunch and have time for tea, I feel like I’m taking care of myself, no matter how hard I’m working.
An ideal week is one in which I feel I did the best work I could, and no one got hurt. It’s one in which I feel in sync with my colleagues, and we have a chance to talk about the practice and any issues at hand. If I got to save a life or help a patient understand their condition better, that’s icing on the cake.
What’s your ideal week like right now? Or, what do you think your ideal week SHOULD look like? Build the ideal week for you, and you might just find it out there in the job market!
Share your thoughts by leaving a comment below.
And a final note for this week: THANK YOU to all the sponsors who bought books for students and trainees around the globe! I couldn’t have accomplished this without them.
Click on their names or business names to learn more about the good they are doing in the world!
This week’s is a guest post from Dr. Sandra Weitz, an anesthesiologist specializing in pain intervention. She shares her path from budding physician, through varied challenges, and into the life of a practice owner. It’s a fascinating ride. Here’s a look back at the career of a real-life superheroine who claims you really can have it all.
I can’t help but smile when I think of the Enjoli commercial from the late 1970’s. It was an advertisement for cheap perfume, but to me, it was a feminist call to action. The message was: if she wore this perfume, a woman could have it all. This commercial illustrated the possibilities for me as a woman early on.
When I was six years old, my father, a two pack/day smoker, died of lung cancer. Somehow I thought it was my fault. My solution was to become a doctor and save the world. So, with tunnel vision, I plunged ahead. It never dawned on me that there was any other alternative. I went to college at 16, majored in Biochemistry, and graduated at the age of 20.
The only thing that (temporarily) slowed me down was lack of money. My father, a cutter of women’s coats in the garment district of New York City, left us with no money. My mother worked as a high school teacher. Scholarships, financial aid and work study got me through college, but I didn’t have enough money to apply to medical school. I took a year off to work as a lab technician at New York University and apply to medical school.
Four years later, I decided to apply for surgery residency. I totally bought into the idea that being a surgeon was my route to saving the world. I moved cross country and got married in the 4 weeks between medical school and internship. My husband and I simultaneously started our surgery internships at UCSF, at a time when call was every other night. We were both off call one weekend a month. It didn’t take long to figure out that we had different goals for that weekend—he wanted to have fun, and I wanted to have a clean apartment. We had 300K in student debt and little expendable income, but hiring a cleaning lady was clearly a worthwhile investment.
I actually wanted to be a neurosurgeon. But, somewhere in the middle of my internship, I had the epiphany that surgeons (and doctors in general) don’t really “save” people. Then, one of the Neurosurgery attendings talked to me about pain management—a new multi-disciplinary field that included minimally invasive procedures. After learning more about it, I made my first pivot, switching into an anesthesia program. After that, I did a pain management fellowship. I figured out that by treating chronic pain, I could significantly and meaningfully impact people’s lives in the way I had envisioned, while enjoying reasonable work hours.
After finishing all of my training, I stayed on as faculty at UCSF. As the Director of the Pain Management Service, I thought I had hit the jackpot. I loved the academic environment and had visions of grandeur, including becoming a department chair. I was appointed, as the only woman and the youngest member, to the Department’s Finance Committee. In retrospect, this was probably a diversity move, but it turned out to be a fantastic gift. This is where I learned the “business” of medicine.
Meanwhile, my husband finished his Urology residency and got a job at Kaiser Permanente in San Jose. After a while, reality set in—we were a two-physician family living in the Bay Area during the height of the Silicon Valley boom. The cost of living was outrageous. We had long commutes, were house poor, and our salaries were stagnant. And did I mention all of our student loans?
We mutually agreed that life is all about choices, and after some soul-searching, we decided to look for jobs elsewhere. When we told our nanny that we were moving, she said, “Great, because I was going to quit. You are under-paying me.” That was at a pay rate of $45,000 in 1997. By the time I paid taxes, the nanny, gas and car insurance, I was essentially working for free.
That job search landed us in Baton Rouge, Louisiana. You might wonder how a New Yorker who went to school in Boston, lived in San Francisco for a decade, and married a guy from California ended up Louisiana. We came to interview in mid-May when the weather was perfect. The cost of living was low, the commute was short, and the opportunity seemed to address most of our criteria.
