The Physician Philosopher https://thephysicianphilosopher.com Fri, 04 Mar 2022 02:31:52 +0000 en-GB hourly 1 https://wordpress.org/?v=5.9.1 https://thephysicianphilosopher.com/wp-content/uploads/cropped-favicon3-32x32.png The Physician Philosopher https://thephysicianphilosopher.com 32 32 I am a Doctor and I Hate My Job: The Cure for Burnout https://thephysicianphilosopher.com/i-am-a-doctor-and-i-hate-my-job/?utm_source=rss&utm_medium=rss&utm_campaign=i-am-a-doctor-and-i-hate-my-job https://thephysicianphilosopher.com/i-am-a-doctor-and-i-hate-my-job/#comments Fri, 04 Mar 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?p=3878 I typed in "I am a doctor and" into google, and was amazed to see the most popular ending to the question. Are you a doctor who hates their job?

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My kids love the movie “Ralph Breaks the Internet.”  The two main characters, Ralph and Vanellope, are video game characters trying to find a replacement for a broken piece to Vanellope’s outdated racing game.  If they don’t find a replacement, her game will be shut down permanently.

As they search for the missing piece, Ralph and Vanellope walk up to a desk called “Knowsmore,” which is meant to symbolize a search engine (e.g. Google, Bing, or Yahoo).

As Ralph begins to talk, the Owl running the search bar tries to finish Ralph’s sentences to direct them to the right information.

Ralph stutters, “Um” and the owl responds, “Um…brella, umbrage, umami?

Of course, this is exactly what happens in real life, too.  If you start typing into a search engine (i.e. you start to “google” something) it will come up with the most popular way to finish your thought so that the search engine can most quickly and accurately answer your question.

How many of us would finish the sentence, “I am a doctor and…”  For some, they would say that they are miserable in a profession that was meant to be a calling.

I am a Doctor and I Hate My Job

According to the 2019 Medscape Physician Burnout and Depression survey, approximately 45% of physicians are burned out with three specialties (urology, neurology, and PM&R) having burnout rates that exceed 50%.

For any of us who have known the lonely and cold road to burnout, this makes sense.  To those who still don’t understand why wellness is important, it is probably a shock.

I’d argue that every one of the top ten reasons for burnout found in the Medscape survey maintains one major theme – they are each a part of the job we are powerless to change.

In other words, we have a lack of autonomy despite the thousands of hours we spent learning how to do our job.

For example, according to the survey, the top three contributors to physician burnout were:

  1. Too many “bureaucratic tasks” (records, charting, paperwork, etc)
  2. Spending too many hours at work (i.e. poor work-life balance)
  3. Electronic Medical Records

See how these items are outside the control of the physician?

Given the relationship between autonomy and job satisfaction (it’s one of three key components to enjoying your work), the increasing rate of burn out makes sense.

Naturally, it begs the question: how do we get more control over our life?

The Cure for Burnout

In past surveys, physicians have felt that getting paid more might help, and I’ve previously discussed why this is a ridiculous idea.  Most physicians are so financially illiterate that more money might make the problem worse.  Not better.

In the 2019 survey, the most common ways physicians are dealing with burnout includes exercise and talking to friends and family.

However, this ignores one major causal relationship: the amount of time spent at work, which directly corresponds to burnout rates. The survey showed that 36% of physicians working 31-40 hours admitted to being burned out compared to 57% of physicians who worked 71 or more hours.

Given the linear relationship between hours worked and burnout, I would propose a different solution, cutting back at work.  We could also consider the other readily accessible options to treat burnout.

Aside from cutting back to part-time work or chipping away at the parts of the job that we hate the most, one of the best ways to combat the physician burnout epidemic is to control what we can – our personal finances.

It is one thing in our control that wields enough power to prevent the bitterness that can often build when the hospital doesn’t love us back.

There is no reason to feel locked in a cage if we hold the key.

We can work towards limiting lifestyle inflation, and widen the gap between our income and spending. Then, we are free to invest our money wisely.  This is a quick recipe to achieve early financial independence, and freedom from administrative tyranny.

A financially independent doctor has a choice.  They can keep working full-time at work, or they can start pursuing Partial FIRE where they cut out the things they don’t like, or go part-time if that is what is needed.

Financial Freedom for Doctors

You might wonder why I am so quick to link burnout and financial freedom.  The reason is that I see them as intrinsically linked.

There are two core beliefs that led to me starting this site.  [The following is copied and pasted directly from my “about” page.]

  1. I believe that a financially independent physician – or one who at least has a clear path to getting there – is a better doctor.
  2. When we choose to practice medicine because we want to (and not because we have to), everyone benefits – including our patients.

Financial independence provides freedom for doctors. This freedom can stave off the worst possible burnout.

Why? Because if it gets worse, we can always walk away.  That’s true autonomy.  Some call if “F-You” money, though I am not quite so bold.

Either way, we must realize that our lifestyle choices lock us in a cage. If we sell the cage (our expensive house, cars, private schooling, and designer gadgets), we might find that freedom we’ve been looking for.

In the end, these “things” are not really what produce meaningful happiness anyway.

Is personal finance hard? Yes.  But figuring it out is also worth it to deal with the burnout epidemic we are currently facing.

Take Home

Like Ralph and Vaneloppe, we can find success if we learn where to find it.

If you are saying, “I am a doctor and I hate my job” I hope you will consider taking corrective actions that place you on the path to financial independence.  It just might save you.

It is important to avoid making the burnout worse through lifestyle inflation.  We should consider part-time work.  Or cutting out the parts of the job we do not enjoy.

If we lack autonomy at work, we can find that autonomy in our personal finances.  Control what you can; otherwise what you can’t will control you.

Have you ever felt trapped in a job?  What were the drivers of your dissatisfaction?  What was the remedy?  Leave a comment below.

TPP

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TPP #68: What Pizza Can Teach Physicians About Priorities https://thephysicianphilosopher.com/tpp/tpp68/?utm_source=rss&utm_medium=rss&utm_campaign=tpp68 https://thephysicianphilosopher.com/tpp/tpp68/#respond Mon, 28 Feb 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?post_type=tpp&p=561772 The natural process that most people go through when trying to gain clarity often complicates things. But what happens if you start with a clean slate and build up to your ideal situation?

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The Physician Philosopher Podcast

TPP #68: What Pizza Can Teach Physicians About Priorities

Editor’s Note: You may not be surprised to hear that I am speaking at the upcoming Physician Freedom Summit on March 4th-5th. I wanted to invite you and let you know that you get FREE access to watch my interview as well as the other 15+ speakers. You can check it out here.

 

There are moments in life where we are forced to get really clear on what matters most to us.  For me, this happened recently with Kristen getting diagnosed with COVID.  All of a sudden, that clarity I am constantly looking for in terms of what is most important. What I should currently focusing my energy and focus on to create purpose in my life…. Came very quickly into view.

I had one job.  Taking care of my family. That was it.  Where I’d normally spend time thinking about my next podcast episode idea, writing for my book, or creating content for upcoming talks… that all went to the way side.  My only job was to make sure that my kids made it to their activities, food was on the table, kids were bathed, and hair was braided so that I wouldn’t have to feed the “Tangle Monster” (what we call the brush we use to get tangles out of Anna Ruth’s hair).  

Going through this experience where we have an all-of-a-sudden clarity made me think about priorities in life.  That’s exactly what happened to me this week as I could really only have one priority. Everything else took a back seat.

Gaining Clarity

Now, you have to understand something about my family’s dynamic.  My wife, Kristen, is our rock.  She is what makes EVERYTHING work.  I am a big-picture, abstract problem-solving visionary.  I make complicated things simple, create frameworks to explain problems other people have a hard time understanding, and have been the person that people come to for advice my entire life.

This might all sound great, but it comes with some obvious failings, too.  I am TERRIBLE with details.  If you want me to help you figure out what you should do with your next steps in your career or life, I can do that better than most.  However, if you want to know what I did last Saturday.  Or you need help creating a detail oriented process.  I am not your guy.  

I am also unbelievably forgetful.  This is why my nickname at work is Dory – as in the forgetful fish from Finding Nemo.  

The point is that Kristen is the one that organizes all of the details, makes sure that the i’s are dotted and the t’s are crossed.  She knows all of our schedules inside and out, and makes sure we all get to where we need to be and when.  She plans out our weeks, because she is the detail-oriented person who has this super-human ability to juggle all of these balls in the air.  

So, when she went into quarantine with COVID I was the one responsible for all of the details.  And since this is not my natural strength, it required 100% of my focus.  Naturally, I was concerned that this would be a problem.

The Great Thing About Clarity

However, it wasn’t a problem.  It ended up being a huge opportunity for growth with my family.  When moments like this in life happen they crystallize our clarity immediately.  Having this one very big responsibility meant I could not focus on anything else.  So, that’s what I did.

In other words, it whipped the slate clean and forced me to get really clear about what mattered most.  I learned to use my problem solving skill set to delegate to my kids to do tasks they would not normally be responsible for on a typical day.  

Our family grew closer together because of the adversity. That’s what these moments often do.  They provide perspective and clarity.  

Other things that would normally happen simply got deleted.  I didn’t have the ability to do them while I was taking care of everything else.  And this clean slate is what I want to discuss in this post.  

Urgent versus Important Tasks

I spend a lot of time coaching clients on priorities.  They are often trying to figure out exactly what they want to do be doing with their career.  They are usually loaded up with leadership positions, various tasks at their job, and the additional clinical responsibilities they have as a physician in medicine.

The natural process that most people go through when trying to gain clarity on the various things they are involved in is to start trying to subtract things from all of their current priorities to try and get down to what they really want.  Unfortunately, this often complicates things.  

Deleting is infinitely harder than starting with carte blanche and adding what matters most.  My situation this week is a great example of that.  With Kristen being sick, I didn’t have a choice.  The slate was wiped clean.  Starting from there it was very obvious I could only do three things.  Take care of my family, go to work for my clinical shifts, and prepare for the three talks I had on my schedule.  Everything else was not getting done.

How did I decide?  By focusing on only one of the four quadrants of time management. I looked at all my tasks as either urgent or non-urgent.  And then separated them into important and non-important. Then, out of self-preservation, I only did the things that were urgent AND important.  And that led me to family, three talks, and my two clinical shifts.

