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Pandemic preparation as a physician family
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Pandemic preparation as a physician family

Financial empowerment

What’s pandemic preparation like for a healthcare worker and a physician family?

California is officially on lock-down for the international pandemic that is COVID-19. According to the Wall Street Journal on 3/19,

“California ordered its 40 million residents to stay at home except for essential activities beginning Thursday night in the largest such lockdown in the U.S., as the nation’s total coronavirus cases rose to more than 14,000 and an intensifying outbreak in Europe pushed State Department officials to advise citizens not to travel abroad.”

We have been bracing for the outbreak, and social distancing since 3/8, the day after my birthday. At a combined birthday party, we learned of our first case of community-acquired COVID in our area. Between having a toddler at school, a musician playing out every night, and a healthcare worker in the family, we will have our share of potential exposures. This is about pandemic preparation as a physician family.

It’s felt like bracing for disaster. My two year old touches everything, and touches his face. He rubs his eyes, and throws food on the floor. Having a toddler makes one feel vulnerable to infectious disease. My husband and I were both saddened and relieved when our son’s school closed last week. While we rely on the care and education he’s getting there, we know it also puts us at risk of catching anything in the community. So my husband is the de facto caregiver while I’m at work.

This is possible since as a freelance musician and music teacher, my husband is essentially jobless for the foreseeable future, while I am the breadwinner, on the front lines of a microbial war. No pressure.

Mentally preparing as the hospital locks down

In the meantime, my hospital has restricted all visitors. The vast majority of patients have no visitors, while those facing death can have up to two dedicated visitors (no rotating). There is a fraction, maybe a tenth of the people walking through the halls, compared to a normal day. Temporary shelters stand outside the ED and cafeteria to prepare for a potential surge of patients. Military style tents can become ad hoc hospital wards when the hospital is overwhelmed.

Sheltering in place as a physician family

As a family, we have been self-isolating ahead of the mandate, hunkered down at home for over a week. My son, whose daycare has closed for several weeks, started coughing, without his usual runny nose. He bordered on a true fever. Then my husband began to cough. While I felt subjectively warm and had viremic prickling of my skin, I measured just a degree and a half above my baseline. I wasn’t coughing, but I wondered whether I could be harboring the coronavirus. Although I have no known exposure so far, it’s spread by asymptomatic individuals, so we really don’t know who’s been exposed.  

Prepping family for the pandemic

My dad’s across the country, isolating himself in his apartment in New Jersey. At the age of 70, he’s someone who might not make it, should healthcare rationing come to pass. He’s healthy, but aging. And I’m worried. Meanwhile, he’s worried about me, and likens my clinical duty to being on the front lines in Vietnam. And he’s not the only one making such war-time comparisons. Many physicians communicating online express this grave parallel. I’ve had a lingering sense of dread, that we will not be able to handle the influx of patients. I’m worried about a relentless stream of patients gasping for air. We will run out of time and resources. And rationing is not part of the American health system. The cultural clash will be devastating. To keep my mind off the grim, I can focus on what I can do right now. 

A couple weeks ago, burned out physicians were talking about feeling like a cog in a wheel, but now, that idea is mildly comforting to me. Being able to do my little part in my little silo gives me some sense of agency in this impending crisis. It helps keep me focused on the things I can actually control. But that illusion of control can be shattered in a moment. Again, I’m worried. 

Fear of PPE shortages

I’m concerned about running out of masks and other personal protective equipment, or “PPE,” for us healthcare workers. Just like the toilet paper hoarding, some people have hoarded masks. It’s upsetting to think about experiencing a shortage of PPE for front line workers, who expose themselves and their families to this deadly pathogen to help others. In some places, healthcare workers are already fashioning their own PPE, and re-sterilizing disposable masks. Manufacturers like Tesla are working to pick up the slack, to make PPE and ventilators so we can save as many people as we can, while staying healthy ourselves.

Preparing my department

As head of my section, I pray we can be prepared to care for patients through this time. The SIR put on a webinar called, “Is your IR Lab Prepared for COVID-19?” It featured voices from the front lines in Singapore, but it was overwhelming. We are so unprepared. There’s also a new resource accessible online, the Covid Toolkit, providing information on proper cleaning protocols and protection for IR staff which can be found here.

Resident education in a time of uncertainty

In the meantime, I have a resident rotating with me. He is an internal medicine resident planning to go into interventional cardiology. I am teaching him about imaging, access, and the care of patients in this crazy time. Together, we are continuing to take care of patients who can’t wait 4-6 weeks for their procedure. This is our current guideline for postponing routine care.

That means we are still doing cases like liver ablation and select uterine artery embolizations (UAE), for example. Some UAE cases would normally be elective, but this patient is bleeding so much, that she can’t make it to the bathroom at work before soaking her pants with blood and clots. She’s even needed transfusion. So she can’t wait until this pandemic is over, especially when we don’t know how long it’ll last. We simply don’t have a timeline, so we forge on, taking care of patients, while knowing there are risks in doing so. 

I even checked myself into the ER to get tested the other day, once the work was done. I wasn’t coughing, but the guys in my house were, and I’d had a low grade headache all day. Running a degree and a half over normal for me, I’d been self-monitoring to ensure I didn’t hit a true fever of 100.4 F. Finally, concerned I could unwittingly spread COVID-19 while seeing patients, I pulled the trigger and got tested. Thankfully, for now, I’m negative. I can have some confidence what I have is just a cold, and I can soldier on. Meanwhile, my husband is sick, and solely responsible for childcare while I work. We don’t want to risk passing the coronavirus to our nanny, who may be more vulnerable.

Calm before the storm

It’s eerie to walk down an empty hallway, but comforting too. Less than a tenth the number of people pass through the corridor. The volunteers, most of whom are seniors, are home, sheltering in place. Most patients can have no visitors, unless they’re imminently facing death. In our department, a family member or friend would usually accompany each patient; now, these patients wait alone. It’s a sad consequence of the social distancing protocol we are forced to impose. 

Bracing for emotional trauma

In some cases, the policy, which I agree with, can have devastating consequences for the individual patient. A friend and colleague had to deliver a terminal diagnosis yesterday, and the patient broke down, just wanting to be with his girlfriend. My friend felt so powerless. With the devastating news, the patient was essentially alone. 

I think also of the people in Italy, gasping for air, without enough healthcare workers to attend to them. They may be in pain, or air-hunger, which seems potentially worse, with someone attending to them who can’t hear them as well, and who is overwhelmed by a high patient load. Surrounded by other victims, with no family nearby, you could die alone. Some people aren’t even making it to the hospital. A pathologist pleaded for the ability to test the dead, so we could get a more accurate idea of coronavirus’s mortality. This information is important for those that remain in the fight. 

How rapidly things have changed

A couple of weeks ago, I would’ve been driving to Los Angeles for laser hair removal. I cancelled the moment I heard LA had its first confirmed case of community spread of coronavirus. I didn’t want to risk spreading the disease for this reason. But I think of all the businesses, large and small, and how they’ll suffer. I wonder how many will be forced to close. Those without a cushion for such a disaster will have no choice. And the same is true for individuals: those without an emergency fund are headed for hardship.  

As a family that has financial reserves, I worry: how much is enough? Even if we have money, what good is it if we can’t find basic supplies due to supply disruption and hoarding behavior? In some ways, there is no true preparation for a pandemic as a physician family; we must do the best we can and hope it’s enough. And I worry about everyone else, and the potential for societal break-down. The lengthening lines at gun and ammunition stores make me shudder. 

The daily routine as a physician preparing for COVID-19

Because I change back to street clothes before leaving the hospital, then shower on entering the home, by the time I see my son, it’s 7 pm or later. I don’t know of any specific viral exposure, but assume there are contaminants everywhere. So I come home, shower, and wash my clothes. We do a lot more laundry these days.

There was an SIR webinar sharing strategy from Singapore the other day, and I saw how well prepared and regimented the hospitals were in protecting their workers. They had UV cases with dedicated goggles, and enough for 15 people. Plastic sheets covered every piece of equipment. It probably took an hour to prepare the room for a Covid patient, and over 1.5 hours to clean the room afterward.

Our national preparation for the pandemic

In our ‘developed’ country, we are nowhere near as sophisticated. We like to think we are, because usually, we throw more money at our weaknesses. But in this pandemic, I worry it won’t be enough. Habit related pathologies from diabetes, to lung disease and nonalcoholic fatty liver cost us all hundreds of thousands per patient. Our lack of social responsibility shows. While many have listened to the warnings and sheltered in place, others have continued to travel, enjoy spring break, and minimize the problem we face as “similar to the flu.” These actions will harm us all.  

