[Editor's Note: Today we have an original post from the WCI Network partner Physician on FIRE, all about how to apply the principles we use in medicine to our lives and finances. Enjoy!]
We Practice Evidence-Based Medicine
Evidence-based medicine is at the heart of what we physicians do. It is the basis for professional decision-making, and a focus of most journal articles we read. Using solid evidence to practice good medicine has been a foundation of clinical practice for decades.
There are consequences for failing to follow evidence-based guidelines. If patient harm results from straying from a more loosely defined ìstandard-of-careî, which tends to be evidence-based, we may find ourselves facing a dreaded malpractice lawsuit.
If certain evidence-based quality metrics are not met, our paychecks may suffer. While there is still a place for the art of medicine, the science of medicine largely dictates how we act out our professional lives.
Do We Make Evidence-Based Decisions In Our Personal Lives?
In some ways, we do, according to the Gallup Well-Being Index. Fewer than 5% of physicians smoke cigarettes. Only 13% are obese, about half the rate of the general population. This tells me we do a better job of exercising and eating healthier than the average patient, which may simply be a reflection of our relative affluence.
In other ways, we fail to make evidence-based choices when it comes to our personal lives. We allow our mental health to suffer, and are reticent to ask for help when we need it. We suffer from burnout, undiagnosed depression, and in some cases suicide, in frustratingly high numbers.
We work long hours under many stressors, and struggle to find the work-life balance that will keep us and our families happy.
We ignore the evidence in regards to our finances. While surveys have shown that a level of spending above $50,000 to $75,000 a year fails to significantly increase our happiness, many physician families spend double or triple that, chasing fulfillment that money can't buy. We splurge on fancy homes, cars, and luxury items that we feel we deserve, not realizing that we're actually selling our future by failing to save now.
A recent Fidelity survey of physicians showed that nearly half were saving less than 10% of their salary, and failing to contribute the maximum to their 401(k) retirement plan. With a high debt load and late start to our careers, failing to save a significant portion of our income is a path to working indefinitely, with no way out if the workload overwhelms us.
Why Not Practice a More Evidence-Based Life?
Try putting at least 10% of the effort your put into evidence-based patient care into evidence-based living. For every 10 hours you spend improving your patients' health, spend an hour improving your own.
I like to include mud and barbed wire in my daily routine
Exercise. Learn to cook healthy meals. For every 10 hours you spend reading journal articles or attending lectures, spend an hour reading a self-help book, or learning about personal finance.
Don't spend yourself into a corner. Think about the things that make you truly happy and you'll likely realize that few, if any, require significant wealth.
Set financial goals, and keep them in your sight. Pay down your debts. Build up your nest egg. I challenge attending physicians to try living on half their take-home pay. Obtaining financial independence, the ability to afford your lifestyle without paid employment, can give you a new lease on your professional life.
I was able to call myself financially independent two years ago, a few months shy of my fortieth birthday. I have yet to retire, but the knowledge that I could grants me serious leverage and freedom to continue practicing in a way that makes me happy.
I'll be using that leverage to afford a part-time position, which I'll be starting this fall. I'm doing my best to make good evidence-based choices in the way I live my life. I do believe that working less will give me less stress, more sleep, and more time to do the things that make us happy.
No, I don't smoke. Yes, I have a normal BMI. I value experiences over things. I drink good beer in moderation, and do my best to exercise a few times a week. If I could just find a way to enjoy five servings of fruits and veggies a day, I'd be in great evidence-based shape.