The Pizza Topping Study

This may sound like a singular experience that I had… but it isn’t unique to me. This is actually how we are wired.  In a 2002 study, researchers from the University of Iowa looked into a question about how people purchase pizzas.  They wanted to know what would happen if people started with a blank slate and ordered their desired pizza versus starting with pizzas that already contained toppings and having to take toppings off they didn’t want.  

Essentially, they wanted to know if consumers built their pizza up from nothing would this look different than when they scaled down from a fully loaded pizza.  The background here is something called the Endowment effect where people value what they have more than the exact same thing if it is not theirs.  For example, if you own a home, you think it is worth more than you would if you did not own it.  

So, they took 115 students to find out.  Half of them were placed into the build up group and given a regular cheese pizza for $5 with an option to add 12 different ingredients at 50 cents per ingredient.  In the scale down group they were given a fully-loaded pizza with all 12 ingredients at a price of $11 (the same price if the other group added all the ingredients) and were told the price would be reduced by 50 cents for each ingredient removed.  

What did they find?  Well, in the build up group, the average pizza ended up having 2.71 ingredients while in the scale down group the number of ingredients was closer to 6. In other words, when trying to delete things that were already included in the pizza, it led to keeping twice as many ingredients on the pizza.  Similar findings were found when performed in a variation of this study in Italian consumers.  

Pizza and Priorities

What can we learn from this pizza study?  It is called the Status Quo bias.  This is what happens when people prefer for things to stay the same way instead of doing the hard work to figure out what they actually want.  

When we start from an already fully loaded schedule, it is much harder to eliminate current responsibilities and tasks than it would be if you started from a clean slate and decided to sign up for what you actually wanted to do.

This means that we have to fight against the status quo if we are looking to gain clarity about what matters most to us in life and what direction we want to go with our careers in medicine, our family life, and the other various asks we have on our time.  

In other words, let’s say that you are currently the medical director of your group, hold three leadership positions on various committees at your hospital, practice clinically, have a physician side gig doing real estate, and you are also married with kids… and you feel completely overwhelmed.

How do you go about figuring out which task to drop?  If you start from the Status Quo, or you current situation, you will end up keeping more responsibilities than you really want.  This is what happens to most of us.  

Wiping the Slate Clean

There are some lessons to be learned from this study and recognizing that we are all wired to keep more than we would voluntarily add.  

First, we should be quick to say no, and slow to say yes… once things are added it is harder to get rid of them.  This is why creating a Hell Yes Policy is so important. Once you have a ton of clarity on what matters most to you, it becomes much easier to say no to anything that doesn’t make you say Hell Yes.

Otherwise, you’ll end up saying yes to many things and saying no to what matters most – like your family and friends.

Second, if you are trying to gain clarity on the direction of your career, how to stop feeling overwhelmed, or to make a tough decision about your next step… it is better to start from a clean slate than it is to try and subtract things that you are already doing.  The Status Quo bias is strong.  

What would you do if you started with a clean slate? Carte Blanche?  That’s the more important question to answer.

The third thing we must ask ourselves is why do we have to wait for an impossible situation to provide this clarity?  Why do we have to wait until our spouse is sick and quarantined with COVID for this clarity?  Or when we become disabled or lose our job?  

The truth is we don’t have to wait.  You can gain that clarity right now, which is exactly what my coach helps me do each week, and what we help clients do when we coach them.  

Regardless of how you decide to gain that clarity, I encourage you to start with a clean slate and “build up” to your ideal situation as opposed to trying to “scale down” from your current Status Quo.  Otherwise, you’ll end up keeping a lot of things that don’t bring you passion or purpose in your life.  And when you lose your way, just remember pizza, priorities, and the Status Quo Bias.

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TPP

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The Tale of Two Doctors: The First Paycheck https://thephysicianphilosopher.com/tale-of-two-doctors/?utm_source=rss&utm_medium=rss&utm_campaign=tale-of-two-doctors Fri, 25 Feb 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?p=2043 You've made it to your first attending pay check. Great! Now what? Is it really that important to start investing? Surely I can enjoy the big pay bump. Let this Tale of Two Doctors answer the question "What do I do with my first paycheck"? Come join Dr. Jones and Dr. EFI as they tell their tale.

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Remember how strange it was seeing that large of a number in your bank account after your first “real” paycheck? After years of being paid as a resident, it seemed a bit surreal.  It is at this exact moment that you make some of the biggest financial choices of your life.  Come join Dr. Jones and Dr. EFI (Early Financial Independence) as they show you the importance of the decisions you make in your early years in practice. This is a tale of two doctors who just received their first attending paycheck.

Further Reading: If you like what you find in this post, you’ll like The Physician Philosopher’s Guide to Personal Finance even more!  Buy your copy today.

The Pivotal Moment

The reason that the moment you start making a “real” paycheck is such a pivotal point in time is because the decisions you make right then will determine your trajectory. It can be very hard to change your course after those first three to five years.  It’s possible, but it’s much harder.

Either you set yourself on a trajectory for great financial success and early financial independence OR you choose a lifestyle that will leave you in shackles and working ‘til you can’t work anymore.

The biggest problem here is that many of the choices you make are often binding. You cannot easily reverse a lot of decisions.  For example, if you buy a $1 million dollar home with nothing down and then find you want to sell it a year later… you better believe that financial pain will be real.

A Tale of Two Doctors: The Set Up

Here is how this post is set up.

We will follow Dr. Jones and Dr. EFI as they make very different choices when they finish training. For each doctor we will discuss their lifestyle inflation after training, decisions on student loans, retirement planning, and their eventual trajectory.

Let’s make some assumptions for both of them, though:

Doctor 1: Introducing Dr. Jones

Dr. Jones has waited long enough.  She spent four years in undergrad, four years in medical school, four years in anesthesiology residency, a year in fellowship, and now she is ready to reap the rewards of a lot of hard work.

Dr. Jones wants to live the doctor’s life she has always heard about.

She doesn’t want to keep up with the Dr. Joneses.  She is Dr. Jones.

Lifestyle Changes After Residency

Her monthly take home paycheck is now $14,500.  That’s $10,000 larger than her last residency pay check!

After signing on to her new contract, she found the exact house that she wants.  It’s only $800K with a 4% interest rate.  With a 30 year fixed mortgage that makes for a monthly payment of $4,100.

And the garage will fit the two new BMW’s she bought for her and her spouse perfectly.  She got a steal with 3.5% financing for a monthly payment of $1,800 to cover both cars.  Don’t forget the $200 monthly car insurance payment.

Student Loans & Retirement

Investing

She understands that she could pay down her debt quickly or max out her 401K, but she just doesn’t see the need.

Her employer has a mandatory contribution, and that sounds great! However, Dr. Jones didn’t see the benefit of chasing after an employer that matched or contributed above and beyond this in her 401K.  Retirement is so far away!

So, she puts in the required 2%, which is matched ($5,000 per year), but doesn’t see a lot of other reasons to save for a retirement that is 30 years away.

Student Loan Plan

Having said that, she also doesn’t want to keep her loans around forever.  So, she refinanced.

Her $250,000 in student loans are now being paid via a 10 year fixed plan with a 3.5% interest rate.  The monthly payment on this will be around $2,500.

The Breakdown of Dr. Jones’ Paycheck

Here is how her monthly paycheck would break down.

$14,500 Take Home
-$4,100 mortgage payment
-$2,000 car payment + insurance
-$2,500 student loan payment
-$600 Disability/Life Insurance
$5,300 remaining

This leaves Dr. Jones and her spouse with $5,300 for all of their other living expenses.  This might include a country club membership, cell phones, designer clothes/jewelry, cable TV, premium gas for the BMW’s, eating out, vacations, utilities, etc.

That doesn’t include furniture for the house she just bought.  But that can all be financed or go on a credit card, right?

All of her bonus pay will go towards the awesome vacations her and her spouse deserve. They’re working hard!

Take Home for Dr. Jones Over The Next Ten Years

Fire Your Financial Advisor

Another big decision to make is who is going to make your financial plan when you finish? WCI has your back.

The take home here is that Dr. Jones is living large.  She bought the house, the cars, and is not being aggressive with her student loans… she is really going to get behind the eight-ball.

How far behind?  Let’s see.

Given Dr. Jones’ lifestyle, she would probably want to have $200,000 each year in retirement.  If she retired at 65, she would likely need $200,000 x 25 = $5,000,000.

If this current plan continues, and we assume an 8% interest growth on the $10,000 she is saving each year ($5,000 contribution + $5,000 employer match).  After ten years (age 45), she will have an unimpressive $141,621 saved for retirement (TPP: corrected from previous math where I forgot the employer match).

At that point her debt would be gone. Maybe I am not giving her plan enough credit.  What if she started saving after her loans are paid off in 10 years?

Let’s say she changed jobs and found an employer with a good 401K after she realized how important that was.  So, she started maxing out her 401K and with her employer’s contribution and additional voluntary matching, she started investing $56,000 (max for 401K in 2019) for the next twenty years.

At age 65 how much would she have still assuming 8% growth?  The answer is a little more than $2.7 million.  Taking 4% of that each year for retirement, she would only have ~$108,000 per year.

Remember, because of her lifestyle, she needed $200,000 per year.  So, that’s half of what she wanted for retirement and she is now 65. Unless things change drastically for her, she will likely never get to that goal.

This is a story of big lifestyle inflation after you finish training.

Don’t do it.

Doctor 2: Introducing Dr. Early Financial Independence

Fortunately, there are better examples and Dr. Early Financial Independence (Dr. “EFI”) is going to show you that.

Dr. EFI knows better.  She has completed her four years of medical school, four years of anesthesiology residency, and also did a one year fellowship. However, she wants to start off on the right foot.

She has done her homework and knows enough about personal finance to do it herself.  And she knows where to get financial help, if she ever needs it.

With a more moderate approach to the lifestyle bump after residency, Dr EFI is not going to chase after a house three times her income right now, but she is going to buy a great house.  Eventually.