To make things worse, the public has been getting mixed messages. While all non essential businesses are closed, “leaders” are still saying gatherings are OK, if they involve 10 people or less. How arbitrary! When an asymptomatic carrier of the virus goes to a gathering, up to 9 people can be infected, and those 9 in turn can each infect an average of 2.5 people. That’s the harm of mixed messages.

A vulnerable system

In any case, I will certainly be surrounded by virus soon. I’m not on the front lines, but just behind them. Our newly renovated emergency department is still inadequate to handle our normal patient load at times. Patients spill into the radiology department, taking over IR holding, and one of our ultrasound rooms.

Being just behind the front lines, I’m glad I have an estate plan in place, in case something happens to me or my husband. Although it was expensive and time consuming to set up, we have our living wills and a family revocable trust. This means we formed a legal entity that holds all of our assets. In a revocable trust, my husband and I still control the assets. We can still sell our house, though it belongs to the family trust. But if we pass, there is a plan for Wesley and for our belongings. If we died without a plan in place, the state would decide who raises Wesley, and what to do with our assets. If you don’t have a living will, guardianship for your kids, and an estate plan in place, now is the time.

Should I freak out about the stock market plunge?

Probably not. For those of you early in your career, you may see big losses in your portfolio. It may seem your hard-earned dollars have disappeared. I’ve seen my investment balance drop by $100k. But unless you’re selling, these should not be thought of as losses: they are unrealized losses. You don’t “realize,” or solidify the loss until you sell a security in your portfolio. In a tax-deferred retirement account, there is no reason to sell right now. If you did, you would only solidify those losses, the worst thing you could do. So even though my balances have taken a hit, I won’t sell. I’ll wait for recovery. As long as society doesn’t collapse, those numbers will rebound, as we’ve seen historically.

The one exception to “don’t sell”

On the other hand, if you have a taxable account, you might consider tax-loss harvesting. It took some time for me to understand this concept, and it can be a huge benefit to certain investors. If you have money in a taxable investment account, you could benefit from selling say, an index fund at a loss, and purchasing something similar. This strategy seizes the realized loss, which you can deduct from gains on your tax return, while retaining the lower price of the similar security. You buy the new fund at the bear market rate, and if history is any indication, it’ll likely rebound in value. 

And some good news: if you’re just getting started investing- everything is on sale, and will continue to be for a while. We are headed for recession. So if you are blessed enough to still have a paycheck coming in, it is time to invest. This recession will be a head start in your investing journey, as we recover over the next several years. As the White Coat Investor says: 

This is what pandemic preparation looks like for a physician family, including those like me who can’t stay safe at home.

What are you doing to prepare for the novel coronavirus arriving in your neighborhood? 

Wishing your health and good hand hygiene,

Tired Superheroine

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find your tribe in medicine
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Find your tribe in medicine

Career & Leadership

A few months ago, I got an e-mail from a successful but isolated interventionalist working north of Seattle. She reached out, wanting to connect in real life. She shared her story on the blog in Real Life Superheroine, LK. Connecting with her inspired me to write a list of the ways women in interventional radiology and similar fields can connect virtually. Because we share common concerns and goals, it’s important we use the tools we have to support one another. Though we may be relatively few in number, we form a tribe in medicine, and we’re stronger together for it!

With all the connections I’ve aggregated over time, I can’t remember the last time I felt alone in my career. But I can tell you, as a woman in a competitive, male-dominated field, there are times in the past I felt ALONE. Through this platform, I want to help eliminate the sense of isolation that many women in male-dominated fields face. Becoming a doctor is hard enough without feeling isolated on top of it! So here are some surefire ways to connect with your tribe in medicine. 

Adding attendings to your tribe 

Social media can help bridge the gap between training and attendinghood. On Instagram, a resident followed me, then reached out via private message. We formed an easy bond, and she shared some of her challenges as a second year radiology resident. One day, as I glanced at my feed, I stopped short. I grew flushed. She’d posted: 

“This is dedicated to someone who unknowingly inspired me through her writing, blog, and career. Midway through my first year of residency, I started to feel disillusioned by my career choice. The reasons were many including my first time living states away from my immediate family, and struggling with the demands of learning a completely new language in medicine, “radiology,” among other transitions. 

“It was during this time that I came across a post written by @tiredsuperheroine, A Radiologist Saved my Father’s Life, which I have read time and again. It has kept me grounded, and reminded me of the importance of my training. That what we do as radiologists matters, despite being behind the scenes. That our role in medicine is essential. 

“Thank you @tiredsuperheroine for being a role model, and for sharing your thoughts with us. You may never know all the people: trainees, radiologists, etc. whose lives you touch, but here’s to recognition of at least one whose life you absolutely impacted in a positive way <3.”

I’ll try to explain how her post made me feel. Blogging, especially in the beginning, is a lot of work without much feedback. So after months of putting my writing on the web, her recognition shook me to the core. It reaffirmed my mission, to help light the way for my fellow women in medicine. And she verified what I suspected when I started this project over a year ago: that this message can make a difference to real people, across the country and beyond. 

Virtual sponsorship through your tribe in medicine

Technology improves our access to each other, improving our ability to mentor and sponsor. As an example, a colleague from residency put me in touch with her resident who was interested in IR, but lacking a female role model. Through our phone conversations, I helped reassure her of her plans. There was an easy understanding between us. Even across time zones, I felt I was welcoming a new member into the tribe.

Then, I had a bolt of inspiration. Not only could I be a sounding board for this young woman; I could be her sponsor. She’d soon be applying for ESIR and fellowship spots, and I knew a couple of women in academic IR in her region. I introduced them via email, and a short time later, they met in person. With these new connections, she’ll have an “in” at some top programs in the Northeast. This is the power of finding your tribe in medicine.

Professionally, I live for these moments: when I realize I can and MUST connect two people in different circles. In 2020, it’s easier than ever to introduce people operating in different social circles, hospitals, or training programs. Our opportunities to connect seem exponentially greater compared to when I grew up. We’ve come a long way since the days of contacting people using landlines and snail mail!

It’s time to find your tribe in medicine

We are living in an amazing time in history; we can connect with people around the globe with the stroke of a few keys. This connectivity has the power to improve your quality of life, especially as a women in medicine. Recently, an IR in Saudi Arabia reached out to me, hoping I could serve as a resource as she started her own women in IR group. Through incredible adversity, she’s risen as the first female IR in her region, and I’m proud to call her part of my tribe.

Even state-side, women in medicine are finding and supporting each other through social media. Through private groups, we can converse, support, and strategize. In these forums, we share each other’s joys and sorrows. We share common challenges, from with childcare issues to choosing the right dress for an event. In big and small ways, we strengthen our sense of community. 

The following are some of my favorite ways to connect with women in IR, and in medicine at large. Through these sites, groups, and hashtags, you can find others like you. You can find your tribe in medicine. It’s worth the extra screen time, I promise. 

My email list

First of all, if you haven’t already, you can sign up for my email list, so you can receive weekly updates from the blog. As you know by now, I write about work-life integration & financial empowerment as a physician leader and a mom on call. When you get my emails, you can respond to me directly, whenever you have a question or feedback. Tell me how you’re doing, what your challenges are, and what you need. I will try to help you, or point you in the right direction. 

Twitter

For those of you not on Twitter yet, I encourage you to make an account. I was a late adopter, but have since found Twitter to be a surprising platform for professional networking. It has connected me with physicians around the world, providing access to their varied perspectives. Beyond drive-by conversations in the hallways, you can use Twitter to connect to the larger conversation happening in healthcare. And there’s a lot to discuss these days.  

If you’re an IR, or aspire to become one, Twitter is a place to share cool cases, and admire others’. Some even use the platform like a living curriculum vitae! There are hashtags you can use to find people interested in similar niches, like peripheral artery disease (PAD), for example. Some key hashtags for IR include, but aren’t limited to: 

#iRad, #interventionalradiology, #TwittIR, #minimallyinvasive, #MIIP, #withoutascalpel, #cancer, #angiogram, #embolization, #WeAreIR, #mentorship, #medtwitter,, #MedStudentTwitter, and #RadChicks, just to name a few.

Some great people to follow, chat up, or tag on Twitter include: @TSuperheroine (me), @SIRSpecialists, @SIRRFS, @SIR_ECS, and @RadiologyChicks. There are hundreds more, so get online and find them!

Beyond IR, I use Twitter to connect with the personal finance community. With my fellow finance nerds, I share ideas and gain inspiration that percolates back into my blog. Twitter’s a wellspring for the financially empowered. Collaboration can happen in an instant when you retweet and amplify the messages of others. A couple hashtags in this arena are #financialliteracy and #personalfinance.

My blogger tribe and what it means to me

I get fired up about the work of my fellow bloggers. When my friend B.C. Krygowski released her book, I wrote a review on the blog, and helped amplify her message. A page-turner, the book has truly perspective and life-altering tips on how to travel, live, and save better. That’s why it felt so good to promote it.

