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Advice from physicians...
Old 10-30-2006, 08:56 PM   #1
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Advice from physicians...

Hey guys,
I'm a relative newbie here, but I've already gotten some excellent advice through one other post.
I'm a new physician (32 yrs old) and have recently paid off my high interest loans and will continue to pay my low interest loans over the long haul. My wife is also a physician of the same and we are both independent contractors in the ED. We work about 12 shifts per month. Her loans are paid off and I still have about 100K left. We have no children and plan on none. Given the fact we have two incomes we put away about 200K per year in savings (Vanguard..mostly index funds).
My questions to you seasoned financially savvy physicians out there...Do you recommend maximizing shifts to 18-20/month to increase savings now and get the benefit of further compounding?...Since we have a good income and can save easily (and hopefully long term job security) would you go to part-time (8 shifts/month...simply max out our sep's and enjoy our 30's skiing, rock climbing, triathalons etc. (all the stuff we didn't have time to do in training, as money isn't everything)? Any other financial/life advice for us would be appreciated.
I've read a few post regarding physicians who have crashed and burned financially as we are 'professionally intelligent', but 'financial catastrophe's'. I can see how that may be true. I don't want to be the 55 yr old with no retirement in sight or the 40 yr old who can't afford to practice due to malpractice premiums/law suits and wish I had taken advantage of the income while it was still available.
Thanks
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Re: Advice from physicians...
Old 10-30-2006, 09:13 PM   #2
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Re: Advice from physicians...

I am no physician, but you have already burned your 20s. You don't need to put away $200,000 a year, so why not take a moderate course and enjoy life?

Youth (relative youth for you) only comes once.

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Re: Advice from physicians...
Old 10-30-2006, 09:23 PM   #3
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Re: Advice from physicians...

Welcome, Scout.

I'm 57 and an academic internist/hospitalist. I'm not sure I know the answers to your questions since they reflect so many personal values and preferences, but here are some observations I hope you'll find useful.

Front-loading your savings certainly has huge long-term advantages. I was not able to do that due to educational loans, etc. If you can do so, by all means it will kickstart your early retirement goals. However, there is a price to pay -- early burnout may affect the rest of your career and backfire not only financially but also personally. This is especially true with shift work. Seen it many times. Watch your step here.

Perhaps a more balanced approach (and Ha is dead on in his post) is to save diligently and start early, but also retain enough to enjoy your nonworking lives and career. Live beneath your means, and shoot for 15% of gross income in your retirement plans, then stick to it 100%. Maybe you can throw a little more in once in a while. You'll work less, enjoy your career more, and stand a better chance at a durable loving marriage, family, etc.

Avoid the conspicuous expenses, like the $80k Beemer and McMansion if you can. Invest the amount if you have it, and live nicely but not shockingly nice.

Don't view your career as mainly a short cut to early retirement. Take some pleasure from it -- remind your self regularly why you chose medicine (presuming it wasn't for the money). Even under the best of scenarios, you'll be at it for a long time, so learn to value it.

Don't let your "best in the class" drive delude you in to thinking you can beat the market. Diversify, shoot for matching a broad range of market indices, and be patient. Lots of sales scams target physicians. Walk away.

Read books by Clyatt, Lucia, and others. Investing is not rocket science, but it's not trivial either.

Well, just a few random ideas to chew on. You'll like it here. A few members will nip at you because of your profession and it's usually in a good natured way unless you've earned a beating . They tolerate me OK, I reckon.
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Re: Advice from physicians...
Old 10-30-2006, 09:34 PM   #4
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Re: Advice from physicians...

Pardon me for my lack of knowledge, but what does a "shift" entail? 24 hours? Or in other words, you work 12 24 hour shifts/month?

"Given the fact we have two incomes we put away about 200K per year in savings (Vanguard..mostly index funds). " I'd say stick to it if it doesn't impede your life too much. A few years of socking away that kind of money, and you'll have a decent, basic "ER" paid for.
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Re: Advice from physicians...
Old 10-30-2006, 09:43 PM   #5
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Re: Advice from physicians...

Is ED the Emergency Department? Sounds stressful--I'd hang onto your current level of well-earned free time if that's the case. You'll never regret the time you spent skiing & rock climbing with your wife Take lots of pictures!

I'm really glad I did a lot of hiking and a little rock climbing when I was young because I sure can't do it now (mid-50s). But I have many happy memories--a and few nice pictures to jog my memory.
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Re: Advice from physicians...
Old 10-30-2006, 09:48 PM   #6
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Re: Advice from physicians...

