By Dr. Jim Dahle, WCI FounderI really love blogging. As WCI grows into a multi-media business, I spend more and more of my time working on the business—training staff, building partnerships, dealing with endless emails, promoting the business, creating and implementing new “products,” and troubleshooting problems. It's fun to be an entrepreneur, create jobs, and try to build something bigger than yourself. But sometimes I miss blogging. Just typing some random crap into the internet and wondering if anyone else is going to read it or like it or implement it. So today I just want to sit down and write something. I don't care if you like it. I don't care if you share it with anyone or not. I don't care if it ever monetizes well. I just want to blog about something and see what you think of it.
Money Taboos
There is a taboo in medicine. It is becoming less prominent, but it still exists. You're not supposed to talk about money. Not how much something costs a patient, not how much you get paid, not how you invest, and certainly not about the freedom from medicine that financial independence can bring.
This first shows up as you are applying to medical school. You don't want anyone writing a letter of recommendation or heaven forbid an admissions committee to get even a whiff of an idea that you might actually want to receive a paycheck for practicing medicine at some point down the road. It is reinforced throughout medical school and residency and persists throughout your career in interactions with your peers, your professional colleges, your board certification organization charging you thousands to take an online test, and your hospital.
Meanwhile, the business world and particularly the financial services world views you as a whale, ready to be harpooned. And all these little doctors in their own little silos who “love science and just want to help people” are taken advantage of one by one. It pisses me off.
But you want to know what makes me even madder? When I see doctors “money-shaming” each other. Reinforcing this taboo that you can't talk about or even learn about business or finance because it's “filthy, dirty money” and you're a “bad doctor” to think about it. Let me give you an example.
PIMD Gets Money-Shamed
Passive Income MD wrote a blog post a while back about how he is financially free from medicine. I read the post and thought, “That's great. Now he can practice medicine if and how he likes. He'll be a better doctor and take better care of people. Or, if he wants, he can get out of medicine and do something else that he finds more fulfilling. If he practices less or stops altogether, it allows the services of other doctors to be more in demand, keeping salaries high for everyone. How wonderful!”
Well, his post gets picked up by Doximity and shared. That's wonderful too. I love it when my stuff gets shared with a larger audience, and I'm sure PIMD does too. There really is (almost) no such thing as bad publicity in this business. So I saw it in the email that Doximity sends out every now and then and took a look at some of the comments below his post. Most were very supportive, until I ran into one written by a psychiatrist, published under his real name (which I'll leave out as it really isn't relevant to my point).
Why did you go into medicine in the first place? It sounds like to get rich. Congratulations. Patients were a lousy revenue stream, too much maintenance. So you are free from an opportunity to do work that actually relieves suffering, and if you are half-as clever financially as you claim to be, you could have made a good living at. You are free from having to do the hard work of medicine. After practicing for 40 years, I still value using my competence to lighten the burden of disease on my fellow human beings, more than the fact I make a good salary doing so. You could have made more money if you had started with an MBA and a Law degree, and skipped the fake wanting to practice medicine. You are free from medicine, from hard work, from dealing with truly heavy responsibilities. Your narcissism is normative in American society. You are free giving, and free to take all you want. Enjoy! You exploited the profession, and now you can live the hedonism that is the core of your value system.
Hey kids! Get off my lawn! Seriously though, other doctors read this comment and say to themselves, “Self, be sure you don't talk about money or financial independence to any of your colleagues because some of them are going to react like this.”
To the psychiatrist's credit, he returned later down in the comments section and left a bit of an apology and a more nuanced, less inflammatory explanation of his views on the subject.
Stop Money-Shaming!
I call this sort of thing “Money-Shaming,” and I want you to quit doing it. Some of us are more altruistic than others. That's always been the case. And there is someone more altruistic than you are. You're a family doc working for $180K? Great. There's a classmate down the road who is a pediatrician making $150K. And one who went into the military and worked for $120K while being deployed all over the world taking care of those defending your freedom. And someone else who works 3 days a week in the homeless clinic for a pittance. And someone who spends their vacation time in Colombia drilling wells for mountainous villages.
But the truth of the matter is that VERY FEW of us are willing to practice medicine for free. Especially on a full-time basis. In fact, it turns out that MOST of us wouldn't be practicing as much as we do now if it wasn't for the money. I have surveyed many groups I have talked to. I ask them if they'd report to work tomorrow if I wrote them a check for $10 Million today. They almost all say yes. But when I ask them if they'd be working less in a year (fewer shifts, shorter days, fewer patients per day, less call, etc.), they almost all raise their hand. My conclusion? Most doctors are working, at least partially, for financial reasons.
Why should that be a surprise? And why would it be a bad thing? Adam Smith pointed out centuries ago that, in general, we benefit each other and society as a whole as we pursue our own self-interest. That's capitalism. And it has led to the greatest increase in freedom, wealth, and humanity that this planet has ever seen. Nurses get paid. Teachers get paid. Garbagemen get paid. Judges get paid. Politicians get paid. Uber drivers get paid. That doesn't diminish the value of the work they do. There's a reason it's called “work”—because they have to pay you to do it.
In fact, I would argue that the MOST selfless and altruistic doctors among us are the ones who are financially independent and still practicing because they love it. I would love to shorten the average time period between when a doctor comes out of residency and when they can practice merely because they love it. But even then, I don't expect them to work for free.