Aside from B.C., there are a couple of bloggers who are always with me: they believe in me, and I can feel it. Just a connection at a conference is enough to encourage a fledgling blogger, through a few moments together, with ideas exchanged. I thought of PassiveIncomeMD as I landed my first ad client on the blog. That’s because he was the one who encouraged me to find some form of steady income, so I could get help when I needed it, and have the resources to grow. He supports me even now, without knowing how much that conversation influenced me. 

I love cross-pollinating expertise and ideas with other creators from PhysicianZen, who’s working on a productivity book for doctors, to Dr. McFrugal, who riffs on lifestyle optimization & travel hacking. It’s a privilege to share their ideas with you, my fellow superheroines.

Instagram

I’ve found real thought leaders on Instagram. From other IRs, to physicians in other specialties who inspire and educate. “Insta” is an image-rich, but also an idea-rich space, if you follow the right accounts. Some of my favorites include: @randdiabmd, @docfuji, @joy.energy.time, @chicnpetitemd, @t.in.the.leadcoat, @learning.ir, @radiology_af_, @radiology_chicks, @_backtable, @heart.beat.doctor, @drdarewreck, and my own, @tiredsuperheroine.

More ways to connect to women in IR: 

On Facebook, you can join forums just for women in radiology, pioneered by Agnes Solberg and Taj Kat. They are: Rad Chicks, IR Chicks, and Future Radiology Chicks

My private Facebook group is Tired Superheroines. It’s a place for women in male-dominated fields and their allies to discuss work-life balance and financial empowerment.

Your tribe within the Soc. of Interventional Radiology

Through the SIR, you can connect to other women in the specialty by joining the Women in IR, or “WIR” Section. There are separate but women in IR committees on the attending and the trainee side. If you’re a student or resident, you should consider getting involved in the Women in IR committee of the Residents, Fellows, and Students Section. Each committee works to amplify the work of the other. But they are governed separately, and work on separate projects too. To get more information or sign up as a volunteer for the SIR, click here.

Connect with your tribe in person 

In simpler times, before the coronavirus outbreak, we could connect in person, at our yearly meeting. Sadly, but prudently, this year’s meeting in Seattle was canceled. In any case, each year’s meeting features dedicated Women in IR programming, including our InspIRed lecture, featuring a thought leader in medicine.

Formally organized and informal meet-ups abound at these meetings, allowing ample opportunity to make quick connections and fast friendships. For me, these friendships have become the basis for what I think will lifelong friendships. That’s why I highly recommend attending the meetings, and if you can, volunteering in the society. Both are fabulous ways to connect and learn valuable skills.

To assist in meet-ups, or to share ideas, many favor WhatsApp. You can form chat groups to quickly organize. I’ve even used these groups to share clinical experiences and challenging cases, assuming you’re HIPAA compliant, of course.

A retreat for my tribe. Are you in? 

In speaking with LK, real superheroine… I was struck by something she said. 

“I intentionally stay away from most social media. With so little free time, and so much of it in front of screens, I just can’t bear to have more of my life energy/time sucked away.  But I probably do miss out on connecting and support for this reason. Still, finding a more personal, tangible connection seems more valuable, and more worth the time invested if I can find it.”

In part as a result of this conversation with her, I’m compelled to put together a retreat for women in IR & surgery next year. If you want to see this happen, let me know. And make sure you’re signed up for my email list, so you don’t miss a thing. 

Tell me, who’s down for a relaxing, inspiring retreat in the Palm Springs area in 2021?

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daily money habits
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My daily money habits

Financial empowerment

When I started earning serious money, I realized this earning power was both a privilege and a huge responsibility. So as the breadwinner of my family, I took on learning personal finance, so I could optimize our money as much as possible. While my husband manages some household bills, I manage the big picture, including the long-range plan. It turns out I’m just more into money than he is. Our discussions about investing don’t last that long, because he’s not that interested. Because I take care of the financial plan, he has a carefree, “We’re fine!” mindset, as he plans his next trip to Sweden for heavy metal camp. I enable his money complacency. But I’m the opposite of complacent. I’m always looking for the next move. So here are my daily money habits that help keep us moving in the right direction, as efficiently as possible. 

Daily money habit #1: Think about money.

Maybe you prefer not to think about money or think it’s un-ladylike, but I’ve come to enjoy thinking about it, planning for it, and learning how to grow it. Maybe it’s how I was raised, but money wasn’t taboo in my family, and it means security to me. 

In addition, I’ve had some financial success, from slaying my six-figure student loans, to growing my net worth to my first big-girl goal. I attribute this success in large part to thinking about money. Because I focus on it, it grows. Personal finance is interesting if you learn a bit about it. And with this knowledge comes tremendous power. This means that I gravitate toward personal finance articles and podcasts. That extra learning makes my success a self-fulfilling prophecy because I’m always combing the universe for more ways to optimize.  

If I spot a recommendation on a mindset book to help me make money, I take it. This sets me up for success, since thought leaders in personal growth and finance are always in my ears.

Daily money habit 2: Invest in myself

With all I’ve learned about personal finance over the last several years, there is still so much I don’t know, and I know it! I can only imagine how empowering it would be to maximize my tax deductions, for instance. I have Kiplinger’s Tax Deductions for Professionals, and have read chunks of it here and there. It’s rather readable, but it’s no 50 Shades or Harry Potter… I know I haven’t optimized everything I could yet.

The other way I invest in myself is with courses. Although there is a wealth of free information on the web, like that on my blog, I’ve taken to actually buying courses, materials, and now, coaching. Whether it’s a career or business coach, meditation course, or a personal finance course, the hundreds of dollars spent pale in comparison to the rewards I know I’ll receive. When you invest in yourself, you’re investing in your most valuable asset. 

Daily money habit 3: Waste nothing 

Whether it’s eating the last few leaves of butter lettuce, or cutting open a container of hair product to get the last dollop, I’ll do anything to nix waste. My ten year old wool socks are threadbare in places, but since my toes aren’t coming out, it’s no problem. I’ll throw them in the washer a few more times to squeeze all the use I can out of them. 

“Isn’t this a scarcity mindset?” you may protest. On the contrary: using everything I have to the max helps me realize how much I have, and I take pride in using the full value of what I’ve brought into our home. It takes a lot of time and energy to find something worth buying, and you trade your life-force to pay for it. Avoiding waste and “sustainable fashion,” if you’d call my holey socks that- have environmental implications beyond the scope of this post. Having a no-waste mentality can be a socially acceptable way to be cheap. And when you cut costs, your bank account swells. 

Throwing money away

Another way I avoid waste is not buying water. Our tap water is fine, and you can filter your water if you choose. But aside from an earthquake kit, why buy bottled water? If I grab a sandwich out, I ask for a cup of tap water. In this case, what’s better for the environment also happens to be better for you and your finances. When I see people with debt buying four dollar sodas, it breaks my heart. They’ve been taught habits that will keep them poor, and likely less healthy than they could be. If this multi-six figure earner excludes bottled beverages from her budget, maybe they should too.

In contrast, when I’m writing, sometimes I buy a fancy lavender latte at my local coffee joint. When I do, it’s an intentional decision. I am willing to pay a premium for free Wi-Fi and the (toddler-free) atmosphere that comes with it. But this can turn into a wasteful extravagance if it’s too habitual. So mostly, my coffee comes from home.

Daily money habit 4: Awareness of outside forces imploring me to spend.

Would you rather be in charge of your money- or have it dictated by the consumerist society you live in? With this in mind, I try to keep my eyes open to forces that would pressure me to spend. I strive to make intentional choices that align with my goals. But sometimes, a group dynamic can make this challenging. A recent example: a friend of mine, I’ve taken to calling her the Social Chair, organized a group to attend Chicago at a local theater. Now I relish the idea of a grown-up night out with these friends- but I don’t love Chicago that much, and I can see these friends at other venues, often for free. 

When I saw ticket prices were up to the $600’s in some sections, I asked my friend about her intentions. Just because I can afford a $600 ticket doesn’t mean I actually want to! I was relieved to hear the tickets she was scoping were in the $60 range. Asking her about ticket cost- rather than secretly hoping it was reasonable- meant I could make a decision in alignment with my own values. I could have an evening with my pals, without any angst, worry, or spending hangover.

Daily money habit 5: Tracking my net worth

Tracking net worth gives you insight into the results your creating. There’s always money coming in and going out: it’s part of living. And your net worth can help to gauge whether your daily actions and habits are improving or eroding your net worth over time. If you’re earning your worth, and making good financial decisions, your net worth should increase over time. If it’s not, you may want to examine how you can change that.