Before she can get the house she is going to make some good financial decisions. She will still enjoy a bump in lifestyle after finishing training, but Dr. EFI is going to limit lifestyle creep through The 10% Rule.

Let’s see how she does compared to Dr. Jones.

Lifestyle Change After Residency for Dr. EFI

Because she maxes our her 401K (pre-tax $19,000) her take home pay is $13,700 utilizing the same federal and state tax assumptions as Dr. Jones.

Dr. EFI followed The 10% Rule when she saw her paycheck increase dramatically. So, she took about 10% of that increase and decided to bump her lifestyle.  She has earned that.

She moves into a small rental home for $1,000 per month. It’s slightly bigger than the $750 apartment they were staying in during her fellowship year.

She drove a beater all during her years in medical school and residency to keep costs as low as she could.  But she really likes the new Toyota Prius (Touring edition for $30,000) because it gets almost 60 miles per gallon.

Making the same assumption as we did for Dr. Jones, she decides to surprise her spouse with one, too.

Despite the advice from other personal finance blogs, she finances a car. At 3.5% for 5 years, this will cost her approximately $1,000 per month for both cars, including insurance.

Dr. EFI wants to keep this plan in place for three years after she finishes.  Once her student loans are gone, she will be able to finally reap the real rewards.

How can she have so much discipline?  Well, she understands how important these beginning years are to her financial success.

Student Loans and Investing

Investing

Dr. EFI decided to take a job with a good 401K plan.  She maxes out her 401K to take advantage of her employer’s 2% required match, 4% voluntary match, and employer contribution. With everything included, she is maxed out to 401K limit of $56,000.

Camp Fire

Catching FIRE doesn’t happen without intentional decisions. Not usually.

Dr. EFI’s take home pay is $800 less each month ($9,600 for the year), but because of her employer match up to the 401K limit she is saving $46,000 more each year than Dr. Jones despite only contributing $14,000 more than Dr. Jones.

That’s a steal right there.

She and her spouse also max out the $12,000 each year for their first backdoor Roth.

All in all, she is investing $68,000 by contributing $31,000 of her own money.

Oh, and after her student loans are paid off… she will have even more going towards investments, likely in her employer’s excellent 457 account and a taxable account.  More on that below.

Student Loan Plan (Turned to investments)

Dr. EFI wants to be done with her student loans as quickly as possible.  So, she refinanced her loans to a 5 year variable because she knew this would offer her the best rate.

She averages 3.25% interest and she decides to pay $6,000 per month in student loans. This way, her loans will be gone in 3.5 years with no additional payments.

If she takes any extra bonus money she receives and, according to The 10% Rule, puts the other 90% of her bonus pay towards her loans; her loans would likely be gone in less than three years.

After her student loans are paid off, which have been costing her $6,000 per month, she plans on taking about a third of that money ($2,000), combining that with her current home rental payment ($1,000) and putting it towards her mortgage on a new “doctor” house ($3,000 mortgage payment on a $550,000 home).

She will take the other $3,000 remaining from her previous student loan payments that are now gone and put it into a taxable account.  That will total an additional $36,000 per year to take her annual investments to $104,000.

We have accounted for $5,000 of the previous $6,000 monthly student loan payment. What about the remaining $1,000 per month?

That, my friend, is for pure enjoyment on whatever she wants to spend it on. She could put it towards her mortgage and pay it off in 20 years instead of 30.  Or she could take two $6,000 vacations each year.

It’s up to her and her spouse, but they’ll find success because they know how to be intentional with their money decisions.

The Breakdown of Dr. EFI’s Paycheck

$13,700 Take Home Pay
-$1,000 rental/apartment payment
-$1000 car payment
-$6,000 student loan payment
~$900 Post-tax Backdoor Roth money
-$600 Disability/Life Insurance
$4,200 remaining

So, Dr. EFI has $4,200 (post-tax) left to spend each month compared to the $5,300 that Dr. Jones has.  Though, it is worth mentioning, that $4,200 is definitely more than she made on a resident or fellow salary.

So, despite buying two new cars for her and her husband and living in a slightly better place than in residency, she still has more money than she did as a resident to spend on eating out, going to the movies, or catching a ball game.

The Next Ten Years

What does Dr. EFI get for the $1,100 sacrifice she is making per month compared to Dr. Jones?

Well, ten years out from training she will be able to accomplish all of the following (compared to Dr. Jones who definitely won’t):

  • Dr. EFI’s student loans will be paid off in three years (compared to 10 + a lot of extra interest paid for Dr. Jones)
  • At ten years out of training, she will have accumulated $1,250,000 in her investment accounts (compared to the ~$141,000 of Dr. Jones)
  • She will have a very positive net worth (compared to Dr. Jones’ very negative net worth)
  • She will be well on her way to financial independence and retiring early (Dr. Jones will never be able to retire at her current lifestyle)

Take Home for DR. EFI

Dr. EFI is making some real progress!

She and her spouse get together and realize that once all of their debt is gone (no more car loans, mortgage, college for kids if they have any) they could live very comfortably on $120,000 per year in retirement.

Since they want to retire early they need it to last a little longer. So, they multiply their desired annual number by 30 (instead of 25 for traditional retirement).

They will need $100,000 x 30 = $3,000,000 to retire.  If they take out 3.3% ($100,000 per year), that should last as long as they need it.

Assuming she doesn’t change anything about her investments above, she will get to that number by age 52.  If she were to increase her investments in her taxable account by $1,000 per month (say, when those car loans are paid off after five years), she would reach that goal a year earlier at age 51.

Not too bad!  Retiring at age 51 would be swell.

This all assumes no increase in pay, no additional money from bonuses towards investments (which she would obviously make), and that her spouse never works or has retirement accounts of their own.  If any of those things happened, they would likely meet their goals in their mid to late 40s.

At that point, Dr. EFI could choose to be a doctor and work because she wants to, and not because she has to.

All the while, Dr. Jones would not be able to retire even at age 65 (fifteen years later).  And that remains true even if she really turned it around after 10 years of making mistakes.  Yikes.

Compound interest is wonderful, but it takes time!  That’s why your savings rate early on are so important.

The Big Picture

I should mention that there is a middle ground where you save 20% of your AGI each year and comfortably retire at 60 or 65.  That said, you can get there much sooner, if you want.  Who knows how much you will love your job in twenty years?

The big picture here is that you can have an increase in lifestyle immediately after you finish, but you have to keep it in check. You can have most anything (except the huge house), but you can’t have everything all at once.

Otherwise, you’ll be like Dr. Jones who looks wealthy on the outside, but will be working until she can’t work anymore.  Unfortunately, this is not as uncommon as you’d like to think.

The take home?

Residents, fellows, and newly minted attending doctors… take a small bump in lifestyle when you finish.  I suggest 10%. Then, put the rest towards building wealth for two to three years.  Your future self will thank you later.

What do you guys think?  What approach did you take (or will you take if not there yet)?  Did I leave anything out?  For those further along in the journey, what would you have recommended to yourself?  Leave a comment below.

TPP

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TPP #67: Money Matters: When Losing Feels Like Winning https://thephysicianphilosopher.com/tpp/tpp67/?utm_source=rss&utm_medium=rss&utm_campaign=tpp67 Mon, 21 Feb 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?post_type=tpp&p=561653 When you learn to act in spite of the risk of fear and failure, that’s when you can unlock financial success. It is also when you can make the change you need to make at work. If we want the freedom that money can provide, we must operate against our fear-based money mindset.

The post TPP #67: Money Matters: When Losing Feels Like Winning appeared first on The Physician Philosopher.

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The Physician Philosopher Podcast

TPP #67: Money Matters: When Losing Feels Like Winning

Editor’s Note: If you are are a physician who wants to find work-life balance in medicine, book a coaching consult with us!  We help burned out doctors master their mindset, money, and time so they can create a life they love.  

If I could convince you of one thing that would make the biggest difference for you when it comes to financial success, it would be that you are irrational.  You heard that right.  While you may think you make logical decisions, study after study shows that human beings make irrational decisions.  This is why when it comes to money, THE most important aspect isn’t “what to do” with your money… it is how you think about it. 

In this post, we are going to talk through mental constructs that will help you be a better investor.  

When it comes to investing money in the market, there are a few things that are paramount to success.  Let’s take a look at each in turn.

Make it easy to win (Loss aversion)

When I give talks on personal finance, I’ll often perform an exercise.  I’ll take out a $100 bill and ask the people in the audience, if they would be willing to make a bet. 

In this bet, we flip a coin.  Heads they win my $100 bill. Tails, they owe me $100.  I then ask them to raise their hands to see how many would take the bet.  

When I do this, there are always a few risk takers who raise their hands, but the vast majority keep their heads down.  Particularly, if I am talking to residents or medical students.  

Then, I raise the odds in their favor.  I’ll say, “what if I offered you $150 if you win, but you only have to pay me the same $100 if I win.”  A few more hands will go up after I increase the odds in their favor.  Yet, it is only when you get to a $200 win for them and a $100 win for me, that the overwhelming majority of hands will go up.  

Said differently, until someone stands to win twice as much as they could lose, it just isn’t worth it for most people.  This thought experiment actually comes from Daniel Khaneman’s work who has run experiments that people hate losing about twice as much as we like winning.  It triggers the fear centers in our brain. 

Myopic Loss Aversion

When it comes to investing, loss aversion has a HUGE potential to impact your finances.  The reason why is because we pay more attention to potential losses.  This comes from our avid hatred for losing money.

This is why when the market goes down, we have a tendency to freak out.  Even though none of that money is actually lost (unless you sell your assets), people have a really hard time watching their $1 million portfolio turn into $850,000.  

This is one of the many reasons that it actually pays to ignore your investments.  Why? Because multiple studies have showed that the more often you check your investments, the more likely you are to see them go down. Then, it is much more likely that you’ll make a change.  And, guess what?  When you do, you are more likely to make LESS money.

You read that right.  Paying more attention to your investments actually leads to lower returns.  There is a name for this phenomenon, which is called myopic loss aversion.  

This is one reason that I joke with people that if they do not have the discipline to leave their investments alone, then they should pay their best friend to change their password on their investment accounts. And then to promise not to tell them what it is when the market goes down.  This is also why I advocate for people having lazy investment portfolios that require them to pay little attention to them.