What do you think? How about you? Are you living an evidenced based life?
the trouble is when it comes to living an “evidence-based life” there’s just not a lot of evidence out there as to what is truly the optimal Lifestyle. Personally, this is a major interest of mine. I feel that I have found the ultimate lifestyle (primal/paleo). I think it is well-suited to almost anyone, but surely there are some people who have tried it and disagree. Moreover, I certainly don’t have randomized trial evidence proving that my lifestyle, diet, and exercise habits Are superior…though I have plenty of anecdotal evidence from my own life and those who have shared their stories in online communities. Personally I find it very frustrating to see so called “evidence-based guidelines” telling people to eat high carbohydrate diets (lots of fruits and whole grains) and/or workout intensely 5-6 times per week (i.e. Crossfit) when there is lots of “evidence” to the contrary. In any event nice post it is very thought-provoking. If people are interested in evidence-based ideas for diet, exercise, and longevity I recommend Dr Rhonda Patrick podcast/videos.
Most “diets” are simply fads and lack any real evidence. Even the so called evidence that we have is quite obviously defined by our ability to infer what they were which is again quite obviously a survivorship bias and preservation luck. Maybe the best diet in history of humanity had their remains washed away or buried under the sea? We’d never know.
The “paleo” diet is bs, like any other fad. Humans in almost any other time in history ate whatever the heck they could find, because if they didnt, theyd die. Any consistency or pattern would reflect their geographic location and technological level, its really no more nuanced than that. Coastal societies eat lots of fish relative to inland ones, really just not surprising at all. Online communities are terrible examples to bolster you’re particular idea, as it is the literal incarnation of confirmation bias from a highly selected subset.
As long as you arent overdoing anything, and getting good variety, and yes, avoiding simple sugars and other processed stuffs that are calorie dense and nutritionally light, you’re doing okay. Make better choices everyday and let that compound over time.
If you were to take forums and the like of highly concentrated ideas as normal or pertaining more broadly you’d likely generalize incorrectly that all doctors are rich, financially savvy and retiring early from this one. That is clearly not representative.
Im personally vegetarian sans the occasional sushi, but not at all ideological. I have no beliefs its superior or the “right way”, in fact I know it isnt right since we have these meat eating teeth. It just works for me. If paleo works for you there doesnt need to be any other extrapolation or justification. Everyone has to find what does it for them in life, spouse, exercise, etc…as long as the end result is a good outcome I dont find much usefulness in arguing one is “best”. Many roads to happiness.
Fwiw, running seems to be the best longevity exercise as far as time spent/gained. Good recent study about it, and you dont need to do too much either, benefit up to 2h/wk, none much above it. I like riding bikes, but its really inefficient, I run when I dont have time or need to burn calories.
I got quite interested in primal a few years back, and got looking at the actual evidence on which nutritional recommendations are based. IMHO it’s pretty thin, most nutrition studies rely on self-reported data, which is of course hopelessly flawed and biased. This frustrates me when people use these flawed studies to promote a certain way of eating as gospel.
There are also those who argue a particular diet based on what some extremely health indigenous population ate, the high carbers favouring Kitavans and the high fat crowd favouring the Inuit. My takeway from the diets eaten by indigenous peoples, which vary greatly, is that humans can do pretty well on just about any kind of food. So do what works for you, as long as you eat real food (ie: minimally processed, without added sugar) you should be just fine.
There seems to be a lot of misinformation in the first few posts above regarding the evidence for what food is best to eat. There is OVERWHELMING evidence, including many randomized controlled trials now, that eating whole foods is best (as LUPA stated above – minimally processed, no added synthetic junk). A “whole, plant-based diet” is the ONLY diet that has been PROVEN to REVERSE atherosclerosis, the number one killer in our country. Why would anyone not want to eat this way as this remains the most likely reason you or a loved one will die too soon? I highly suggest everybody familiarize themselves with the actual evidence, which unfortunately takes time to really find. There is so much conflict of interest in nutrition (with companies promoting bogus research for their benefit) that I agree it can be very difficult to make sense of anything. Companies stand to profit from the confusion. Like I tell my patients, “if it’s on TV, it’s not good for you.” I have been on a search of the best evidence-based data out there as I realized that even though my medical school did teach us some nutrition classes, I still sucked at it and that was unacceptable. After reading quite a bit of OPINIONS, which we would do well to avoid if we want to follow the evidence, I have not found anything better than nutritionfacts.org, a non-profit website where summary videos and articles of all the English language pubmed nutrition studies from around the world are posted for the public health benefit. If you don’t buy it look up the actual studies, they are all cited below each summary video and article. I did and made my senior resident speech using several of the more ground breaking RCTs and other prospective studies and it blew other MDs away. Unfortunately MDs are illiterate when it comes to this and have poor nutrition knowledge as it has not been traditionally a strong element in most medical schools. We need to change this obviously.