I track my net worth using Mint.com. The free site and accompanying app allow you to see all of your financials in one place. I’ve found seeing everything in one place to be helpful. A huge benefit of using Mint is the ability to track your net worth. I can see my mortgage has been paid on auto-pay in my transactions feed. Under accounts, I can see my mortgage balance go down, and since Mint can link to Zillow, I can even see the estimated value of my properties creep up. Compared to manually doing a spreadsheet or a yearly audit, this is far easier. With the app and I can check my net worth in real time whenever I want! 

I love that I can see transactions from different accounts as they’re happening, without having to log into multiple accounts. Between the transaction reel and free credit alerts, it’s easier to identify any fraudulent activity quickly.

One thing Mint is not- is perfect. My health savings account and Mint just can’t seem to get along, no matter how I’ve tried. So the $20,000 in our HSA’s is not counted in Mint. It’s not a big deal. Sometimes, transactions in Mint are mischaracterized (but you can recategorize them if you wish). For some reason, when I pay myself a salary from my corporation each month, it’s categorized as “kids.” So I’m alerted to the fact that I’ve spent a lot on “kids” because it’s over $17,000. But even with its quirks, you can’t argue with the value of this free tool.

Daily money habit 6: Automation.

I aim to automate my money as much as possible. In my view, there is no reason to spend your valuable time paying bills manually anymore. Nowadays, there is an auto-pay option for nearly any recurring bill you can think of. If you want to keep tabs on your bills, you can track them in Mint or login to your online banking platform.

When auto-paying, I pay for anything I can with a credit card, then pay balances in full each month. Not only does this help protect you from fraudulent or incorrect billing, but this allows for the accumulation of credit card points. My largest monthly bill payable by credit card is our health insurance premium, at just over $1000 per month. On my business credit card, the points rack up because of this bill, and can be claimed later as free travel, or even cash back! 

Automating is a priority, in part because I’m a landlady. I aim to minimize any busy-work associated with managing my rental property, so I can use it to build wealth without it eating up my time. To that end, the rental property utilities are on auto-pay from a dedicated bank account. Tenants pay rent via Venmo. I can hear a “cha-ching” notification each month when rent’s paid. From Venmo, I can transfer money back to my bank account, so it’ll be there when the mortgage payment comes out. The alternative, dealing with checks, is unthinkable at this point. And automating as much as I can means that the management I do is otherwise limited to incidents like maintenance and repairs, not lost checks and trips to the bank.  

Daily money habit 7: Optimizing cash-flow 

To meet my yearly financial goals, I need to move money to various tax-advantaged accounts. Accounting for estimated tax payments, our largest bills, and automated savings, I look for money idling in our accounts. When I see more cash than I need, I ask myself what job I can give that money. That might mean a lump sum contribution to the family health savings account (HSA), or my solo 401k. 

Since my solo-401k goal is substantial, I’ll put $10-20k in there at a time, knowing I need to reach $57k by the end of the year. If I waited till December, that might be a stretch, and frankly, it might not happen.

Beyond that, if I still have cash, I’ll make lump sum payments on our mortgage. Recently, I was close enough to the $500k mark on the principal that it tempted me, and I wanted to knock it down (to show it who was boss). Gamifying your finances can make it fun to slay your debt. It worked for my student loans, and now, it’s motivating me to hit my mortgage. And I can’t wait to be mortgage free!

A note on staying organized 

OK, organization isn’t my strong suit, but I have a couple tricks to share. For bank accounts, I enable face ID on my iPhone. This streamlines logging into accounts as needed, so I’m not digging for passwords when I need to check a balance against Mint, or deposit a check, for example.

I use the Lastpass app to keep track of passwords I use less frequently. As doctors, we have a ridiculous number of passwords to remember, so when I need my American Board of Radiology ID a couple times per year, it’s in the app, securely stored. Every time I use it, Lastpass makes me feel successful in a small way. And who doesn’t want that?

For credit card optimization, I’ve embraced Apple Pay. This allows a way to store and use credit cards without having to actually carry them around. In this way, I can use the best card for a given scenario, even if I don’t use the card often, for example, my Amazon credit card at Whole Foods. This ensures I get the bonus points and savings attached to that transaction, without the risk of carrying excess cards around.

What are some of your daily money habits? Where do you spend, and where do you scrimp? Do you execute money moves on a daily, weekly, monthly, or yearly basis?

Share a key habit in the comments below!

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The Physician Philosopher’s Guide

Financial empowerment

This post contains affiliate links. If you purchase anything through my links, the site will benefit at no additional cost to you. 

I had the pleasure of meeting The Physician Philospher (TPP) in real life at last year’s FinCon conference, “where money and media meet.” Of the many inspiring physician bloggers I met at Fincon, Dr. Jimmy Turner, the philosopher himself was one. He created a successful blog focused on personal finance with a focus on intentional living. A practicing anesthesiologist, he’s been an advocate for physicians at his own institution, teaching the principles of personal finance, whether he’s giving a formal lecture or working behind the drape. Aside from his teaching experience, he draws from his own debt repayment journey to synthesize his book, The Physician Philosopher’s Guide to Personal Finance. After reading it, I wanted to share my thoughts, in case you’re looking to do some reading in this area (and I recommend that you do)!

Give yourself a short-cut

The Physician Philosopher’s Guide applies the Pareto Principle to personal finance: you only need to know about 20% of personal finance to get 80% of the results. That’s good news for those of you who don’t have a lot of extra time, or don’t relish the topic. It’s a good read for those who are overwhelmed by the thought of learning about personal finance. This is a book you can read in a couple of sittings. If you can block some time to invest in your financial future, but can’t be bothered with nitty gritty investing axioms, read on.

As a bread-winning woman, learning the basics of personal finance benefits you and your entire family. And this book can be your guide.  While learning about personal finance, intentional spending, and life optimization has become a hobby of mine, I understand not everyone may feel the same way.

Ten things to know about The Physician Philosopher’s Guide

With that, here are ten things to know about The Physician Philosopher’s Guide.  

1.

The author was actually a philosophy major! In the book, you get a chance to know TPP: he was the liberal arts guy sitting next to you in medical school! That means if you’re inspired by great quotes, and like a bit of philosophy infused in your personal finance reading, you’ll like his Guide

2.

He brings practical perspective. TPP dedicates pages to the big-picture ways one can minimize debt accumulation in med school and training. I’ve noticed it’s easy to get bogged down in minutiae in some of the personal finance groups online. Don’t lose the forest for the trees: read about the key ways to save money and minimize the bleeding during the training years.

3.

TPP knows a lot about student loan repayment plans, and he explains the options in chapters 6 and 7. Optimizing your student debt pay-back can save tens of thousands of dollars, so this information has the potential to cover the cost of your book plus a copy for every friend you’ve ever made.

All the acronyms related to government-sponsored repayment plans can seem like a nonsensical letter salad. But the way TPP explains it, it’s pretty easy to understand. He outlines who is most likely to benefit from each kind of program, even laying it out in flow-chart form. I just haven’t seen this well- synthesized elsewhere. But be warned, these chapters are not oversimplified. They may send some running for help. If you’re not a fan of numbers and spreadsheets, read these chapters, then book a consult with our friends at the Student Loan Planner.  

4.

TPP is forthright about his own personal finance errors, as well as his conflicts of interest. He emphasizes his own conflicts to demonstrate the inherent conflicts common within the financial industry. He’s a teacher through and through.

5.

He’s funny. Like a dry, anesthesiology funny. On page 104, I chuckled as I heard his voice in my head:

“What? You don’t have time for that? Then, just invest in index funds. You can thank me later…”

TPP would be a hoot to be on service with as a student or resident! And you’d be guaranteed to learn a ton. 

6.

He uses nice simple language where it’s needed. In this way, you can absorb the knowledge, and sound smart later, when you tell your friends about dollar cost averaging, and actually know what it means (p105). 

7.

He’ll give you a gentle slap in the face. You still think people who have nice things are wealthy? Society gives us conflicting messages, many driven by advertisers, he explains. But if you think buying a sweet car right out of training is a good idea, he’ll straighten you out. The panhandler on the corner has a higher net worth than you. So please, don’t buy the car.

8.

He tackles the personal finance question: “How much fun are we allowed to have with our money?” His answer is the 10% rule, which you can read about on page 114.

Six years into attending life, I still struggle with this: how much to save, and how much to spend, lest we fall on the apocalypse, cancer, or similar fate, wishing we’d “lived” more. I found the 10% rule helpful and refreshing: a moderate approach to “carpe diem.”

9.

“You can never hear true things enough.” It’s a quote from the pastor that married TPP. Like the quote, I appreciate the morsels of wisdom sprinkled throughout this book. 

10.

On p137 he distills the perils of emotional investing:

“Buy and hold investors in the US made an average return of 8% during the 15 yrs from 1995 to 2009, but if they missed the 30 best days, their return would’ve been negative.”