Framing Paper Losses

One way to fight back against our myopic loss aversion is to frame things differently.  Framing is the process of putting a positive or negative spin on things in order to change our decision making.  

Remember, you aren’t rational when it comes to decision making.  And this has been shown over and over again in a variety of arenas, including medicine.  I often tell the story about the study from the 1980’s where they broke patients with lung cancer up into two groups.  They told them they had two choices – radiation or surgery. 

Both groups were told that surgery had a better chance of long term survival.  The difference between the two groups was how they framed the mortality of the surgery.  When the patients were told there was a 90% chance of survival, 82% of them chose surgery.  This was the positive frame. When patients were told that they had a 10% chance of dieing on the table (the same statistic, only said differently), 56% proceed with surgery.

In other words, the percentage who chose radiation – which had a lower chance of long term survival at five years – skyrockets from 18% to 44%.  The only difference was whether the mortality statistic was framed positively or negatively. 

The same can be done with your personal finances.  When you see the market going down, you can view this as a “loss” or you can choose to view it as an opportunity to “ buy stocks on sale” while they are at a lower discounted price.

Historical Perspective on Loss

You might think that I am trying to feed you magic beans, but I’m not.  If you understand market history, you’ll know a couple of things that will encourage you to frame market dips in a positive light.

First, if we look at the market, we know that the trend is an overall upward trajectory when we lose our myopia and take a bigger picture view.  The average rate of return over the last 100 years has been 10%.  This means that some years it went down by 10% and other years it went up by 20%.  It is a bumpy ride, but with an overall positive trajectory.

The second aspect we must understand is that when the market takes a major dip more than 50% of the time these dips are followed by some of the biggest market gains.  Said differently, the times when our loss aversion is going berserk, and we want to sell… are immediately followed by the days it is most important to stay in the market. 

The Importance of Staying in the Market

 

doctor money

In the above image, three of the largest losses in market history (according to the Dow Jones) occurred on March 9th, 12th, and 16th of 2020. This was right around the time that the pandemic was happening. Many saw this and their amygdalas starting going crazy due to their loss aversion.

Yet, if you didn’t look at the largest gains, this wouldn’t tell the whole story. Three of the largest gains also occurred immediately following these days on March 13th and 24th, and then on April 6th.  

So, for all those who gave into their fears and sold. They lost major money as the market recovered quickly.  This isn’t new either.  When JP Morgan looked at this phenomenon from 1995 to 2014, they showed that 60% of the ten best days in the market occurred within two weeks of the ten worst days.

Working Through Fear

In coaching, we spend a lot of time working with clients on their ability to tolerate negative feelings. Why? Because all of our decisions in life are motivated by our feelings.  

We can either let the fear, anxiety, and worry we have in our life dictate our actions.  And lead to negative results. Or we can learn how to tolerate them and choose our course despite being anxious or fearful.  So, the next time the market goes down… remember the importance of staying the course. And that your brain is wired to make you hate losing.

Don’t let your lower animal brain control your actions. Fear doesn’t have to win.  You can stay the course, even when your loss aversion tells you otherwise.

Subscribe and Share

If you love the show – and want to provide a 5-star review – please go to your podcast player of choice and subscribe, share, and leave a review to help other listeners find The Physician Philosopher Podcast, too! 

TPP

 

 

You might also be interested in…

TPP #67: Money Matters: When Losing Feels Like Winning

TPP #67: Money Matters: When Losing Feels Like Winning

When you learn to act in spite of the risk of fear and failure, that’s when you can unlock financial success. It is also when you can make the change you need to make at work. If we want the freedom that money can provide, we must operate against our fear-based money mindset.

TPP #66: What Communism and Physician Culture Have in Common

TPP #66: What Communism and Physician Culture Have in Common

Burnout in medicine is expensive. Each year it costs us billions of dollars. What if the healthcare industry can transition to a different model of care that centers people over profit?

When leaders learn to choose people first, the results are positive and endless. In this episode, I spend some time explaining a fundamental concept that will help physician leaders make a decision that not only reduces burnout but provides a return on their investment.

Are you ready to live a life you love?

The post TPP #67: Money Matters: When Losing Feels Like Winning appeared first on The Physician Philosopher.

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Time is money, but money can’t buy time https://thephysicianphilosopher.com/time-is-money/?utm_source=rss&utm_medium=rss&utm_campaign=time-is-money Fri, 18 Feb 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?p=2116 Please, tell me I am not the only one who thinks like this?  My monetary mindset currently revolves around our biggest (current) financial goal: Paying off our student loans. I hope that some day I can truly learn that Time is Money and that money is a means to an end. It's not an end in itself.

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“This broken water heater is going to set us back.  If it costs $2,000 to replace, that’s an extra two weeks of payments towards our student loans.”  Please, tell me I am not the only one who thinks like this?  For a while, my monetary mindset revolved around our biggest financial goal: Paying off our refinanced student loans. Time is money, and I didn’t have the time for costs that slowed our financial progress down.

It is important to realize, though, that money is a means to an end. It is not the end itself.

This is a common concept that many struggle with in medicine, particularly if you work in private practice or you work in a shift work specialty.

Time is Money

The first person to use the phrase “Time is Money” was Benjamin Franklin in his book “Advice to a Young Tradesman, Written by an Old One”.

The original quote is actually the following:

Remember that Time is Money. He that can earn Ten Shillings a Day by his Labour, and goes abroad, or sits idle one half of that Day, tho’ he spends but Sixpence during his Diversion or Idleness, ought not to reckon that the only Expence; he has really spent or rather thrown away Five Shillings besides. ~Benajamin Franklin

The point that Benjamin Franklin was trying to make is that for every moment that you do not work, this will cost you money.  Of course, this is only true if there is a job that would pay you during times that choose not to work.

Shift work and The Problems it Entails

For those of us that do shift work, this idea hits close to home.  For example, I know that if I get sick and cannot go to work that is going to cost me what my shift normally pays.  As a physician who earns a lot of money, getting sick just got expensive!

Or what about that week of vacation you want to take to the beach?  That week, for me, is five days of missed work.  So, that beach trip costs more than just renting the house, buying the gas to drive the cars, and the cost of food.

It is also missed opportunity cost from not working.  Most of the time our beach trip costs more than twice what we paid for it.

Speaking of vacation, I know that in many private practice groups people will have to pay others to get a day off.  All of this costs money.

Money is a Means to an End

As we contemplate all of our decisions and the opportunity cost involved, I want to encourage you to think differently than Benjamin Franklin.

What’s the purpose of money?  Many of us work for money in order to buy something else.  It’s not like we cherish the feeling of cotton (or plastic) in our pocket.

We use money on college degrees, weddings, vacations, and essential items (food, water, housing, etc).  All of these things have an intrinsic value.  Your time has a certain value, too.

The point is that you can work your whole life to make money just to find that you missed all of the life opportunities to spend time with family and friends.  Money is not the end all, be all.

Trust me when I say no one on their death bed wishes that they had worked more, made more money, or spent more time away from their family.

How Do We Decide About Time Off?

This begs an important question.  How do we decide whether to say yes or no to something? Remember, It’s not all about the benajamin’s (I guess Benjamin got it wrong twice).

For me, it has to do with being valued.  In my mind, this means being valued with money (being paid more), time (off), or recognition.

If I am not getting one of those three things, then whatever opportunity I am considering is usually not worth it to me to be away from my family or hobbies.

Enter here my Hell Yes Policy where I say no to everything unless it is something that makes me say, “Hell Yes!”  Anything that doesn’t meet that criteria, including extra work shifts, isn’t likely worth my time.

Take Home: Time is Money

When you are deciding whether to pick up that extra shift, don’t forget why you are trying to make money in the first place.  Or, if you are considering the opportunity cost of missing work for vacation, just remember the point of obtaining money in the first place.  It’s just a resource.

Time is money, but money can’t buy time. Time is precious. And you only get so much of it in this life.  So, use it wisely and spend it well.

Do you have a shift work mentality? Do you tally up the money lost when you don’t pick up a shift (or miss one)?  How do you view time and money?  Leave a comment below.

TPP

 


 


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TPP #66: What Communism and Physician Culture Have in Common https://thephysicianphilosopher.com/tpp/tpp66/?utm_source=rss&utm_medium=rss&utm_campaign=tpp66 Mon, 14 Feb 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?post_type=tpp&p=561551 Burnout in medicine is expensive. Each year it costs us billions of dollars. What if the healthcare industry can transition to a different model of care that centers people over profit?

When leaders learn to choose people first, the results are positive and endless. In this episode, I spend some time explaining a fundamental concept that will help physician leaders make a decision that not only reduces burnout but provides a return on their investment.

The post TPP #66: What Communism and Physician Culture Have in Common appeared first on The Physician Philosopher.

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The Physician Philosopher Podcast

TPP #66: What Communism and Physician Culture Have in Common

Physician burnout is expensive.  Each year it costs us multiple BILLIONS of dollars. That’s billions with a “B”.  At an individual level, physician burnout has been shown to cost an average of $7600 per physician.  This isn’t surprising when you consider that replacing one physician costs an institution on average $250,000 to $1 million.  That’s a lot of money.

This is one reason that organizations like the Cleveland Clinic have not only invested money into physician coaching, but reaped massive rewards for providing that help.  In fact, it is estimated that they have saved over $133 million do to the coaching program that exists there.  Really incredible stuff.  

For this reason, I wanted to spend some time explaining a fundamental concept that will help physician leaders to make decision that not only reduce burnout, but provide a return on their investment.  

Leaders Do Care

It is important to first point out that the reason that burnout happens in medicine is because well-meaning leaders attempt to make decisions with the information they have.  In other words, these leaders use what they can measure to make decisions.

The argument goes something like this, “If I cannot keep the lights on, then I cannot pay people’s salaries.  So, my main job is to make sure we are profitable.”  And when the organization is profitable, THAT is when we will take care of the medical professionals on the front line. 

Sometimes the mantra that is used in this setting is called “No margin, no mission.”  In other words, if there is no profit margin, then the mission of the healthcare organization cannot be accomplished.  This includes taking care of the nurses and doctors on the front line who are burnout out at epidemic rates.