Absolutely agree 100%. And this advice is important for anyone living in the United States. We have a food system run by greedy corporations with powerful lobbyists in DC and a government that subsidizes cheap, unhealthy food and gives poor nutrition advice as a result. Its going to require some major political change as well.
For instance, the sugar industry is so powerful that they have been successful at preventing the government from giving daily recommended intake guidelines for sugar. If you look at any nutrition label right now, you’ll see that there are percentages next to everything EXCEPT sugar. That’s because the sugar industry doesn’t want you to see that we’re all eating WAY TOO MUCH sugar all day long. Its criminal. Especially since we now know that high sugar intake is so closely linked to coronary disease.
I really liked this article. It’s important to lead an evidenced based lifestyle not only in terms of finances, but work and our personal lives as well. As a psychiatrist, I see depression, burnout and large amounts of irritability in my physician colleagues. I’m still working on having a more balanced lifestyle, but have come a long way. Work is overrated!
Thank you, Pistol Pete.
Part of my mission is to help other physicians break the cycle of overworking, overspending, and being overstressed as a result of it all. I believe we’re on the same wavelength.
Cheers!
-PoF
I’m definitely trying to shape my life to follow the evidence out there on what brings people happiness. You’re right, curb your spending cause that doesn’t lead to the promised land. Ultimately everything seems to point to the fact that good, solid relationships (family, friends, community) lead to happiness and a longer life. That’s what I’m trying to focus on….
You’re absolutely right, PIMD. Ask your parents or grandparents. Their most cherished memories are the relationships and experience they’ve had with other people, not the houses or cars they owned.
Similarly, regrets tend to be not spending more time with friends and family. Few regret working too little.
Best,
-PoF
I love this article. It is right up my alley. I’m a resident in OBGYN and I have subconsciously always asked the same question; why aren’t more physicians leading better lifestyles? I agree that there is no absolute optimal diet or exercise regimen, but we all have a pretty good idea of what foods we should eat less of, which we should eat more of and that we should exercise.
I hear you, WCT.
I know that it’s easier to preach than practice sometimes. I understand it’s a good idea to exercise five times a week and never eat Chicken in a Biskits. Yet, I struggle to exercise three or four times a week and have a serious weakness for those crackers.
Cheers!
-PoF
Knowing how bad financially it is to lease automobiles I just had a call from a physician who saw a new Tesla in the parking lot. When he asked around, it turned out to belong to a recent hire who is just out of residency. He is leasing the car for $1,400 a month. Just because the information is out there on living a good/smart financial life, doesn’t mean everyone will see it or want to follow it. Sometimes people will want a shiny new toy no matter what the cost. I wish he had read my book “The Doctors Guide to Eliminating Debt” before he made that move. Granted, a lease is not debt, but it is a close second in bad financial decisions.
Some people just don’t want the advice. I had a student in one of my financial classes who quit after the second class. She said “I can see where this is going. I’m going to find out I shouldn’t be shopping so much. Since I’m not willing to give it up, I need to quit the class now, before I know better.”
Make sure you work that plug in for the book somewhere in the comment, lol.
Shoot, I wish he’d read ANY financial book.
I agree with the general gist of the post. This reminded me of a clinical PharmD that rounded with the team during my IM rotation in medical school. He was exceptionally kind and impeachably brilliant; virtually any patient with any condition he would offer something useful/evidence based…and more times than not he could even cite the year/journal that particular study was published in.