In other words, don’t try to time the market. 

In summary, The Physician Philosopher’s Guide is an enjoyable read, which will jump-start your jalopy on the road to success. It’s for those short on time- doctors who need the high-yield concepts that will have the greatest impact on their future. It’s a guide for those digging themselves out of student loan debt. While outlining the ways to get your financial life started on the right foot, the Guide strikes a balance between readable and comprehensive.

There are moments his advice isn’t for everyone: “Just stick with index funds!” (I don’t)- but it’ll provide the 20% you need know to get 80% of your results. Not a bad deal if you ask me!

For doctors in training: 7 Things to Keep You Strong on the Path to Becoming a Doctor

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Work with me

You shouldn’t have to compromise because of who you are. 

As a medical student or trainee, chosing your specialty can be tough. The stakes are high. And sometimes, you don’t see people like you succeeding in the field you want to pursue. 

Do you wonder if your desired career path is compatible with a life outside the hospital or having a family?

Have others told you it can’t or shouldn’t be done? 

Do you lack role models who look like you, or resonate with you?

Are you worried about caregiving, being stretched too thin, or feeling guilty due to future responsibilities?

Are you concerned about earning what you are worth? 

What you’ll get from working with me:

  • Clarity in your career choice
  • Discussion about the work-life balance you want to achieve
  • Exploration of self-limiting beliefs
  • The confidence to excel at whatever stage you’re currently in

As a woman & mother in a male-dominated specialty, I can apply my own experience and insights to your particular situation, including your hopes & plans for the future. 

I can help erase shame and decrease doubt if you want to thrive in a male-dominated specialty like interventional radiology or surgery. 

Let me help you see a way forward, to your future self: a person who saves lives, and enjoys her own.

Discovery call

20 minutes to see how I can help you. 

Level I : The 90 minute intensive

Get my undivided attention on you for an hour and a half. To prepare, you’ll tell me about your challenges & goals using a pre-call worksheet.

$239

Level II: Career Clarity

Three 45 minute sessions with me. We’ll look to achieve, or get you on the path toward: 

  • Clarity in your career choice
  • Confidence to pursue what you wish
  • Personalized resources to help you find balance as you start your career
  • $479

Level III: Queen Bee

You’ll get everything in the level II package PLUS:

  • A lifestyle design session (45 min)
    • With my guidance, you’ll design your ideal day and week.
  • A financial trajectory session (45 min)
    • With my guidance, you’ll set financial goals for the year and beyond, mapping out a plan to achieve them. 
  • 3 monthly follow-up calls (30 min each), for doubt-busting and accountability. 
  • The Tired Superheroine book bundle including:
    • The Simple Path to Wealth
    • AmBITCHous
    • Tribal Leadership
    • Girl, Stop Apologizing
  • $899

I’ve chosen to become a wife & mother, blogger, physician leader, speaker, and investor.

Work with me and I’ll show you how you too can do whatever you choose. 

Testimonials: 

It was midway through my first year of residency when I started to feel disillusioned by my career choice. It was during this time that I came across a post written by Tired Superheroine. I have read it time and again throughout residency. It has kept me grounded, and reminded me of the importance of my training. 

Thank you for being a role model, & for sharing your thoughts with us. You may never know all the people whose lives you’ve touched, but here’s to recognition of at least one whose life you absolutely impacted in a positive way.”

-Amina Farooq, MD

What you’ll get from working with me:

  • Clarity in your career choice
  • Discussion around the work-life balance you want to achieve
  • Exploration & identification of self-limiting beliefs
  • The confidence to excel at whatever phase you’re currently in
  • Personalized support & cheerleading
  • Hand-picked resources and education to support your plan

To start the transformation, email me: TiredSuperheroine@gmail.com

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How to protect your income with disability insurance

Financial empowerment

I got lucky. I ended up buying disability insurance (hereafter shortened to “DI”) of the right kind, with the right company, at the right time. But not everyone is so fortunate. While some employed physicians rely on limited employer-provided policies, others neglect this kind of coverage altogether. But hoping you’ll never become disabled is not a strategy. This is a post about how you can protect your future income with disability insurance. 

A resident lecture clued me in.

One of my attendings in residency gave us a lecture on personal finance and the key types of insurance to have in place as we transitioned from training to the “real world.” Not all training programs included this kind of material, but we were fortunate. That’s how I was already aware of the importance of DI by the time I needed to purchase it. It was a helpful perspective to have, since getting an individual, specialty-specific policy can be expensive. 

The end of training is the best time to buy a policy for many. But at that time, it may not feel like a top priority. At the end of training, the burden of student loans weighs heavy, and that first attending paycheck hasn’t arrived. With a negative six-figure net worth, it can feel like you have bigger things to worry about. But as a new doctor, your future earning power is one of the most important assets to protect. You can insure against the loss of future income with the right disability insurance policy. 

Common objections to getting disability insurance

A common objection to buying DI is the sense that disability is a problem that affects other people. We don’t think it will happen to us, especially if we’re healthy, and have never faced a physical setback. But disability does happen, and disability benefits are utilized. That’s why it’s important to have it in place before you need it. 

Another stumbling block is that to doctors, learning about disability insurance, its features and implications, can feel like learning a different language. It takes some research and working with a knowledgeable professional to ensure you know what you’re buying. This language outlines how the policy will actually function to bail you out in the case of a long-term disability. Now that we’ve addressed some common misgivings, read on for some of the reasons you need it. 

Why you need your own long-term disability insurance policy

As a physician, especially early on, your biggest asset is your ability to earn a high income. You may still have a large student loan balance, and you haven’t yet had the chance to save or invest much, if at all. Therefore, you’re dependent on future income to repay your loans, cover living expenses, and reach your financial goals. That’s why it’s crucial to have DI coverage in place during your early and mid career. 

You should protect your income with a long-term disability policy if:

  • Anyone relies on your income.
  • You’d have to move out of your home if you lost your income.
  • You have student loans. Student debt isn’t discharged in bankruptcy, so if you were unable to practice medicine and had no disability coverage, you could be stuck paying your loans back at a lower paying job.
  • You’re a woman. We are statistically more likely to become disabled (sad, but true). So protect yourself!

The best time to buy it

Most residents and fellows should buy an individual long-term DI policy before finishing training. As a trainee, you’ll be eligible for discounted pricing. Not only will you get a price break when you’re at a lower wage, but the discount may stick with you for the life of the policy. Click here to learn about disability 101 for trainees

Applying for DI involves a medical history, labwork, and a physical exam. That’s another advantage to getting disability coverage in training. You’ll have the best chance of approval, and you’ll get the best rates when you are young and healthy. That’s a win!

More on timing your purchase 

Women who plan to become pregnant should secure coverage before pregnancy. Since growing a human has the potential to bring on pesky diagnoses from gestational diabetes to pre-eclampsia and the like, it’s best to buy DI beforehand. Again, this will help you secure the best rates and prevent any potential disqualification. Unfortunately, these conditions limited to pregnancy can still count against you when applying for DI! 

It may seem unfair to be penalized, but it’s true: a diagnosis like gestational diabetes puts you at increased risk of developing diabetes later in life. Therefore, your risk of disability increases. So please take that into consideration and buy long-term DI before getting pregnant.

My experience buying disability insurance

As we’ve discussed, there are a couple of reasons it costs more to insure a woman against long term disability compared to a man of the same age, health status, etc. Women are more likely to become disabled and use their disability benefits; therefore, their premiums are higher. As a graduating fellow, I was offered a gender-neutral policy. Since then, many carriers have done away with gender-neutral pricing, but may offer gender-specific trainee discounts. Other carriers have gender-neutral discounts for attendings. It’s gotten confusing! That’s why it’s so important to shop around for the best deal for you.

When I was buying my policy, I worked with a financial advisor, but I can’t recall if he shopped around to multiple carriers or not. Thankfully, I ended up with a decent policy at a decent price. 

Optional adjustments to your policy

My policy includes a cost-of-living adjustment (COLA) rider, or option. That means that if I become disabled, my benefit will increase yearly to keep pace with inflation. Another rider I’ve taken advantage of is called the future benefit increase. I used this rider to increase my coverage when planning my pregnancy. Maximizing my coverage was a way to hedge against the unlikely event of a pregnancy-related disability. Later on, I can decrease my coverage to a lower level if I wish. You can discuss options like these with a qualified agent. 

The cost of income protection

My own-occupation (specialty-specific) policy with Principal runs $7-8,000 per year. This means if I’m no longer able to function as a radiologist, or my income decreases due to partial disability, a large portion of my income will be replaced. This may sound like a large premium, but it protects a large income. Your premiums may be lower, especially early in your career. You may opt to pay in installments, or as a yearly lump sum. Installments can take the edge off the cost (but may cost you in additional installment fees).