This is what I call a profit over people model.  It is well-meaning, but having this sort of metrics-based model has unintended consequences.  When we focus on quarterly budgets, annual balance sheets, and fail to keep a long-term view that is when our systems inevitably burn people out.

I will say that for most leaders I know, this doesn’t come from a place of hatred or malicious intent.  It comes from a place of trying to make decisions through things we can measure.

The ABC’s of the Self Determined Physician 

We have talked previously about the importance of autonomy, belonging, and competence on this show before.  Briefly, these are the three elements that every person needs in order to become a Self Determined Physician – or someone who is fulfilled, intrinsically motivated, and engaged at work.

These ABC’s of Self-Determination can be broken up into five sub-components.  These include personal and professional autonomy.  That’s the two subcategories of autonomy.  This means that you have control over your personal life, including when your schedule. You are able to get home when you want, make the tennis practice and tee ball games.  And you don’t have to continually find new childcare because you are constantly late.

The professional autonomy is also really important. This means you control how you practice medicine, the way you take care of patients, and have the ability to not only diagnose your patients but enact your plan.  Professional autonomy occurs when doctors are able to provide the care they know their patients need.  These are the first two elements of the Self-Determined Physician.

The third and fourth elements of the Self-Determined Physician exist in the area of belonging.  Each doctor needs to feel like they are (1) a valued member of the team who is (2) accomplishing a deeper purpose.  In other words, doctors need to feel appreciated, respected, and heard.  In addition to this, they need to feel called to something that is bigger than the team itself.  

Feeling like a valued member of the team who is also attached to a deeper purpose are the two components of belonging, and make up the third and fourth components of a Self-Determined Physician.

The final component of the Self-Determined Physician is confidence.  Doctors need to be successful clinically and (just as importantly) they need to BELIEVE they are good at what they do.  In other words, they need to have confidence in their skills and abilities.

Downstream impact of People Over Profit

When you think about the five elements of a Self-Determined Physician, this is when the profit over people model falls apart.  

For example, when hospitals install a new electronic medical record system to better capture patient billing without fully considering the impact of those who will be using the system… that can lead to massive rates of burnout as doctors feel like their autonomy is being attacked.  In fact, I’ve known clients in the Alpha Coaching Experience who have changed jobs because of bad EMR’s that were installed where they work.

Similarly, when insurance companies require peer to peer conversations to justify the care doctors know their patients need… this is a direct affront on professional autonomy.  So are the pre-authorizations that are often required.  

When administrators institute quality hold backs (which by the way, what the actual hell… why would you call something like this a “hold back” instead of an incentive?)  to try and provide extrinsic motivation to reach annual metrics… all this does is destroy any sense of belonging doctors have.  This is when they start to feel like cogs in the wheel or numbers on a balance sheet.

Again, it is important to realize that the people putting these things in place likely think they are driving down costs and improving patient care.  Yet, the end result is a profit focused system that results in physician burnout.  In turn, this causes higher physician turnover, and actually decreases profit margin.

And this is a life lesson… when money is our goal (instead of helping people)… the end result is usually a loss of profit.  Not more profit.  

Errors of Commission versus Errors of Omission 

After coaching a lot of physicians in ACE, I’ve come to realize that people regret not doing things more than they regret trying something and making a mistake.  This is why some have said that “errors of omission” (i.e. not doing something you feel you should) causes more regret than errors of commission (i.e. when we try something, and it doesn’t work out).

Knowing this, I often wonder why more organizations aren’t doing what the Cleveland Clinic is doing?  Why aren’t they investing in figuring out how to flip the script on this people over profit model?  

If leaders would instead put in place an employee first model (what I call the “People Over Profit” model shown below) where every decision they make is focused on whether it increases the five elements of self-determination, they would see that this not only decreases physician burnout.  It would also result in lower rates of physician turnover, which is where the estimated savings from the Cleveland Clinic coaching program are made.  This, in turn, INCREASES profit margin.

People Are Always The Best Investment

Can you measure how much an organization will save on the front end by putting their employees first?  Not usually.  Of course, you can make an estimate.  

Yet, we know that when we invest in people, this will produce a better culture.  A better culture will lead to less burnout, and lower rates of turnover which costs hospitals TONS of money.  This, in turn, will produce higher profit margins.  

And since we know that errors of omission bother us more than errors of commission, why aren’t more healthcare leaders taking a leap of faith knowing that when they fix the culture, the profit will take care of itself?  The answer is that it is harder to measure… even when we know it is the right thing to do, it takes true leadership to trust in the process.

Practical Examples of People Over Profit

Sometimes when I discuss this model with administrators, they ask for some specific ways the model might be applied.  As any good coach would, I often tell them that they know their people best and that it will look different for each department and organization.

That said, here is one great example of what this might look like called Results Only Work Environments (ROWE).  In ROWE’s employers are less concerned with how long a person works, when they work, or how they work.  Instead, they place their focus on results.  If the results get done, employees get paid regardless of how they accomplish the goal.

Why would they focus on this?  Because of the ABC’s of self-determination.  They want people to have control over their own schedule (personal autonomy), get work done how they see fit (professional autonomy).  It also provides an atmosphere where people feel like valued members of the team all working toward a goal that is bigger than themselves (taking really good care of people in a way that also allows them to love their job).

This transitions the operating room environment from one of communism (where everyone gets paid the same no matter how hard they work) to one of capitalism (you get rewarded for getting more done in less time).  

ROWE’s in the Operating Room

For example, in many operating room environments when you work harder, your just and right reward is getting more work added to your operating room.  You can imagine that if you are in the shoes of the circulating nurse, scrub tech, or anesthesia teams who often get paid by the hour or by the shift… their incentive is not aligned with a system where when you work harder, you just get more work.  

On the other hand, the surgeon (who is often paid by the RVU) has every incentive to operate as much as possible.  This misaligned incentive causes major cultural issues and often leads to late starts, long turnovers, and inefficient operating room practices.  The surgeon is upset that they cannot operate more and get home when they want.  The operating room staff are upset that they are continually asked to work harder without being paid like the surgeons.

This sort of misaligned model attacks people’s self determination.  They don’t feel valued as a team member when surgeons get upset with them.  No one gets home when they want, and people cannot take care of people how they want because incentives are misaligned.

In a ROWE, a set amount of work would be required and everyone knows that when that work gets done, they get paid.  Regardless of how long it takes.  The only metrics that the hospital cares about then are patient outcomes and efficiency.  ROWE’s are something that many companies outside of healthcare employ to encourage autonomy while getting the work done. 

A Transition from Communism to Capitalism in the Operating Room

Initially, this may lead to less surgical volume being accomplished in less time as surgeons are asked to operate within certain hours.  However, as we place our focus on the staff in the OR (instead of on profit), staff start to have more control over their personal autonomy and schedules. Inevitably, the result is higher efficiency and more work getting done in less time.   

This transitions the operating room environment from one of communism (where everyone gets paid the same no matter how hard they work) to one of capitalism (you get rewarded for getting more done in less time).

When everyone is on the same page… guess what?  That also improves team dynamics and helps everyone feel like they are working together to accomplish a deeper purpose of caring for patients. 

This is just one example of how the People Over Profit framework might be applied in medicine. The possibilities are endless, but one truth remains.  When we invest in the people on the front lines of healthcare and make sure they are fulfilled, engaged, and intrinsically motivated… this leads to better cultures, lower burnout and physician turnover, and ultimately increases the profit margins healthcare organizations desperately want.  

It is time to start focusing on our people.  They are always the best investment.

Subscribe and Share

If you love the show – and want to provide a 5-star review – please go to your podcast player of choice and subscribe, share, and leave a review to help other listeners find The Physician Philosopher Podcast, too! 

 

TPP

You might also be interested in…

TPP #67: Money Matters: When Losing Feels Like Winning

TPP #67: Money Matters: When Losing Feels Like Winning

When you learn to act in spite of the risk of fear and failure, that’s when you can unlock financial success. It is also when you can make the change you need to make at work. If we want the freedom that money can provide, we must operate against our fear-based money mindset.

TPP #66: What Communism and Physician Culture Have in Common

TPP #66: What Communism and Physician Culture Have in Common

Burnout in medicine is expensive. Each year it costs us billions of dollars. What if the healthcare industry can transition to a different model of care that centers people over profit?

When leaders learn to choose people first, the results are positive and endless. In this episode, I spend some time explaining a fundamental concept that will help physician leaders make a decision that not only reduces burnout but provides a return on their investment.

Are you ready to live a life you love?

The post TPP #66: What Communism and Physician Culture Have in Common appeared first on The Physician Philosopher.

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Saving Money. How Much is Enough? The 30% Rule https://thephysicianphilosopher.com/third-decree-30-rule/?utm_source=rss&utm_medium=rss&utm_campaign=third-decree-30-rule Fri, 11 Feb 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?p=644 What percentage of your annual income should you be putting towards your financial goals each year? If you haven't answered this question, you probably should. The 30% Rule can help guide you.

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I often give talks to my residents on Investing 101.  Before I can talk about investing, we have to discuss some personal finance basics, including budgeting and preventing large lifestyle inflation after finishing training. One of the biggest questions we answer when it comes to saving money, though, is “how much should I be saving?”

The slant on my site isn’t towards just answering tough math questions, though.  Let’s specifically focus on how much of your income you should be using to save money and build wealth when you are feeling stressed out by your personal finances.

In that situation, what’s the cause?  And how much should you be saving?

The Big Picture on Saving Money

Let’s keep this simple.  Money can dramatically impact most relationships.

The first time I witnessed this was when a couple – two of my best friend’s parents – had starkly different views on finances. The husband could not have been more frugal, and the wife enjoyed spending the money that they made without a second thought.

They were doing well financially by most standards, but they still experienced an enormous amount of financial stress because they had different views on expectations and reality as it related to finances.

Further Reading: One of the biggest sources of financial stress for many is student loan stress.  Check out the student loan refinance page to lessen that stress!

We all know the feeling – when finances put a strain on our relationships with those that we love.  The question is whether this feeling of stress is caused by overspending or by being so frugal that we aren’t just trimming the fat, but have now sunk the knife deep to the marrow.

