I wasn’t supposed to get sick. At 36, I was a health nut. I followed all the recommendations I preached with enthusiasm to my patients: regular exercise, at least five servings a day of fruits and veggies, 7-8 hours of sleep every night, no smoking, and almost no alcohol. I thought that I would live to 100.
Then, I woke up dizzy. Double vision and taste changes followed. When my symptoms didn’t improve, I saw a neurologist and then an ENT doctor. An MRI showed that I had multiple sclerosis.
I was stunned. MS is a leading cause of neurologic disability in young adults. It can cause mobility problems, sensory changes, visual disturbance, cognitive dysfunction, and fatigue. Because its course is unpredictable, I didn’t know how it would impact me. Would I be able to drive, to continue my morning runs, to travel, to raise my kids? Would I be able to return to work as director of a clinic for people without private insurance? Would I be able to contribute in a meaningful way to our household income?
In the first few months after my diagnosis, I had dizziness every day and other symptoms that seemed to pop up at random. My job supplied an endless source of stress. When I went home, my daughters—then 2 and 4 years old—demanded my constant attention and regularly woke me up in the middle of the night.
Worst of all, I faced a new level of uncertainty. I was still early in my career. The prospect of becoming disabled at a young age weighed on me and threatened a future that once had seemed so promising.
That was nearly 14 years ago—and so far, I’ve done well. New, more effective treatments for MS have been developed. I’ve continued to focus on self-care, and I’ve found ways to manage my dizziness. I am not disabled. In fact, earlier this year, I completed a half Ironman triathlon (a 1.2-mile swim + 56-mile bike ride + 13.1-mile run) and biked the MS150—over 150 miles—from my hometown of Austin to College Station, Texas. Despite some relapses, I’ve continued to work as a family physician and just published a memoir, Up the Down Escalator, about my transformation from a doctor to a patient with MS.
I’ve also fortified myself and my family, to some extent, against financial hardship—even if my MS starts to worsen again.
Here are some of my financial lessons learned during nearly a decade and a half living with MS:
Live Below Your Means
We all have that one friend (or more) from medical school or residency who has made it big. They invented a remarkable new device, became a chief executive for a large hospital system, or started a flourishing cosmetic surgery business. Now, they are living the dream: traveling the world, going out for extravagant meals, buying a vacation home or maybe a boat or fancy car. It’s tempting to try to keep up. But don’t.
Be realistic about your financial situation and strive to earn more than you spend—always. You can save more and avoid creating a posh lifestyle that is costly to maintain. I don’t own expensive jewelry, shoes, or handbags. My car is 9 years old. When we bought our house 17 years ago, we fixed up the garage apartment, and we rent it out for some extra income—almost enough to cover our property taxes. I could buy a nice bottle of wine every time we go out to eat, but I rarely do. I’m on track for retirement, even if, due to MS, it comes earlier than I’d like.
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Be Smart About Student Loans
Medical training is long and expensive. Student debt for doctors finishing residency averages more than $200,000. It can be overwhelming, and it’s worth understanding your options for managing your student loan debt. Consolidating loans can be very useful to get a lower interest rate. I was fortunate to avoid loans, thanks to generous family support and a scholarship that covered much of my medical school tuition. But my husband, a hospital-based pediatrician, finished training with significant debt from college and medical school. By refinancing and consolidating his loans, he got a repayment rate so favorable (about 3%) that it made sense for him to invest more of his income elsewhere rather than try to pay off student loans faster than required.
We learned that while it may seem counterintuitive, paying off student loans as slowly as possible is often financially smarter than paying them off quickly. Many investments earn higher returns than the interest you accrue from your student loans. If you can weather the (admittedly much higher) short-term risk, generic stock market investments (like the S&P 500) earn a historic average of 10% per year. If your student loan interest rate is significantly under 10%, chances are you will do better to pay the loan minimum and invest as much as you can. A further benefit of continuing to pay student loans is that the interest is tax deductible (for individuals making less than $85,000 a year or joint filers making less than $175,000).
You should also find out if you’re eligible for loan repayment by working in an underserved area and/or if you see a lot of patients with Medicaid or CHIP. My husband ultimately had much of his loans paid off as part of a student loan forgiveness program to encourage Texas-based physicians to help care for patients with Medicaid.
Avoid High-Interest Debt
The exact opposite advice generally applies to credit card debt. Credit card interest rates average over 20%; debt this expensive becomes extraordinarily damaging to one’s financial portfolio. I am always surprised to hear other physicians mention their credit card debt. Even when we were in medical school, long before my illness, my husband and I made it a habit to pay off our credit card balances in full every month. I’m glad we made that choice because having to deal with credit card debt on top of an MS diagnosis would have been stressful and difficult. Now, we are set up for autopay with our bank.
But given the excessive marketing and ease of putting off monthly payments, it’s understandable that even relatively high-earners can end up with significant credit card balances. While it can make sense to take advantage of introductory offers of free airline miles or low/zero interest rates, be vigilant about knowing when the rates shoot up, and avoid carrying any monthly balance on a high-interest rate credit card.