How it works

DI premiums are generally paid after tax: meaning, they are not deductible. Therefore, the benefits you’d receive in the event of a disability would not be taxed either. That means that the monthly income replacement benefit may appear lower than your current monthly pay, and that’s OK. I know that if I needed it, my coverage would replace most of my income, allowing us to stay in our home and maintain our lifestyle. 

Hindsight is 20/20

My policy is with a reputable company, and I trust it will be there if I need it. But if I had to go back and do it over again, I’d find an independent broker to guide me through the decision. I wish I had known about PearsonRavitz!

PearsonRavitz is a company formed by a former OB/GYN, Stephanie Pearson, and her business partner, Scott Ravitz. I learned about them in the past couple of years, through trusted friends and contacts in the personal finance space. My DI purchase is a done deal, but you may be in a position to work with them.

How do you find the right policy for you?

Your best-case scenario is to work with a knowledgeable, independent broker who can help you compare the best policies for your situation. That’s what you’ll find in PearsonRavitz. I believe in their mission and am honored to partner with them. Here’s a bit about them and how they got started.

Stephanie Pearson, MD, FACOG is an OB/GYN turned physician advocate who puts a face to the issue of DI for physicians. When she got injured in the prime of her career, she was forced to learn the intricacies of her own coverage, and fight for her benefits.

An expert she could trust

With the help of Scott Ravitz, she was able to advocate for herself and ultimately prevail. Since then, she’s helped other doctors to get the coverage they need. To learn more about Stephanie, read her full bio here. It is easy to see why she’s passionate about what she does! 

Scott Ravitz was an insurance agent muddling through his own personal and professional challenges, when he met Stephanie and guided her through her ordeal. His search for meaning in his work was answered by Stephanie, and her approach to the setback she faced: 

“As I worked with Stephanie to secure her claim, I couldn’t help but notice she was doing a lot of helping herself. Unlike anyone I’d ever worked with before, Steph became obsessed with understanding the ins-and-outs of her policy — and the policies of her friends and colleagues, who naturally went to her with questions. Without skipping a beat, she’d begun advocating on behalf of other doctors, encouraging them to learn about their coverage, to protect themselves. I knew she’d be a natural insurance advisor. And she was. She is.”

PearsonRavitz has an inspired story. When protecting your livelihood with DI, trust is paramount. You want people like Stephanie and Scott in your corner. And I don’t know about you, but I’d trust an OB/GYN with my life. As a disabled physician, Stephanie has transformed her own pain into a personal mission. She and the team at PearsonRavitz can help protect your income with the right disability insurance policy.

As Dr. Pearson says, 

“We know insurance isn’t as exciting as practicing medicine. But if you’re a physician, it’s an absolute necessity. Let us help you find a plan that’s made for you.”

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Real-life Superheroine: LK

Balance

Since I started this blog, I’ve wanted to share the stories of other real-life tired superheroines out there. These are women saving lives, often while serving as the breadwinner of their families. It takes a ton of courage to share one’s story in a public forum. And with the hope that others might benefit from it, L.K. has offered to do just that. In this post, read about her career arc so far, along with her hopes for & questions about the future. Enjoy!  -Tired Superheroine

The superheroine in training

I’ll start with my intern year in 2003. It was a tragic one. My first husband had received a kidney transplant 10 years prior, for complications related to Henoch-Shonlein purpura. During my intern year, he was diagnosed with lymphoma, and spent the year undergoing chemotherapy. Later, he underwent an unsuccessful stem-cell transplant. After my first year of radiology residency, I stayed home to take care of him, delaying the start of my second year. He died three months later. I returned to my program and soldiered through, but I will not lie, it was rough. 

Finding love again

By post-grad year five I was back on my feet, and had met my second husband. We married the summer after I completed residency. We were aspiring surfers, and I was an avid rock climber at the time. We decided I would postpone fellowship for one year to work locums while enjoying a gap year of travel and adventure.

But that didn’t happen. The program at the University of Washington made an administrative error, and they were one fellow short. So on match day, I received a call from the fellowship director begging me to join them a year earlier than planned. With some discussion, we settled on an October start date, which left me and my husband four months to get married and go on our honeymoon. Our trip included a month of surfing in Portugal and climbing in Greece, followed by a month of surfing in Central America. 

Time to make some life decisions

When we came home, we decided if we were going to have kids, we’d better start trying. I was 35. I figured we could try for six months, then consult an IVF specialist. But by December of fellowship year, I realized I was pregnant. My due date fell a month before the end of fellowship. Therefore, I decided to work straight through the year, forgoing any vacation, so I could finish fellowship before giving birth. I worked so much, that when I finagled a three day weekend off to spend with my husband, it felt like the highlight of my year.  

Crush your goals in a white dress… why not?

Pregnancy as an IR Fellow

The first trimester was rough. I felt like I was walking through cold molasses while the other fellows ran circles around me. But by the second trimester my energy returned, and it was boundless. Whether I was up at the crack of dawn, operating late in the cath lab, or attending to another pelvic trauma in the middle of the night, I did it all. In retrospect, I have no idea how I did it. It was probably fueled by my love of interventional radiology. 

During this time, we had very little savings. We had purchased a house with a gigantic mortgage in Seattle. So on my weekends off, I flew across the state of Washington to work locums. With my impending maternity leave, I felt I had to provide a financial buffer to ensure we could continue to cover our mortgage before my first attending job began. 

A source of support

I had one unbelievably supportive attending during my fellowship: Karim Valji. He’s the current Chair at the University of Washington, and also a bit of an IR rockstar. Here’s a story about how his support helped me through as a fellow. 

I went in for my six month review with the fellowship director at the time. For me, it was more like three months into fellowship, because of my late start. Despite this fact, the director told me he felt like I wasn’t as confident as the other fellows, and that my skills weren’t as good. I listened politely, and went straight to the bathroom to sit on the toilet and cry. 

They can’t handle a real-life superheroine

The very next day, I was scrubbed in a case with Karim, and as I slipped in a nephrostomy tube he said, “I just love working with you. You are so much more confident and skilled than the other fellows.” 

I stared at him dumbfounded, before explaining what had happened in my review the previous day. After the case, we retreated to his office. He explained the way he saw things: I was the only female fellow they’d had in over five years, I was pregnant, and I was still out-performing the others. He figured they didn’t know what to think; their egos just couldn’t handle my presence. I don’t really know if it was true, but he claimed I was running circles around everyone. His words gave me the support I needed to soldier on in what was an otherwise hostile and misogynistic environment. At least we never had a journal club at Hooters…

Attending life begins

I started my first job out of fellowship with a three-month-old. My husband, previously a landscape architect, left his prestigious job to become a stay at home dad.

This happened at the apex of the economic downturn ( in January of 2010). Therefore, many radiologists in Seattle due to retire decided to keep working because their retirement accounts had suffered. As a result, there were no IR positions, and we had to leave Seattle. We headed to rural Washington for work- not part of the original plan. We didn’t want to sell our house in Seattle because it was worth $100,000 less than what we’d paid before the crash. As a result, we had to rent it a rate that only covered half of the mortgage. We were forced to pay for the other half of the mortgage, as we found a place of our own in the new job location.  

In the wrong job as a new mom

My first position was not a good one. There was one other interventionalist who had zero support from his diagnostic partners, and so abandoned any hope of building a robust practice. This left me on my own, fresh out of fellowship, to play tug-of-war with the surgeons and interventional cardiologists. I attempted to start an interventional oncology program with a hostile group of oncologists. To add insult to injury, I was to help replace the night-time radiology service. That meant covering eight weeks of nights at 74 hours per week. 

My pumping routine consisted of sneaking away from the reading room a couple times a day. I’d frantically pump while standing in the bathroom of the fluoroscopy room. This involved tenuously balancing my equipment on a soiled linen container, while hoping no one would come in for a procedure while I was there.   

A financial awakening

I discovered Mr. Money Mustache (MMM) three months into that job. At my wits end, I thought, “There is no way in hell I can sustain this for 30 years.” I had watched my first husband waste away and die two weeks after his 30th birthday. There was no way I was going to spend the precious time I had remaining working like that.

I soaked up every word MMM wrote. I had never been a fan of debt, and never had a credit card. The only debt I carried was $30,000 in student loans from medical school, and the albatross of a house that we now owned but couldn’t afford. I lived at home through medical school and for four years of residency, before moving in with my now husband. Being frugal was always just a part of me. 

In diving into the world of financial independence, I educated myself ruthlessly. I learned everything there was to know about low-cost index fund investing

Random opportunity strikes

Nine months into my first job, I met another interventional radiologist at a wedding, and he recruited me to his group. I have been with that group for nine years now, and boy, did I luck out! I actually thought my first job was OK. I mean sure, I often worked six days a week, and I worked a ton of nights, but I got to do some IR, and it was easier than fellowship (even if it was harder than diagnostic radiology residency).