Thanks for the replies. To Rich in Tampa...Did you find that you were able to enjoy your job more once you became closer to or achieved financial independence simply b/c you didn't have to carry the stress of lawsuits, job security, etc. Being just out of training I'm probably over sensitive to this risk, but it seems that so much of our self identity is tied to being good at what we do and unfortunately we automatically relate lawsuits to failure. It seems however, that if we came to work knowing we didn't actually have to be there financially if we didn't want then we would enjoy our job more and practice the type of medicine we are taught (not defensively). Did you feel this way when you first started and when did was that fear alleviated?

Justin,...A shift length varies per hospital. For me a shift is 11 hours. Just a bit more than the typical work day. So 12 shifts a month isn't really that much to begin with. Thanks for replies on the other forum...they were very helpful.
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Re: Advice from physicians...
Old 10-30-2006, 09:56 PM   #7
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Re: Advice from physicians...

Scout,

I'm a 50 yo Dentist. I have a private practice which doesn't allow me the flexibility that you have, but I'll take a crack at answering some of your questions based on my experiences. I started practicing at 25 and quickly decided that vacations and family time (I have 2 kids) were more important than working myself to death just for more income. I coached my son in pop warner football, select soccer, etc. and never missed any of my daughters gymnastic meets, dance recitals or school activities. I also decided early that vacations were very important to me. I have no regrets about taking the time off in my 30s to go scuba diving once a year, and I also took a trip out west once a year to go rock climbing. I can still dive, but I sure as heck can't tackle those rock climbs now. If you enjoy that type of activity figure a way to do those things while you can.

As far as work goes........ Well a lot depends on how much you enjoy your career. You make a fabulous salary, more than me certainly, but money isn't the same as professional satisfaction. I'm trying to put myself in a position to work a little less in the future (a divorce 10 years ago knocked me back to basically zero) and to only do the type of cases that interest me. You and your DW gave up a lot of time during school and residency and you will have to decide for yourselves the correct balance of work and play. Many people will look at your income and say.... bust your @ss for a few years, put a ton of money away, and walk away to do anything you want for the rest of your life. Maybe they are right, but I didn't spend all the years in school that I did just to make a lot of money. I love practicing Dentistry and most days I can't imagine doing anything else, however, I sure can imagine doing it maybe 3 days a week instead of 4 and a half. If your like me, they taught you all about caring for your patients and left out teaching you anything about finances. One of the other things that I would urge you to do is to educate yourself about finance. Don't trust brokers and financial planners to educate you (you'l hear from them a lot... trust me on that) or to have your best interests at heart. Learn everything you can, so you can work with them or on your own if you are so inclined to take care of your financial future. I'd suggest William Bernstein's - The Four Pillars of Investing or Frank Armstrong's - The Informed Investor as good introductory books.

Good luck, youve worked hard to get were you are now. Take some time and settle in, and then find your perfect balance of work and life away from work.

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Re: Advice from physicians...
Old 10-30-2006, 10:31 PM   #8
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Re: Advice from physicians...

Quote:
Originally Posted by justin
Pardon me for my lack of knowledge, but what does a "shift" entail? 24 hours? Or in other words, you work 12 24 hour shifts/month?
Basically, any schedule which regularly involves nights, e.g. 11pm - 7 a.m.
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Re: Advice from physicians...
Old 10-30-2006, 10:39 PM   #9
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Re: Advice from physicians...

Quote:
Originally Posted by Scout
Thanks for the replies. To Rich in Tampa...Did you find that you were able to enjoy your job more once you became closer to or achieved financial independence simply b/c you didn't have to carry the stress of lawsuits, job security, etc.
Well, I guess I pretty much always enjoyed my job. Never fussed too much about malpractice etc. Just tried to stay diligent, document well, behave myself.

It is true that having achieved basic financial independence I rest well knowing that if I had to stop I could. But my dilemma is that I like the work still (never did burn out) and will be looking for ways to cut back once I step down from my senior position. But just being financially independent isn't the goal, it's having something you look forward to doing once you are financially independent.

Pacing yourself is the key. Work hard but not so hard it consumes you. Save impressively but not so impressively that it hamstrings you. Enjoy work then enjoy retirement. It's all a bit elusive so why not appreciate wherever you happen to be.
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Re: Advice from physicians...
Old 10-31-2006, 01:11 AM   #10
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Re: Advice from physicians...