Celebrate the Financial Success of Your Colleagues
So my challenge to you is that rather than money-shaming your colleagues, you celebrate their successes. What a difference between going to FinCon (a conference of financial bloggers where you are invited to give a talk and everyone celebrates your achievement because you doubled your income) and a medical conference (where financial or business topics are generally given short shrift)!
When we start talking about paying off our student loans and our mortgages and avoiding whole life insurance and becoming millionaires and becoming financially independent then we'll all, doctors and patients alike, be better off. If nothing else, at least a lot of salesmen masquerading as financial advisors will be driven out of business.
What do you think? Why do we money-shame each other? Is it jealousy? Is it a desire to preserve the purity of “the greatest profession?” Is it simply doing what others before us have done?
Doctors are one of the most intelligent, dedicated and hard working group of people, but as a group they are definitely nowhere close to being as rich as they are intelligent. I am sure there are many who might challenge this, but it takes a lot of brains and hard work to be at the top of your class through high school and college and then you get to med school. The only doctors who are free to practice or not to practice have inherited the money, married the money or earned it from something other than taking care of patients. The richest doctors have not earned the money doing patient care. We cannot blame doctors who want to go into higher paying specialities as practicing Peds or Family Practice just wont pay your student loans, mortgage, kids education and save for retirement. Any intelligent realistic doctor these days is looking at other sources of income few years after they finish residency when they realize their dream job is just a dream. When MBAs and engineers start making 250k to 350k at age 24, when their studious intelligent classmates are in still in residency, making 60k and under the yolk of 350k student loans, there is something bad wrong with the reimbursement system and income of doctors.
Most residents and fellows put in about 80 hours per week. The “compensation” on an hourly basis is competitive with an ASSISTANT MGR at McD’s or a SANITATION ENGINEER. See Glassdoor or DOL tables.
https://www.uthsc.edu/pediatrics/salary-benefits.php
No benefits for tests, relocation, job search travel for PGY positions, required testing or licensing and accreditation fees. To be “eligible” to apply, must have completed a rigorous science focused college degree in the top 1-5%, impressive MCAT’s, outstanding recommendations, and interviews that emphasize a team focused drive serving healthcare needs on a compassionate basis.
A first year attending superstar BEGINS offers at MGMA average. Welcome to the draft.
Meanwhile your two college buddies get together for a college Hall of Fame Induction Ceremony.
1. Football- 10 years as an NFL running back retirement opportunities and endorsements and my foundation.
2. Baseball- 10 years as a starter in MLB, might find a spot as a closer. Same as #1 but might do color commentary.
How bout you Doctor?
3. Looking for a job to payoff debt that pays more than McDonald’s and a little more than MGMA average.
By the way, I can fix the knee, hip and shoulder. Noticed the limp and wincing when they handed us the placques.
There is no draft, arbitration , nor agents looking out for doctors. From a financial standpoint, those with the “cold blooded killer instinct “ will exploit weaknesses, run deceptive plays, holdout and declare free agency, demand bonuses and incentives. Healthcare is a business. Everyone is replaceable.
The 35 year old athlete needs to pay you. Payback is sweet.
I disagree with a bit of that. My first million was all from clinical medicine. Many doctors who take care of business financially in the first half of their careers are free to punch out at any time. That’s the whole point of this website.
I remember making it seem like I had NO interest in making money all through the medical school applications and medical school itself…while I racked up $60,000 in debt (double that in today’s dollars).
These days, when I talk of early retirement from corporate medicine (I’ve always been an employee), I get incredulous looks and “at your age?” comments.
It turns out that to practice the way one wants, FIRE is a viable path. The idea of being free to pick and choose occasional shifts or opportunities, and have more leisure, you need to have a chunk in the bank. Enough assets to pay basic bills = freedom.
I find this forum much healthier for me for some of those reasons. The attitudes on other forums come from the same kinds of people I always stayed away from anyways. Also why I need to go to a conference to meet all of you. I have few close doctor friends because I find sharing life with others much more fulfilling. The doctor friends I cherish most are the ones I would have befriended even if in other professions. I could care less who passes judgement on me. Focus your energy on your life and making the world better, not criticizing others who—shriek—make different choices in their lives.
Yes! Finally something about best beer blogs.
The animosity toward physicians and wannabes talking about money starts earlier. I got crap about it from another student when I was in college. People feel vulnerable to physicians, which triggers insecurity, which some counter by creating an imagine of the ‘noble physician’ who ‘lives to serve’ (if this reminds anyone of the splitting borderline personality patients do because it’s hard for them to tolerate ambivalence when dealing with insecurity, yeah, it is reminiscent!) in whom they can have faith, which counters their fear and anxiety.
When someone like me ‘pokes a hole’ in that by rudely discussing reality, it can trigger people.
Here’s a simple test of how indoctrinated our profession has become. Seems like everyone else on Earth gets what’s called ‘pay.’ Or a ‘paycheck.’ But articles in professional publications seems to call what physicians get ‘renumeration.’
Renumeration? Who dreams up this crap? Who needs a 5 syllable fringe term when a common one word term will do? Unless, of course…you are trying to distance yourself from the concept, or you’re scared someone else might figure out what we’re talking about.
I like pay very much. Benefits, too. Hope to be blessed to retire with a pension very soon. Not apologetic in the least to other people about any of that.
Oh, and I’m a Psychiatrist.
Or “reimbursement.”