In contrast, my new group was a lifestyle group. When I was hired, we had about half the year off. We worked some long shifts, weekends and evenings, but we never worked nights. The biggest point of friction between members of the group was between those that wanted to work more than 65%, and those who wanted to work no more than 60% time. It was amazing. 

A shift in work-life balance

With me contributing to the childcare more, my husband was so much happier. He even went back to work part-time in his field. I was able to have another baby, and this time, pumping and nursing were so much easier, since I only worked part-time. The thing was, everybody worked part time. So I wasn’t marginalized in any way for raising my children; I was working just as much as everyone else!

Financial independence

Despite my good fortune with the new job, my desire for financial independence has always been a driving force for me. We sold our house in Seattle, and I paid off a $500,000 group buy-in in 18 months. Now, everything that’s left over goes into tax-deferred savings or low-cost index fund investing. We have started to diversify with real estate. We own a rental property, have invested in real estate syndications, and have even self-directed a Roth IRA (which is pretty awesome). Now, about 60% of my post-tax income goes into some kind of savings vehicle.

An uncertain future

We are now approaching financial independence. I still love interventional radiology, and diagnostic radiology too. The question I am wrestling with is, “What do I do next?” I have a pretty good job, and life is very comfortable. Is this it? Although I get quite a bit of time off, the lifestyle-oriented partners have retired, and the younger partners want to work more to make more money. To this end, we have tightened up staffing so that each radiologist now works more. 

But I want more time, not more money. My husband and I want to delve into slow travel adventures, and our kids ( seven and ten years old) have had enough travel experience to also be interested. I’d love to spend more time traveling with my family now, and focus back on my career as the kids get older and go off to college.  

Real-life superheroine reflections

What about my skills?

I have explored trying to work abroad, but I’m not sure if it’s worth the trouble if we only plan to do it for a six month to two year period.

Should I pursue mission work? Does it exist for radiologists? I’m not sure. And really, we want to see multiple countries, not just hunker down in one place. I’m exploring whether this is realistic. Being a physician makes a gap year difficult. Especially in a skill-based discipline. I worry about taking time off from IR: would I be able to jump back in? I’m not sure it’s like riding a bike! One thing is certain: I am not ready to leave radiology for good.

The circuitous path to financial independence and beyond

It’s funny, when I set out for financial independence a decade ago, I never imagined I would end up here with this dilemma. I figured I’d make enough and get out. But I’m not ready to stop, maybe just reroute. If I could just figure out what comes next…

There you have it: a snippet of life as a real-life superheroine. Once you “make it” to the attending level, the road can still be windy. New challenges can arise. It’s a good lesson for us all. We should do our best to appreciate where we are in the journey, wherever that currently is. While attending life is a light at the end of the (training) tunnel, when you get there, it isn’t just rainbows and unicorns. There will always be decisions to make, forks in the road, and dilemmas to solve.

Women in interventional radiology, other procedural fields, and surgical subspecialties are scattered around the country, sometimes disconnected from each other. But there is strength in numbers. We can help each other navigate these beautifully complex careers. Reach out and connect with another real-life superheroine. To share your comments and questions with L.K., you can email her at kiviatleah@gmail.com.

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Why I blog

Career & Leadership

According to growthbadger.com, “there are over 600 million blogs in the world today, out of over 1.7 billion websites. In the United States, there are over 31 million active bloggers posting at least once per month.” So why blog? Hasn’t everything been covered already? Well I don’t think so. The following are some reasons why I blog, and why you might consider the medium yourself. 

It teaches me to write. 

Everyone has a story, and I’ve always wanted to develop mine, so I can understand it, and so others might take something from it. Before me, my parents and grandparents had a story of war, immigration, and growth, and writing has encouraged me to start capturing some of their stories before they fade away. 

The process of blogging involves spitting the words on the page. Ideas and phrases spill out of my fingers in a tapping commotion until my forearms ache. The words want to get out. Then comes the editing: make it cogent, make it flow. I arrange ideas so they’re more pleasing to the eye and the brain. 

Editing and re-editing myself has taught me to express myself better, even off the page. Now, I can get my points across better than before. As a result, I have more confidence. It’s a surprising benefit, for someone who previously had difficulty expressing herself in person. 

It’s practice in “putting myself out there.”

Whether because of my introvert nature, imposter syndrome, or a number of other factors, I have struggled to put myself out there in the past. Thinking others would consider my ideas pedestrian, I’ve held back in many forums. Basically, I was worried I had nothing worth contributing. But during my journey into a male-dominated, surgically-oriented field, I didn’t see my perspective or voice out there, at least not in a widely accessible place like the internet. I lacked female mentors, and I knew sharing my story could help others who might feel the same way.

Putting myself out there has helped me verify that I do have something to add to the conversation. I can be a voice for women in male dominated fields like IR. To share my account, I’ve had to dig into the recesses of my memory, and often push beyond my comfort level. In growing used to putting myself out there, I can now offer my opinion more readily in real life (IRL). Less afraid of what others will think, I can speak up with less hesitation than before.

Now, if I have an opinion or a idea, I’m more likely to “reply to all,” rather than work through one-on-one back-channels. Maybe someone else will join the conversation, or ideas will cross-pollinate. The same thing can happen in blogging.

Blogging has helped me find my voice. People are more aware now of who I am and what I can contribute. When you speak up, you become a leader. When you show up consistently and produce, you become a valuable contributor. These are skills you can hone at your own laptop. 

I have even more purpose than I did as “just” an IR.

As a blogger, my brain and hands can produce different work from what I do at the hospital. I feel more multi-faceted. As physicians, we must work within a pre-existing, often flawed system, with its associated constraints. Culturally and professionally, some feel they need to stay in a box, and it can be confining. With my chosen method of self-expression, I can step outside the box.

As I develop this outlet, I see what the world is doing outside of medicine. Outside the medical bubble, my self-worth isn’t all wrapped up in my profession. A different part of my brain is active. And maybe when you read what I write, it activates a part of your brain that’s laying dormant. As a blogger, I’m not just doctor and mom, I can be an influencer and a thought leader. I’m a developer and propagator of idea and strategy. Maybe you are too.

Blogging feels like mass-mentoring.

One-on-one mentoring will always have its own verve, and personal interaction is so valuable. But some questions get asked repeatedly, especially for women in interventional radiology. I’m banking on there being other women like me, secretly wondering if a male-dominated surgical field or the on-call lifestyle is right for them. My hope is that my account will bolster their confidence in their choices. I believe their lives can be shaped as they wish, despite the benevolent or overtly sexism forces that suggest otherwise.

Through blogging, my time and reach as a mentor can expand to help many more people than I could otherwise impact individually. I can reach hundreds or even thousands of people when I hit “publish” on my site. 

I’m a creator.

I value creativity and enjoy cultivating it. Creativity requires space and time. As a working mom, the space exists when I’m waiting for my last case to start. In a silent reading room, all my colleagues are gone. I used to stare at msn.com reading the lifestyle section, until one night, the words poured out.

Putting my ideas down, developing them, and re-working them is gratifying. I relish creating something that didn’t exist before. Growing up, I journaled, scrawling through notebooks in a pre-computer era. This writing inevitably left me with a clearer direction and a quieter mind. Reading and writing help us work through life’s conundrums, like finding work-life balance as a mom on call, for example.

It’s fun.

The blogger milieu is filled with fascinating people who love to learn and create. By getting to know each other online, consuming each other’s content, commenting, sharing, and amplifying each other, our connections and impact grow. Many of us met at a conference in September. It was uncanny going out to lunch with twelve veritable strangers who all liked to talk about the same things. As you’d imagine, it was a blast.

When a fellow blogger put on her first online course, I got to help her sell it, spreading the word about financial literacy. Another blogger released his fourth book, and offered to send the series to me, so I could spread the word. As I grow my own platform, if I’m listening to a podcast and have a great idea to contribute, I can text or DM-pitch a creator colleague. I was thrilled to receive a cold-email request to interview on a podcast for IR trainees. I love surprises, and blogging is filled with them. 

Creating and promoting weekly content takes time and commitment. For me, it’s been a rewarding way to flex my creativity. What about you- would you start a blog?

Share your own inspiration using the best web hosting and support around. I love using Bluehost and you might too. There are seasonal promo rates you can take advantage of right now, to secure your own unique domain at just a few bucks per month. As a bonus, if you use my link, you’ll help support the growth of this site at no additional cost to you.

Yours,

Tired Superheroine

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Barbara Hamilton, MD
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Speaking

Barbara Hamilton, MD
physician speaking about male-dominated fields
Barbara Hamilton, MD

Welcome to my speaking page!