The 30% Rule can help us figure out what’s causing our issue if we are saving enough money (or too much).

WAR and the 30% Rule

I don’t talk about war much on this blog, but today it’ll be necessary as I introduce you to a different kind of WAR – your Wealth Accumulation Rate (WAR).

In simple terms, your WAR is the % of your gross income spent towards building wealth.

The amount of money you are putting towards building wealth involves both the amount of money you are using to aggressively accumulate assets (savings rate towards investments) and destroying debt.

To calculate your WAR: Add your annual savings rate (hopefully at least 20%) and the amount of money you are putting towards debt (hopefully at least 10%) until you are debt free.

Wealth Accumulation Rate (WAR) =
% Gross Income paying down debt** + % Gross Income savings rate

For example, if 20% of your gross income went towards saving money for retirement and 20% of your income was going towards paying off student loans, this would result in a 40% WAR.

A Case Study 

For someone making $250,000 gross per year, a 30% WAR would amount to $75,000 each year going towards paying off debt or investing.  For the physician on the traditional path, this kind of WAR will typically result in financial independence before the age of 60.

Here is an example of what that might look like for a married couple:

  • Maxing out your 403B/401K at 19,500 (any matching money goes towards your WAR, but it also increases your gross salary!)
  • $19,500 into your spouses 401K
  • A backdoor Roth annual contribution of $6,000 (per spouse, if married) = $12,000
  • Paying $24,000 in student loan debt each year

Of course, the higher the student loan debt burden that exists, the more likely it is that a person will need to shift their WAR percentage towards paying off debt.

Hopefully, you are also applying The 10% Rule towards their bonuses and promotions to help increase their WAR, which will allow them get to your goals even faster!

**Edit: Debt being paid off when calculating your WAR should be “Good debt” such as student loan debt.  It has been pointed out that it should probably not include your consumer debt like that Tesla or buying more house than you can afford.  Increasing your WAR in this way prevents wealth accumulation. 

Saving Money.  How Much Is Enough?  

Obviously, the higher your WAR the better – as long as your life is tolerating it.  A high WAR is how people achieve FIRE.

However, aggressively building wealth to the extent that it negatively impacts your wellness may not be worth it. A WAR that is too high can negatively impact your life and relationships.  On the other hand, if your WAR isn’t high enough, your wellness will also be impacted as you limit your future choices and fail to obtain financial independence.

How much you should be saving can be directly answered after you calculate your WAR.  And, if the thought of saving stresses you out, then you need to figure out if you have a spending problem or a frugality problem.

After you determine whether your WAR is above or below 30%, you put yourself into one of two camps.

Less Than 30% Wealth Accumulation Rate

You are putting less than 30% of your gross income waging WAR and yet you are still feeling financial stress.

This means you likely need to build something I like to call financial resilience.

Life can be full of tough decisions, but if you are suffering from financial stress (not related to other happenings in your life) and you are at a less than 30% WAR, as a physician, you likely need to find your frugal gene and express it.

Speaking of genes, are your other jeans all designer brands? Are you paying two brand new car payments? Did you buy the big house (or are you contemplating it)? Do you live in a high cost of living area?

Maybe, its time to make lifestyle changes if you are feeling financial stress with a WAR of less than 30%.

More Than the 30% Wealth Accumulation Rate

If, however, you are feeling the tight constraints of your budget and you are saving money at a WAR over 30% of your Gross Income, you may need to question the extent of your frugality. Is it cutting too deeply?

For example, my friends parents mentioned in the introduction:

Their WAR was likely much greater than 30%, but this was clearly negatively impacting their marriage. It simply isn’t worth it to pinch pennies with a high-income if it negatively impacts your marriage. Becoming Financially Independent and Retiring Early (FIRE) is important, but it should not be an all consuming goal that prevents you from living a life well lived.

Who cares how big your bank account is if you aren’t enjoy life?

Take Home

Calculating your WAR and using The 30% Rule should serve as a guideline for discussion and thought. You can either adjust your spending or adjust your WAR to improve your wealth and live the intentional life of your dreams.

I think a 30% WAR is a pretty reasonable goal, but I need to show some grace and recognize that not everyone’s situation is the same.

Regardless, this is one of tools I use to consider how I am doing in my mission to obtain both wealth and wellness.

Am I investing enough? I don’t know… What is your WAR? Does it impact your lifestyle negatively? Are you feeling financial stress with a WAR more than or less than 30%? What do you think?

TPP

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TPP #65: The Difference Between Simple and Easy https://thephysicianphilosopher.com/tpp/tpp65/?utm_source=rss&utm_medium=rss&utm_campaign=tpp65 Mon, 07 Feb 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?post_type=tpp&p=561520 Have you ever wondered why you have a hard time sticking to your goals? Maybe you think it is willpower or motivation? Maybe you think you end up not having enough time to put in the work required? What you will learn in today’s episode is the ONE thing you need to know to reach your goal.

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The Physician Philosopher Podcast

TPP #65: The Difference Between Simple and Easy

There are a lot of things in life that are simple to understand, yet hard to put into practice. This is the difference between simple and easy. For example, when it comes to having a healthier lifestyle we all know that adopting healthier eating habits and consistent exercise routines are going to likely play a part.  

Yet, for many of us, we find ourselves unable to stick to the routine.  Maybe it is because we chose a diet that wasn’t something we could actually adopt as a lifestyle.  Or we told ourselves that – if we just stuck it out – running marathons is something we could learn to love.  

Regardless of the reason, one thing is super clear.  There is a huge difference between simple and easy.  This perhaps explains why there are entire self-help books on habit formation (James Clears’ Atomic Habits being my favorite).

In this post, I wanted to spend some time exploring a few concepts that are simple to understand, yet often hard to employ.  And then discuss some ways that you can cultivate your goals and then obtain them.

How to Create Financial Freedom

Money is not complicated.  The formula for success looks like this.

  1. Earn a good paycheck.
  2. Spend less than you earn.
  3. Build Wealth with the difference.
  4. Let your money work for you, instead of working for your money.

That’s it.  Money in four steps.  I cannot make it any simpler than this. And it is easy to understand, right?

All you have to do is earn a good paycheck, which every physician does (even those of you in lower paying specialties).    According to the 2020 U.S. census the median family income for 2020 was just under $70,000. Odds are that regardless of your specialty, you ALONE make more than the median household income.  

Now, I totally hear you. You also have a lot more debt due to student loans. The point remains. You make a good income, and if you can learn to spend less than you earn – and save the difference, you are going to find financial success.

For physicians who want to retire by the age of 65, this means saving at least 20% of your gross income.  For physicians who want freedom sooner than this – like I did – this means building wealth with at least 30% of your income.  

Yet…

50% of Physicians Don’t Save Enough Money…

In fact, a 2016 systematic review of physician retirement planning by Michelle Silver showed that physicians expect to retire by age 60, while they actually retire closer to the age of 69.

You might say, “well maybe that is because they LOVE their job?”  To you, I’d say… being someone who spends their time coaching physicians on how to create work-life balance and to find their dream job… that’s just the case.

And this is born out in other studies, too, like the Comphealth study that asked doctors who planned on working past the age of 65 why they were doing so, which showed that 50% of the doctors were going to continue working because they couldn’t maintain their current lifestyle if they retired.

Putting these two things together, that the average retirement age is closer to 69 for most docs.  AND 50% of the docs who work past 65 do so because they cannot afford to retire means only one thing.  They never mastered personal finance.

Despite earning millions of dollars during their career, they never accumulated enough wealth to retire with their desired lifestyle.  Maybe this was because they spent what they earned.  Maybe it was because they invested in things that didn’t get them to their goals.  Or perhaps it is because they never learned about any of this stuff

The point remains. Just because money is simple does not make it easy.

Cast More Votes in The Right Direction

This highlights the point that making progress in life is often fraught with errors.  Most of us want our paths to be a constant upward trajectory toward our goals. Yet, we all know this isn’t really how it works.

Life is often a three steps forward two steps back kind of process.  And when we shift our focus this turns out to be a good thing.  Far too many hard working doctors (yours truly included) have suffered from an Arrival Fallacy more times than we can count.  How many times do we have to learn the lesson that the next accomplishment or achievement wasn’t the answer we thought it would be?

When we shift our satisfaction in life to the process, is it really a bad thing that the process takes longer to get to our goals?  Isn’t that when we are often the happiest in life? When we are engrossed in what we are doing?  Totally enraptured in the “flow” that Mihali Csikszentmihalyi so aptly described?

So, the question isn’t about how to get to our goals as quickly as possible, but how to stay on the journey ever-present in the moment. Really, the right question is, how can we enjoy each step along the way to getting to our goals?  Even when the going gets hard.  Let’s talk about it!

Number 1.  When You Vote in the Wrong Direction, Choose Curiosity. Not Shame

As we discussed, the process of getting to our goals is really a three steps forward, two steps back kind of process. One that requires consistency, but also recognizes that we are going to make mistakes and experience mishaps along the way.

The question, then, is less about how do we celebrate things when we cast a vote in the direction of the person we are hoping to become.  That is the easy part.  No, the hard part is figuring out how to deal with ourselves when we cast a vote in the opposite direction. One that runs counter to where we are trying to go.

The answer to this involves choosing curiosity over shame.  Why? Because shame is a universally unhelpful emotion that never serves us. Nothing good comes from a place of shame.  Only hurt, pain, and spinning.  We are never productive from a place of shame.

So, if we are to avoid the internalization that shame often produces, what can we do instead?  We can choose the curiosity that is produced by guilt.  We can say, “huh, that wasn’t what I wanted to do… I wonder why I did that?”  

This allows the space for self-compassion that we all need, because as I constantly tell my kids “we all make mistakes.”  Expecting perfection is not only unrealistic (because none of us are perfect), it is also harmful.

So, when you spend money you didn’t mean to spend. Or you drink more alcohol than you intended to.  When you get on your phone at home when you promised you would work on being present… don’t shame yourself.  Take that same problem-solving doctor brain you use at work and ask questions. Why did that happen?  What situation was I in when I cast a vote in the wrong direction? What can I learn from this? What can I do differently next time to make it easier to do the right thing?