Strategize and Plan with Your Partner
If you have a life partner, get on the same page about finances so you can support each other. Differing financial goals and values are a major source of stress for many couples, and spending some time understanding one another’s perspective can help reduce tension and improve financial (and relationship) health.
Although we’ve always been pretty well-aligned with our priorities and values around finances, my husband and I don’t agree on everything. When we travel, for example, I often prefer more basic accommodations to save money. He likes a more upscale hotel. We might squabble over whether to walk to dinner (my preference) or take an Uber (his). We have to compromise, and it’s not always easy. But in general, we agree about big expenditures and priorities.
As I’ve learned from having MS, it’s also important to agree on a contingency plan, if one or both of us suddenly can’t work. Since my diagnosis, we talk more often about our finances, and we have to factor in the extra uncertainty created by MS. We have made sure to save money and invest well to give ourselves a cushion, should we need it.
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Get Disability Insurance
Especially if you are the main income earner for your family or if you have a chronic disease or a strong family history of any disabling condition, I strongly recommend disability insurance. Many employers offer it, but before my MS diagnosis, I didn’t give it much thought. Now, I'm happy to withhold a small amount from my salary every month to maintain long-term disability coverage. (Since I’m not the sole-income earner in our family, I haven’t opted for short-term disability coverage.) Although I hope I never need it, having disability insurance has given me peace of mind. If you are self-employed or it’s not available through your employer, you may be able to get disability insurance through your medical specialty society or the American Medical Association.
Save for Retirement
Estimates vary, but a sizable portion of Americans aren’t prepared for retirement. A survey published earlier this year by Fidelity showed that 52% of respondents are not on target with their retirement savings. Don’t be one of them.
Most working physicians should be able to set aside a portion of their monthly income for retirement. If you are employed and eligible for an employer-sponsored 401(k), max out your contributions and be sure to take full advantage of any employer match. If you are self-employed, talk to a financial advisor about setting up a solo 401(k) (or do it yourself). Any money invested in these tax-deferred accounts gets deducted from that year’s income when determining your tax burden.
Eventually, you will have to claim that income, but it will be during your retirement, and nearly everyone’s tax bracket is lower in retirement than it is during their working years. My husband and I have contributed to employer-sponsored 401(k) plans for most of our careers. We also remember to review our investments regularly and adjust as needed.
Set Up a 529
If you have kids, start a 529 educational savings fund as soon as possible. These 529 plans allow you to set aside up to $17,000 (or $34,000 for a married couple) [in 2023] per beneficiary per year for education expenses. You can then continue to contribute until you reach an aggregate of about $250,000-$550,000 total per child, depending on the state where the plan is based. You do not have to set up your 529 in the state where you live, so compare plans, looking for one that has a higher limit and favorable investment options.
Unlike retirement accounts, the money invested here is not deducted from one’s income for tax purposes. But once invested, returns earned on these contributions are never taxed again as long as they are used for educational purposes. In other words, there are no “capital gains” taxes. Another appealing feature of these funds is that anyone (grandparents, uncles/aunts, even unrelated friends) can contribute.
My husband and I established 529 plans for each of our daughters soon after they were born. Now, 18 years later as we prepare to send our older daughter off to college, we are well-prepared to pay the bill (even as we think the amount seems like enough money to create, not just attend, a university).
Look for Extra Fees on Your Investments
“You get what you pay for” is generally a good mantra, except perhaps when it comes to investing. Management fees on investment funds can vary considerably, and they often don’t correlate with a higher rate of return. In fact, essentially unmanaged funds with low fees, such as index funds, historically perform better than managed funds with their high fees. Many of these lightly managed funds have fees that are less than 0.1% per year, whereas some managed funds will take 2% of your money right off the top. That money may help the fund managers pay for their yachts, but it often leads to a rate of return that is worse than you’d achieve with random chance.
More information here:
Taking care of your own health is critical to maintain your earning potential. I decided pretty soon after my MS diagnosis that this one chronic disease was more than enough. I learned mindfulness meditation and other ways to control my symptoms. I continue running and biking, and I’ve recently added regular resistance training. I eat a plant-rich diet, and I stay up-to-date with preventive care and immunizations. Several years ago, I even changed jobs, in part to better control my stress. By prioritizing self-care, you will hopefully add on a few post-retirement years, in which to enjoy the benefits of a healthy bank account and investment profile.
I still resent MS. I worry about the long-term effects of taking immunosuppressing medications and the possibility of progressive disease. But I like to think I’m a little wiser—and maybe even a better doctor, able to relate to the fears and frustrations experienced by many patients. And I’m grateful for the lessons I’ve learned throughout this journey. Here’s hoping that some of them are helpful to my peers.
Have you planned out your finances in case you or your partner get sick? What other steps can be taken? Comment below!
[Editor's Note: Lisa Doggett is a family doctor and the author of a new memoir, Up the Down Escalator: Medicine, Motherhood, and Multiple Sclerosis, published in August 2023 by Health Communications, Inc. She was diagnosed with MS in 2009. This article was submitted and approved according to our Guest Post Policy.]