Quote:
Originally Posted by Scout

My questions to you seasoned financially savvy physicians out there...Do you recommend maximizing shifts to 18-20/month to increase savings now and get the benefit of further compounding?...Since we have a good income and can save easily (and hopefully long term job security) would you go to part-time (8 shifts/month...simply max out our sep's and enjoy our 30's skiing, rock climbing, triathalons etc. (all the stuff we didn't have time to do in training, as money isn't everything)? Any other financial/life advice for us would be appreciated.
I've read a few post regarding physicians who have crashed and burned financially as we are 'professionally intelligent', but 'financial catastrophe's'. I can see how that may be true. I don't want to be the 55 yr old with no retirement in sight or the 40 yr old who can't afford to practice due to malpractice premiums/law suits and wish I had taken advantage of the income while it was still available.
Thanks
Scout
A few comments from what you said above:

1) I presume that your job (in some way) is dependent upon your physical ability to perform your work. I might keep the rock climbing and other somewhat hazardous activities until after you've reached Financial Independence/Early Retirement and work just 1 day per week for the fun of it.

There are arguments on both sides of the aisle - don't push yourself too hard, and enjoy life while working steadily to ER, versus (my camp) that says "go ahead and push it to make even more to retire sooner". As a compromise, why not sign up for (initially) 1/3 of the extra shifts (2-3 extra shifts per month). Work that for 2-3 months and see how both of you feel with your fatigue when outside of work, and how it has impacted your free time and time together. Easier to do that, than sign up for 6-8 more shifts and finding yourselves at each others throats when you're not at work due to the sudden increase of stress and pressure.

I basically didn't have a life (by modern society's standards) from age 23-26 so I could save about 98% of my after-tax income. I let my hair down a bit from age 26-28, spending perhaps 10% of my after-tax income on relationships, but still saving a prodigous majority of my income. Some might say "but if you died, then you wouldn't have been able to enjoy the fruits of your savings", to which I would reply "you might think so, but I would have died a happy man, because I knew that I fulfilled my goals I set, and was executing my plans without hardly any mistakes". Now, I am able to look at being FIREd at 33/34 due to some luck along the way and some more hard work (and savings) from 28-30. If I spent $10k/year more from age 23-28, I would still have a fair amount, but I'm personally fine with making the sacrifices I did. (and hindsight is always 20-20)

In short - it all comes down to your personal feelings. How would you feel if you found yourself with a terminal illness at age 40? Would you wish you were still working part-time and had 'lived life' more at age 33-38? If so, go ahead and work just 1 or 2 extra shifts, and spend more time doing the things you truly enjoy. Or, do you find enjoyment in making personal sacrifices to reach your goals? Feel a little INTJ personality in you?

Personally, I did suffer from the professional 'crash and burn' by working for my father's construction company (bringing blueprints home at night to work on bidding more work, staying late at the office, pulling all-nighters to bid more work, doing the work of 2 - and sometimes 3 - people, without really even asking or expecting to get huge bonuses....but, receiving somewhat equitable compensation once the fruits of my labors were apparent). However, part of that was just the nature of the construction industry not really being compatible with my personality (I would have burned out eventually - my excessive effort merely hastened the process).

However, knowing that my financial future is much more bright than it was 2 years ago, I can definitely say that the things at work that used to drive me crazy and piss me off to no end are DEFINITELY more palatable. Even though I'm not FIREd yet, I can almost taste it, and that alone is an amazingly huge way to give yourself a drug-induced high to withstand a lot more than you did before.
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Re: Advice from physicians...
Old 10-31-2006, 08:01 AM   #11
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Re: Advice from physicians...

200K a year at 8% for 10 years = 2.9 mil, not counting whatever you already have saved. Take the easier path and you will still be able to retire in your 40's.

Good luck with it all.
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Re: Advice from physicians...
Old 10-31-2006, 11:13 AM   #12
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Re: Advice from physicians...

To take care of the scenario where you become too disabled to work, buy disability insurance with after-tax money. My brother the dentist did this (his wife was trained in accountancy and is excellent at handling personal finance). In his early 50s, my brother lost most of the vision in both eyes. So for aobut 12 years (until he turns 65), he collects nearly $200,000 in insurance payments each year, untaxed (Federally anyway). I'm sure this coverage wasn't cheap, but it protected his wife from working his family--he had one child in college and one about to go when this happened.
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Re: Advice from physicians...
Old 10-31-2006, 11:38 AM   #13
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Re: Advice from physicians...

Quote:
Originally Posted by astromeria
To take care of the scenario where you become too disabled to work, buy disability insurance with after-tax money. My brother the dentist did this (his wife was trained in accountancy and is excellent at handling personal finance). In his early 50s, my brother lost most of the vision in both eyes. So for aobut 12 years (until he turns 65), he collects nearly $200,000 in insurance payments each year, untaxed (Federally anyway). I'm sure this coverage wasn't cheap, but it protected his wife from working his family--he had one child in college and one about to go when this happened.
This would be a wise choice. I would shop three companies: MasssMutual, Northwestern Mutual, and Guardian. Stay away from the others in this field even if they are cheaper.
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Re: Advice from physicians...
Old 10-31-2006, 11:51 AM   #14
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Re: Advice from physicians...