I’m Barbara Hamilton, MD, an interventional radiologist, author, and physician leader practicing in Southern California. As a physician in a male-dominated field, I’ve experienced the challenges of balancing a demanding career with life outside of the hospital.

I’ve made it my mission to help patch the leaky pipeline of women aspiring to male-dominated fields like mine, through demystifying what life is actually like in these fields.

I help aspiring & early career physicians see how they too can save lives and enjoy their own.

Topics I speak about include:

For samples of my speaking, tune into these podcast interviews:

Contact me to book a speaking engagement

For a speaker’s CV, or to inquire about an upcoming engagement, please email me at tiredsuperheroine@gmail.com!

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10 early lessons that shape my money philosophy
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Ten early lessons that shape my money philosophy

Financial empowerment

We all learned things about money growing up, whether intentionally or not. Does what we learned in childhood matter to our financial lives once we come of age? Raised by an ultra-frugal dad and a joyful spender of a mom, I appreciate what I’ve learned from each approach. Here are ten early money lessons that have shaped my money philosophy. 

1. Hustle and save.

My dad came to the US as a young immigrant after fleeing communism in Czechoslovakia. He made his way to New York, and put himself through Queens College, driving a taxi and an ice cream truck to make money. Through the 80’s and 90’s,  he made a solid living as a ceramics engineer, around sixty thousand per year. He saved most of his earnings, spending the smallest amount possible.

He’d patch his own muffler instead of replacing it. His twenty year old Civic’s axles made metallic clacking sounds for over a decade. Without knowing exact numbers, it was clear Dad had a high savings rate. He kept me in the dark about the particulars so I didn’t ask for more stuff growing up. The first super-saver I knew, Dad’s origin story likely helps to explain his ultra-frugal ways.

2. Divorce kicks your finances in the gut

Divorce rates surged in the 80’s, and my family became part of that trend when my parents split. From a young age, even I could see that divorce took us down a peg. Now there were two households to pay for instead of one, and the gas money in between. Mom and I even moved to my grandparents’ place for a year, to get back on our feet. In our temporary location, I attended a new school with frightening, upper middle class children. Attending a high quality school with all of its enrichment programs, my academic skills advanced.

When we returned to our small town the following year, I was a step ahead of the other kids. I saw first hand what more resources meant for kids in a well-to-do area. By age seven, I resolved to find financial stability, so I’d never be forced to move for monetary reasons again. 

3. Don’t be duped

Meanwhile, Dad taught me to find the least expensive version of anything. When he picked me up from mom’s for the weekend, our first stop was the market. We needed milk and food, since Dad spent most of the week eating lentils. He taught me to compare prices on everything from sardines to toilet paper. He crooned about the ways in which companies tricked consumers, from shrinking the product over time, to using a different unit than a competitor. But we were not fooled! 

4. Spend according to your values

Dad taught me to spend according to a values system: his value system. These were fitness and education. “We” chose free sports, like running. To feed our brains, we ran a couple miles to the local library, perusing books and magazines for hours, sometimes for an entire weekend. 

I learned to play tennis at the local park, first hitting against a concrete wall, and later, playing with Dad. We had matching neon orange and purple rackets from K-mart, since they were the cheapest. We carried old tennis balls in a paper shopping bag. I stared at the branded tennis bags carried by others. I wondered if people would notice our humble equipment and make assumptions. Comforted by my growing skill in lobbing the ball over the net, though, I reminded myself: we weren’t poor, we were just acting like it. 

5. An introduction to stealth wealth?  

For vacations with Dad, we traveled by bicycle, first circling the state of New Jersey, and later, riding to Canada and back, over 1000 miles for each trip. It was Dad’s version of road schooling I guess. Sometimes we camped, others we stayed at an inexpensive motel along the way. While other families relaxed on vacation, I chugged up and down hills in the Catskills, taking an occasional dip in a lake or a roadside pool. Like a tween-age hobo, I rinsed sweat and dust off my face in convenience store bathrooms. By the time we took a break from pedaling, Fig Newtons and a bottle of tea tasted divine.

We propelled ourselves over hills and valleys, through humid and drizzly days. From a bicycle, we could see each yard of the countryside that passed, and I learned to appreciate traveling this way. Dad and I had shoestring adventures. 

6. Restriction can be a blessing

Having an ultra-frugal parent helped me have a lower than average threshold for material satisfaction. Since Dad often ate rice and beans, I came to realize how good they smelled and tasted when I was hungry. Plain boiled chicken was pretty delicious, and I loved to soak up the schmalz with a piece of rye. We ate in front of the TV, sharing stories from the week. Our simple routine cost very little, and it made any deviation, like eating out, feel special. 

7. Single mom bootstrapping

I lived with Mom during the week. After shacking up with my grandparents for a year, we moved to an apartment complex on a two-lane highway, across from a mobile home park. In the morning, Mom left for work, and I spent the final hour waiting for the bus with a fellow rider and her family. They had so many animals in their space, that I still remember the smell, which lingered on my companion long after we left her house.

Our bus route circled town for 30-40 minutes each way, to and from school, bumping over hills and around lakes. We passed single family homes, each neatly sitting on its own lot, with its own driveway. I dreamed of living in one of those homes: the bi-level, or the beautiful tudor… 

Child support helped make ends meet. We had a pleasant existence, my mom intermittently dating, while I tried Girl Scouts and various sports. Friends and I scampered on the grassy common areas of our complex. We picked apples in the courtyard. I was a latch-key kid, and I enjoyed the responsibility and solitude of arriving home to an empty apartment. With the help of neighbors and friends, Mom and I did the single parent thing into my early teen years. 


8. Vacation was not negotiable

Mom made twenty-five thousand dollars per year as a psychiatric counselor with a bachelor’s degree. We had an inexpensive mortgage, but lived paycheck to paycheck, carrying a credit card balance from month to month. Despite our debt, we faithfully took vacation by the shore each year, and shared the cost with friends. We went to a large complex in Delaware, where I had my choice to swim in the pool or ocean. I was in young girl heaven, cruising the beach for my future husband between sunburns and cones of cookies and cream. 


9. My first (little) budget!

My allowance covered the ice cream budget; I received a few bucks per week, with opportunities to make more, doing extra chores. Mom introduced me to budgeting through that small allowance. I never saved a significant sum, since savings were for spending. But I learned that resources were finite, and that I could make decisions accordingly. Delightfully, I had some control over how much I earned, and how much money I had at any given time. 


10. Depend on yourself

By high school, Mom remarried, and this improved our financial picture. My new stepdad let me practice driving his car. There was more money, but it wasn’t handed to me. I was eager to start my own financial life: I couldn’t wait to get a job. Following in the footsteps of my more sophisticated friend, I became a barista at the mall. From learning to use the espresso machine, to feigning interest about the origin of different coffee beans, I was an eager worker bee. I ground coffee into giant filters, stacking them for brewing, my clothes and pores retaining the scent. The experience and the paycheck were both great rewards: I was hooked.

Deciding to pursue a science degree, I headed to the state university, where the tuition was shaved according to class rank and SAT score. My in-state education was a deal. During college, I worked part time, and later traded up for a server position at a local steakhouse. I worked there through the first semester of medical school. In this period, I became more self-reliant, and set myself up for a bright financial future by minimizing my education costs

What does it mean for us now?

Growing up on the humble side of middle class, I couldn’t fathom making six figures like I do now. Back then, living in a single family home was a fantasy. Now, I wake up in a lovely ranch with landscaping and solar panels. My daily surroundings still surprise and delight me because of my humble beginnings. Remembering this not-so-distant past makes me grateful. Now, I’m positioned to think about how much I’d like to work, rather than how much I need to work. These early money lessons have shaped my financial outlook and served me well so far.

Everyone has a money story. Yours could be affecting your daily thoughts and decisions about money. Consider writing down your own financial history to see what you find in there! 

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Done is better than perfect

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...and perfect is the enemy of good.
These concepts in medicine & parenting are parallel.

career, balance

10 early lessons that shape my money philosophy
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Ten early lessons that shape my money philosophy

Financial empowerment

We all learned things about money growing up, whether intentionally or not. Does what we learned in childhood matter to our financial lives once we come of age? Raised by an ultra-frugal dad and a joyful spender of a mom, I appreciate what I’ve learned from each approach. Here are ten early money lessons that […]

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WElcome to the BLog

The TiredSuperheroine blog is all about building your career capital and thriving in a male-dominated field.

Confidence

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As a female physician, are you allowed to be confident? Are you allowing yourself to be confident?

career

Balance & parenting as a momma doc

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What does self-care, parenting, and life outside the hospital look like for a parent in a high-octane field?

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The path can be riddled with failures, even if you're doing it right. In this recording, I share some of my gaffes with you.

How to frame failure
on the road to success

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