And this brings me to my second point about casting votes in the right direction…

Make it Easy to Do the Right Thing (And Hard to Do The Wrong Thing)

Life is about friction.  The less friction we have, the easier it is to do something.  So, the question becomes, how do we make it easy to do the right thing and hard to do the wrong thing?

For example, when it comes to money… we often talk about “paying your future self first”. What people mean by this is that you set up automatic processes that sweep money out of your accounts before you even have time to see it and then spend it.

For example, my 403B and 457 contributions are swept out of my paycheck at the hospital before it ever hits our bank account.  Then, when the money does hit the bank account, automatic transfers are already set up for the day it arrives to contribute to my three kids’ 529 plans and our taxable brokerage account.  That money is then automatically invested in our low-cost, diversified index fund strategy that I’ve set up inside each account.

All of this required some work on the front end, but now makes saving money automatic.  It happens without even thinking about it.  The same can be said of setting out workout clothes prior to the morning you plan to work out. Make it easy on yourself. 

The opposite is also true. Let’s say that you are trying to drink less alcohol, or you’ve decided to give it up completely.  One thing that you can do to help the cause is to make it harder to get alcohol.  

Take the alcohol out of your home.  Make it so that you have to be at a social event to have a drink.

Obstacles Are Opportunities

One thing that stops many doctors in their tracks is the possibility of failing. So, when we run into potential obstacles on the way, we would rather not try than to fail. 

We have talked about this before on this show (the importance of flipping the script on failure), but the truth remains.  If you want to learn how to cast votes in the direction of the person you want to become, you will have to learn how to turn obstacles into opportunities.

Changing your paradigm or perspective on obstacles is fundamental to your success.  For example, let’s say you want to become a scratch golfer (someone who consistently shoots par each round) there are few things you’ll likely have to do.  Like get fitted for the right golf clubs, find a good golf coach, create the time in your schedule to take the golf lessons.  Oh, and you’ll have to find a place to consistently practice and play.  You’ll also likely want someone to play with for fun and accountability.

You can look at each of these as just one more thing that gets in the way of your goal. Or you can enjoy the process of learning how to create time in your schedule.  Maybe you could make it fun checking out the various places you might play.  It could be a fun experience getting fitted for clubs.  

Whatever your goal, learn to make a list of things you’ll need to do to accomplish your goal.  And then instead of viewing them as things that are in the way of your goals, learn to consider them as opportunities.  They may be an opportunity to learn. Or an opportunity to prolong a process you enjoy. 

You’ll also have to flip the script on the obstacles that it will “cost too much money” or “I don’t have the time.”  When it comes to not having enough time or money to do things we want in life, these thoughts aren’t facts. They are thoughts. And they aren’t obstacles either. They are opportunities to learn how to create the time and money you need to get better at something you enjoy.  

The Difference Between Simple and Easy

The next time you set a goal, I encourage you to learn how to enjoy the process of becoming.  Stop focusing on the future goal, accomplishment, or accolade.  Focus on the journey.  The process.  Not the end product.

And while you do this, recognize that you sometimes you are going to get it right. Sometimes you won’t.  Even when ideas are simple, they aren’t always easy… but there are ways we can make it easier to cast more votes in the direction we want than in the direction we don’t.

Learn to choose curiosity over shame.  Make it easy to do the right thing (and hard to do the wrong thing). And learn that obstacles are opportunities.

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TPP

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TPP #66: What Communism and Physician Culture Have in Common

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Burnout in medicine is expensive. Each year it costs us billions of dollars. What if the healthcare industry can transition to a different model of care that centers people over profit?

When leaders learn to choose people first, the results are positive and endless. In this episode, I spend some time explaining a fundamental concept that will help physician leaders make a decision that not only reduces burnout but provides a return on their investment.

Are you ready to live a life you love?

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Physician Heal Thyself…And Why Doctors Don’t https://thephysicianphilosopher.com/physician-heal-thyself/?utm_source=rss&utm_medium=rss&utm_campaign=physician-heal-thyself Fri, 04 Feb 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?p=6156 Have you ever wondered where the phrase "Physician heal thyself" comes from? It might have a different meaning than you thought, and it certainly has a different meaning today.

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You have suffered sorrow and humiliation. You have lost your wits and have gone astray; and, like an unskilled doctor, fallen ill, you lose heart and cannot discover by which remedies to cure your own disease. ~ Chorus from Prometheus Unbound

These words were published in 1820. They come from a Greek mythological play, and they could not ring more true today. The medical world is filled with burned out doctors and nurses.  Many feel that they have lost heart and have become unskilled in their ability to treat their own disease.  This is certainly a part of my burnout story. Yet, the root of this passage in Prometheus Unbound can actually be found elsewhere in the phrase “Physician heal thyself!”

Physician heal thyself comes from the Bible. Specifically, it can be found in Luke 4:23 where Jesus quotes a common Jewish phrase of the time, saying, “Ye will surely say unto me this proverb, ‘Physician, heal thyself’.” (KJV).

What exactly does Physician heal thyself mean?  How has that meaning changed in today’s modern medical world, and what can we learn from this important idea?

What does “Physician Heal Thyself” mean?

In Biblical times, it was common among the Jewish culture to use the phrase “Physician heal thyself”.  This had a nuanced meaning. They believed that before a physician could adequately cure the disease that others were experiencing, they must first heal themselves.

It is the idea that you cannot fill the cup of others unless your cup is full, too.  This makes sense.

Physician heal thyself could be extrapolated to mean that before you venture out into the world to heal others, you probably ought to heal you and your own town first.  In fact, this is exactly how Jesus meant it in the passage in Luke.  At the time, he was being accused of healing acts that seemed to occur everywhere; except for in his home town.

This idea also stretches to the crucifixion of Christ.  On the cross Jesus is implored to save himself.

Those who passed by hurled insults at him, shaking their heads and saying, “You who are going to destroy the temple and build it in three days, save yourself! … In the same way the chief priests, the teachers of the law and the elders mocked him. “He saved others,” they said, “but he can’t save himself! ~ Matthew 27:39-42

It was a strong belief in those times that if someone was powerful enough to save others, they must be powerful enough to save themselves, too.

Do physicians need healing?

Physicians must be fiercely hard-working, intelligent, resilient, and self-sufficient.  That’s how they became doctors.  Yet, because of the very characteristics that got them into medical school, they often don’t ask for the help they need.  Doctors often try and fix things themselves, even when outside help would be best.

Due to a myriad of reasons, physicians cannot heal themselves, though they desperately need it.  In fact, physician suicide rates are alarming.  In fact, Pamela Wible maintains a list over 1,000 physicians who have committed suicide.

Is Physician heal thyself the right idea?

The burnout and mental illness that is pervasive in the physician community is alarming.  In part, this comes from an expectation for physicians to fix their own problems.  Physician, heal thyself!  Because of their personalities and this expectation, doctors have a hard a hard time seeking help.

In truth, physician heal thyself can be an inappropriate ideology.  Like any other human, physician healing from burnout, depression, and suicidal thought requires others to help in the healing process.

The causes to physician burnout, depression, and suicide are many.   Many causes are systematic in nature.  These include insurance company demands, administrator expectation, and electronic medical record difficulties. All of these problems lead to physicians who feel unable to provide the care their patients require.  They are left seeing traumatic events in the lives of those they are meant to serve.  Ultimately, this results in a phenomenon called moral injury.

Personal Causes for Burnout

Of course, the medical system isn’t completely to blame.

There are personal aspects to burnout, too.  Physicians are human.  We have challenging marital and family situations. Our average student loan debt graduating from medical school is around $200,000.  We also struggle with health problems, mental illness, work-life imbalance, and demands outside the workplace.

Financially, physicians are like professional athletes. We often turn to money to find happiness.  Yet, no matter how much money a doctor earns, our profession has shown time and time again that doctors are financially illiterate.  We are notorious for financial decisions that make our burned out and morally injured situations worse.

It turns out that big houses, fast cars, private schooling, and expensive gadgets… do not make you happy. It is the tale of two doctors.  Most follow Dr. Jones by taking the financial road to burnout.  Yet, it doesn’t have to be this way.

If physicians want to continue on and provide excellent care to their patients, it seems that Physicians do need to take part in healing themselves.  Though, this needs to occur with the help of others as well.

Can Physicians Heal Thyself?

If the medical system – which produces burned out and depressed physicians refuses to change – it seems that the doctor must heed the advice to heal themselves.  What options exist for this?

Of course, there are the typical methods that are often spouted in this arena.  Things like meditation, exercise, deep breathing, counseling/therapy, and medications.

Some of these help.  Yet, these items treat the symptom; not the disease.  They are a bandaid when we need an operation.

How Can Physicians Find Healing?

The tool that provides the most help and hope is financial freedom through financial independence.  Physicians who free themselves from the financial shackles that bind them to their dedicated road to burnout can follow the call to heal thyself.

There is hope on the road to burnout.

With this new found financial freedom, physicians have the opportunity to pursue partial FIRE where they take less shifts, move to part-time work, focus on locum tenens (part-time) work, or leave a hostile work place.

Many physicians who take this step find the true meaning in “Physician heal thyself.”  Often, they fall back in love with medicine, and find a new-found passion for a job that has become a daily nightmare.

Take Home

If you have found that the light at the end of medical training is not as bright as you anticipated, there is hope. Physicians cannot completely heal themselves.  We need help.  Just like anyone else.

Yet, there are ways that we can make bad situations better.

First, we must become financially literate by reading a good personal finance book for doctors.  Then, we can remove ourselves from the financially paved road to burnout.  This new found financial freedom will allow us to help reshape both the culture of medicine and our individual lives.

Don’t lose hope.  There is a remedy to your disease.  Physician, heal yourself – and, please, ask for help along the way.

Has you ever lost your way in your job?  Have you ever lost your work-life balance, or found yourself burned out, morally injured, or depressed?  How did you find your way back?  Leave a comment below.