My move involved joining an anesthesia group that claimed they wanted a pain specialist. Despite our conversations regarding my approach to pain management leading up to my accepting the position, once I started, it became apparent our expectations were not aligned.
The anesthesia group thought that I would do “blocks” in the back of a PACU. I explained to them repeatedly that I believed in the multi-disciplinary approach to pain management, and that I needed a true clinic with access to multiple modalities. They laughed. I explained that the clinic and I could generate a lot more revenue than their model. They laughed. I laughed too when I told them I was leaving.
I started my own practice in a rented space within a regional 1000-bed medical center. Within a year, my practice had grown exponentially, and I needed to bring in additional providers to handle the volume. We all know that there are only so many hours in the day, and only so many patients that you can see.
By adding additional providers, I was able to have greater flexibility. If I had to leave to pick up a sick child, clinic did not come to a screeching halt. My clinic hours became more manageable. I made it to every soccer and volleyball practice, every school event, any and every activity that was important to my family. I controlled my own schedule.
As a pain management specialist, I obviously did interventional pain procedures. I went to the hospital’s administration and proposed a joint venture for an ambulatory surgery center (ASC). Why? Because I recognized that they were collecting the facility fee for every procedure I did. Did you know professional fees make up just one-third of total charges, and the facility makes the other two-thirds? I understood that the facility had to cover expenses, but still felt like I was giving up a large piece of the pie. After the hospital declined to form a joint venture, I decided to control my own destiny. At that time, my kids were 3, 5 and 7.
We bought a lot and built a 25,000 sq ft medical office building. Having my own ASC would allow me to capture the revenue from the facility fee. We decided to have my clinic and an ASC on the first floor and lease out the second floor. By the time the building was completed, I hired an additional physician and two mid-levels. Within six months, we had outgrown the clinic space. Shifting gears, we finished the upstairs as a new clinic space with 23 exam rooms, and expanded the ASC to occupy the entire first floor.
Ever since my fellowship, I have utilized a multi-modality approach to treating chronic pain. As a result, I was referring patients to psychological services, weight loss programs, physical therapy, chiropractic care, massage therapy and more. I ordered imaging studies and laboratory tests as part of the evaluation process. I recognized that my practice controlled the outflow of these referrals. By bringing all of these services in-house, I was able to provide a comprehensive approach, improve patient care, and capture the extra revenue.
Over time, I added additional specialties to the ASC and sold shares to other physicians. I invested in an imaging center and a physical therapy service. I started an anesthesia company to provide services to the ASC. Then, I added psychological services, weight-loss services, massage, chiropractic care, and lab services to the practice. The practice and ASC paid rent to my real estate company. All of these businesses were horizontally and vertically integrated with my medical practice to maximize both my patients’ care and the revenue produced.
What did I figure out through this journey? I could indeed have it all.
In order to to that, I took on risk. And at times, that was scary. Especially at the beginning, when I started my practice with three little kids. But I recognized that I could let fear paralyze me, or use it to empower me. Developing an action plan supported by real data allowed me to mitigate the risks I faced. And with each small win, I got braver.
It didn’t take long for large amounts of money to come rolling in without my having to see each patient. The more each business grew, the more it fueled the other businesses, and the more I made. Whether I went on a long vacation, took six weeks off to take care of a sick child, or simply wanted to work fewer hours, I made money. I controlled my own destiny and achieved financial freedom. I sold my businesses on my terms and retired at 53.
Looking back, I feel that I lived a feminist’s ultimate dream. I’m proof that you really can have it all. While I’ve had a successful professional career and owned several profitable businesses, I’ve had a loving, supportive husband and raised 3 children, who each became successful in their own right.
If I can do it, so can you!
Dr. Sandra Weitz is a retired anesthesiologist specializing in pain management. She now splits time between her family and mentoring other physicians in their business pursuits.
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.
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.
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
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
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.
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.
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.)
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.
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.
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.
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.
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.
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!
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!
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!
...and perfect is the enemy of good.
These concepts in medicine & parenting are parallel.
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 […]
The TiredSuperheroine blog is all about building your career capital and thriving in a male-dominated field.
As a female physician, are you allowed to be confident? Are you allowing yourself to be confident?
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