Few years later I was remembering my med school days and I realized…did that PharmD live every day of his life according to evidence? Friends and I joked about him looking up studies of mundane daily activities before making a choice.
While I think the entirety of WCI et. al. is great for frugality and lessening financial harms to physicians, I can’t help but wonder…is evidence based equivalent to “the best there is”?
Obviously for medical decisions this is without question. But maybe there are other life decisions that can’t or even shouldn’t be reduced to objective/scientific evidence? Just thinking out loud here…maybe things like having kids, or what color shirt to wear, or etc. etc…
I had a really good pharm D on my neuro rotation and I loved that man! I swear he knew everything.
Anyway, I get where Ming is coming from- there is no perfect life or only one best way to do something that works for everyone. And all available research points to having zero kids as happiness goes down as the number of children goes up ?. However, I think we do have general ideas as to what makes a good life. I remember in residency thinking that I was at my unhappiest and unhealthiest I’d ever been and I was counseling patients on those exact things. I felt like a total fraud. But in residency you have no balance and you’re in total survivor mode. Now I have time to sleep and exercise daily and make usually ? healthy foods at home. I try very hard to practice what I preach to patients because I believe that it really does help to take care of your body, to do things in moderation, to live a balanced life. As a psychiatrist I spend a good part of my time talking to patients about that as part of increasing quality of life. Meds only go so far and do so much.
EBM and other evidence comes from the research ‘they’ choose to do. Few are going to prove the value of something they can not monetize, and few will pay for research if there will be no payoff for it. So evidence that choice A is good is not proof that B is not as good, or is bad.
Especially if A brings in a lot more revenue to the researcher. In our beekeeping Ag extension remote classes some grad student in bee culture will tell us which scary sounding miticide to use and the multi layers of chem protective attire we should wear when using this stuff. Someone asked, since thymol (ie from thyme) oil is a patented treatment, does it work to “just” dump some thyme in the hive? Grad student says !!! “Don’t take the chance, no research on doing that so it could be dangerous!!” !!!
Now I could buy into “it might increase resistance of mites to treatment because it is so mild a remedy” or “Like other (chemical) treatments don’t eat the honey after using that treatment.” And sure we’d be skeptical of patients who want to eat moldy bread instead of take antibiotics. But putting plants I sometimes eat in a bee hive instead of probably carcinogenic synthetic (or even just concentrated thyme oil) chemicals could be more dangerous?!?
Does the 50-75k a year statistic account for higher COL areas (I’ve tried low, but I just can’t stand driving and owning a car) and family size?
No. Last I checked it was something like $112K in the Bay Area.
And technically, happiness does still go up beyond $75K, but at a much lower slope/rate.
I have this thought quite a bit, but based on the statistics of living. While working with local public health I found the government funding conversations heading toward terrorism at almost every meeting. Finally I asked them why we were talking about a 1 in 2.4 million death event, when our local highways are thought to have a 1 in 112 death risk over our lifetime. The evidence would say that we should berate ourselves, our family, and patients if they are on their phone while driving. I have yet to find a book that guides daily living based on the statistics, that would be close to evidence based living.
I think the fact that physicians don’t do what they “should” be doing in terms of personal finances and lifestyle choices just further brings home the point that we’re all human too. We make mistakes. We all come from different backgrounds. We’re all at different maturity levels when we graduate and start working. We all have different levels of self control.
I know for me, I sort of had to learn the hard way with my finances before I finally woke up and started saving aggressively/appropriately. I was 34 before I finally figured it all out. Prior to that we spent way more than we should on ourselves (traveling, buying things, etc). I don’t beat myself up for it though because that’s life. I did have a lot of fun, so it wasn’t all that bad. I just have to make sure we stay on track now. It is hard to make those adjustments though. We got used to that lifestyle of just mindlessly spending whenever we felt like it. Old habits die hard I guess.