TPP

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TPP #64: The Importance of Financial Freedom and Mindset with Dr. Daniel Shin https://thephysicianphilosopher.com/tpp/tpp64/?utm_source=rss&utm_medium=rss&utm_campaign=tpp64 Mon, 31 Jan 2022 09:00:00 +0000 https://thephysicianphilosopher.com/?post_type=tpp&p=561497 Dr. Daniel Shin, the Darwinian Doctor, is a practicing urologic surgeon. He's also a really experienced investor, in particular, in real estate. Daniel is not only successful in the financial realm, but he's also a prior client of the Alpha Coaching Experience. He has lived and experienced how doctors can really tie together the three things that we focus on the most- your mindset, your money, and your time.

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The Physician Philosopher Podcast

TPP #64: The Importance of Financial Freedom and Mindset with Dr. Daniel Shin

Editor’s Note: Don’t forget the doors to the Alpha Coaching Experience are finally OPEN, but will only be open until midnight on Thursday, February 3rd.  Make sure to visit thephysicainphilosopher.com/ACE to get all the information. 

One of the pillars to physician freedom and finding balance in your life as a doctor is money. It’s no secret that financial freedom can help you build a life within medicine that you love. And when coupled with understanding your mindset, it can help you build a life that doesn’t take all of the time you have away from the things you love, but supports it. 

I recently spoke about personal finance, part-time work in medicine, and finding a work-life balance as a husband, father, physician, and entrepreneur with an Alpha Coaching Experience client, Daniel Shin. Coaching has played a  huge part in helping him overcome burnout and allowed him to find the work-life balance he needed.

Dr. Daniel Shin, the Darwinian Doctor, is a practicing urologic surgeon. He’s also a really experienced investor, in particular, in real estate. He really likes to help accelerate people’s financial journey, and really ended up doing that on his own through getting rid of $300,000 in debt, working through burnout, and figuring out a job he felt handcuffed in.

Now Dr. Shin is on the other side of those things. And he did a lot of that through financial literacy, financial education, by creating financial independence for him and his family, and working through burnout. Daniel is not only successful in the financial realm, but he’s also a prior client of the Alpha Coaching Experience. He has lived and experienced how doctors can really tie together the three things that we focus on the most- your mindset, your money, and your time. 

Finding Freedom Through Money

Dr. Daniel Shin was originally from the East Coast, or as he likes to say, “I’m from the suburbs of New Jersey.” ,That is where Dr. Shin spent his formative years which was a very idyllic childhood, in the beginning.  But then around middle school when there was a recession in the US, his dad’s industry, which was commercial real estate, really took a hit, and that perfect lifestyle went out window.

Over the course of a very short amount of time Daniel’s family had their house foreclosed on and had to move across town to a rental. As a child not really understanding much about money, this was really scary. This sort of financial scarcity and insecurity marked the rest of his primary education through middle school and high school, and shaped a lot of his decisions later in life. 

So Daniel saw becoming a physician as my means to a stable financial future. But basically, what happened is that Dr. Shin became an attending physician, and all of his dreams seemed to be realized.

He had a great job, a family, was having kids, you know, everything was going great. And he was doing everything that you were “supposed to do,” you know, like his family got a new car, it was this fancy red SUV, and moved into a big house. 

Sounds familiar? 

But like two or three years into it, Dr. Shin found himself working 60 hours a week with a two hour drive on top of that, and he was feeling really burnt out.

So while money was the first step to security and freedom in life, Daniel was starting to understand that money alone could not help him have the life he wanted. 

Finding Work-Life Balance Through Mindset

So Dr. Shin considered cutting back,  but his lifestyle had sort of expanded to a point where he felt very shackled by his expenses. You know, the mortgage, car payment, daycare costs for two kids.  

He felt like he had these very heavy golden handcuffs on and was looking for a solution. 

This is when Dr. Shin started down the path to trying to gain control over his finances. So he started to document his journey on his blog, The Darwinian Doctor, and inspire others to do the same. 

But, the golden handcuffs didn’t get much better. Now Daniel could add income streams to his family and continue to increase their ability to reach financial freedom sooner, but the burnout was still there. 

This is very similar to my own story. I figured out the financial stuff first and put my family on a glide path to be financially independent by our mid 40s. And yet, I was still burned out in medicine just like Dr. Shin. 

As Dr. Daniel Shin noted, “I often ask myself, what differentiates people you know, successful people who on paper look very, very similar to people that maybe have the same financial means and the same, you know, resources but are not happy? And I realized that a lot of that is mindset.”

Your mindset it so important to burnout. The way that you perceive the world, the way that you perceive your place in the world, and how you relate to other really plays into how you feel. 

So over two years, Dr. Shin was gaining more and more control over his personal finances. And he’d gotten to a point on paper, where he was quite successful. But Dr. Shin was still very burnt out at work and overextended. 

He felt like he still needed something to help make that leap to regain a little bit more freedom and time. 

And that’s when Dr. Shin found the Alpha Coaching Experience and started on the path to decrease his burnout, find freedom, and get his time back. 

So while money is still a really important tool, it’s really a means to an end, it’s not the end itself. 

Becoming a Self-Determined Physician 

Once Dr. Shin found coaching he started to learn the tools that could really help him regain his freedom. And after a few months of practice, Dr. Shin began to implement these tools into his life. 

One of his biggest takeaways was that there’s a difference between your thoughts and circumstances. When you initially learn about these terms it seems very, almost so rudimentary that it’s like, of course, that makes sense. 

But once you actually learn how to apply that to your life then it is a different thing entirely. It’s almost like a superpower. 

So basically, it took Daniel about a month and a half to two months of hearing about this tool, how to look at his thoughts before it really started to sink in. 

For example, there are things that happen in your life that are facts, like you stub your toe, “I stubbed my toe,” that’s a fact. But the way that you then think about these things that are facts in your life is completely under your control. Your thoughts and the way that you perceive what’s going on in your life is very much under your control. 

After a while,  Dr. Shin began to realize that he was actually in control of a lot more in his life than he initially realized. And that was very freeing. That was the big sort of aha moment from coaching for this doctor. 

It is definitely a work in progress. The course in ACE is 3 months and it’s definitely sort of a practice that you don’t sort of flip a switch, and all of a sudden, you’re, you know, you’re fine, and you’re completely in control of everything. 

It’s something that you continually practice in your life. 

Daniel noted that those 3 months, “… did start me on this path where I do feel a lot more control. And I realized that a lot of the fears that I had about trying to exert more control over my schedule as a physician, a lot of those fears were just in my head.

I’m in a leadership position at work and one of the biggest fears I had was that if I tried to cut back from 120%, or 125%, which was my usual week, to closer to 100%, that I would be letting my department down, or we wouldn’t be able to sort of meet our metrics and all that. And then I realized that you know, that is just not true, we are going to be just fine. In fact, by exerting control over my life and being less burnt out and more healthy than I think I’ll it’ll be inspirational to my department.”

You just have to decide what’s best for yourself or are you going to let society or some stigma that might exist, basically prevent you from making a transformation in your life? 

A lot of people have this assumption that when you’re getting coached, or you’re seeking help, you’re asking for help that you look weak, or that you have some problem that you need to have fixed. 

Ending Physician Burnout 

One of the other important keys to reaching freedom and ending burnout is putting boundaries on your time. This is the third boundary and when Dr. Shin stepped back from clinical medicine a little bit going from 1.2 or 1.25, FTE to just 1 FTE (isn’t it crazy that a doctor’s regular schedule is OVER 40 hours a week?). 

In December, Dr. Shin just went to his scheduler and I said, “Look, in December, I would like to as much as possible, given the responsibilities I have, and you know, taking care of the patients, I want to be as close to 100% time as possible. So 40 hours a week.”

So by December, he started trying to do that and essentially, it’s just sort of a math game. Daniel was able to  arranged his schedule to concentrate his hours into four days of the week. And then he has one day a week where he can work on his blog, real estate business, educational stuff, like on TikTok, and it is actually working.

Dr. Shin noted, “And as soon as that started happening, my mental health took a significant step forward. I was so much less burnt out.”

While Daniel loves the financial security he has created from getting passive streams of income from stocks from real estate investing, there’s only so much he could do to optimize his schedule before his was just burning the midnight oil. 

Gaining a bit of control over this time has been really, really rewarding.

So while Dr. Shin is sacrificing more money by going from 120% to 100%, it was watching a coach in ACE point out that you’re not giving up as much as you think you are, because you’re in the highest tax bracket so (in this doctor’s case) California taxes you like crazy. 

For Daniel, that was actually was one of the most pivotal moments for him. He notes,  “I was like, you are absolutely right! So in making these calculations and thinking about what am I giving up? It allowed me to think about what I’m gaining more than just the numbers.”

How Doctors Go from Good to Great 

Coaching is more than just for people looking to end burnout. Coaching, fundamentally, helps you go from good to great as well. 

I’ve met people that have a growth mindset, have an abundance mindset, that are accomplishing massive things in their life, and they all have coaches (and all of the best coaches that I know, have coaches themselves). It’s not like this process just stops. 

And if you are finding it hard to invest in yourself, know you are not alone but you should really explore why. 

Dr. Shin reflected on this same struggle. He noted how when it comes to things like signing up for a coaching program, or literally buying himself a new shirt, he would tell himself that he didn’t need it.

But then he would struggle a lot. 

So this is the advice that Dr. Shin offered, “… the thing that helps me make that investment was that as physicians we are some of the most highly educated people in the world, right. And through medical school, college, and residency, we will go into debt to the tune of $300,000, thinking that there’s going to be a benefit. It’s getting to the point where you believe that the coaching is worth the money too. Hearing from testimonials from prior students, and then just seeing it around me, I can tell that it was absolutely worth the money. So, you know, putting out that initial investment of a few thousands dollars to change the rest of my life… it’s going to be worth it. And it was.” 

So wherever you are in that spectrum, coaching can help and the Alpha Coaching Experience is open right now to help. Get out of burnout, get your time back, and find the freedom you are searching for… all while still practicing and loving medicine. 

Daniel Shin is the author of the Darwinian Doctor Blog. If you are looking to learn about how you can create financial freedom through real estate investing and other means, I encourage you to follow Daniel and learn how.

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The post TPP #64: The Importance of Financial Freedom and Mindset with Dr. Daniel Shin appeared first on The Physician Philosopher.

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