Hi Scout,

I'm a 49 year old intensivist in Canada and I'm FI though my earnings are not remotely in your ballpark. I agree with everything Rich and Gojagators have said.

From observations of my Emergency Medicine colleagues, I would say that you are in an extremely stressful branch of the profession. Right now you appear to be doing clinical work only. I would be wary of working yourself to the bone at this stage without developing some balance with a personal life. I would also want to make sure that you build in time for ongoing professional learning and skills maintenance. This is a risk management strategy for your clinical skills (you don't want to be at the sharp end of a major error), but it also applies to building a skill set that you may want to use later in your career - that is, assuming you don't (a) burnout, (b) have an early MI, or (c) FIRE safely. Even if you FIRE in your 40s, you may want to dabble in something related to your field. For example, do you have any interest in owing or running your own private walk in center, becoming an academic department head, consulting on patient flow, or volunteering in a disadvantaged country? All these opportunities and more are open to you if you build the right skill mix.

You are very young and you have a huge amount of human capital. Don't squander it by killing yourself for a fast buck. Two other risk management suggestions: first, ensure that both you and your wife have adequate disability insurance; second, if your state allows it, consider incorporating your practices.

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Re: Advice from physicians...
Old 10-31-2006, 12:51 PM   #15
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Re: Advice from physicians...

Quote:
Originally Posted by brewer12345
This would be a wise choice. I would shop three companies: MasssMutual, Northwestern Mutual, and Guardian. Stay away from the others in this field even if they are cheaper.
With both spouses being working doctors, i probably wouldnt bother. I cant imagine the odds of an event where both of you becoming disabled, but not dead. I'm sure its possible, from a mathematical/theoretical point of view.

Disability is more important when there's just one bread-winner, and his/her income is irreplaceable.
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Old 10-31-2006, 12:53 PM   #16
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Re: Advice from physicians...

I am not a doctor, but I did play that role as a youngster with the girl next door.

I can't see the point of working so hard now, and having no enjoyment now, so that you can relax at some future date. I suggest that you work as much as you feel like. Enjoy the now and save some for later. For those that are mathematically inclined this is an optimization problem in that you need to optimize your lifetime spending distribution versus working personal-cost function. I'll let you solve this overconstrained set of equations for yourself.

regarding being financially independent and job satisfaction. I have posted on a number of occassions that once I became FI that my attitude really changed about work. The boss wasn't an a$$hole anymore, the co-workers weren't so bad. The drudgery of work disappeared which was actually quite a revelation for me. So much so that rather than retiring early I am contemplating working on just for "fun" and satisfaction that the work provides.
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Re: Advice from physicians...
Old 10-31-2006, 01:02 PM   #17
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Re: Advice from physicians...

Quote:
Originally Posted by MasterBlaster
I am not a doctor, but I did play that role as a youngster with the girl next door.

I can't see the point of working so hard now, and having no enjoyment now, so that you can relax at some future date. I suggest that you work as much as you feel like. Enjoy the now and save some for later. For those that are mathematically inclined this is an optimization problem in that you need to optimize your lifetime spending distribution versus working personal-cost function. I'll let you solve this overconstrained set of equations for yourself.
I'm glad more than one person has pointed this out because I also agree with it. It can be mathematically shown (and its relativley intuitive for anyone that has rudimentary understanding of compouding effects) that the harder you save, but reducing the length of savings, that you get exponentially less gain as you save more. This is because of cutting out/shortening compounding effects of growth. Mathematically, there should be a sweet spot for how much you should save, because once you go past a given percentage, the extra pain/suffering to save more just doesnt translate into comparable benefits.

Restated, % saved and years saved are the two key factors, and if you make "years saved" too low, it just hurts your growth potential too much to justify the sacrifice.

Quote:
regarding being financially independent and job satisfaction. I have posted on a number of occassions that once I became FI that my attitude really changed about work. The boss wasn't an a$$hole anymore, the co-workers weren't so bad. The drudgery of work disappeared which was actually quite a revelation for me. So much so that rather than retiring early I am contemplating working on just for "fun" and satisfaction that the work provides.
Ive been suspicious this would be true for me too, so its had me thining more recently that perhaps I need an attitute adjustment at work, because i'm perceiving problem(s) that just aren't real. IE: My job is much more secure that I think it is, things aren't as big a deal as i make them out to be, etc. Point: who says i have to get FI to make this change. Why not just do it now, since its mostly a self-created problem anyway?

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Re: Advice from physicians...
Old 10-31-2006, 01:08 PM   #18
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Re: Advice from physicians...

Quote:
Originally Posted by Azanon
With both spouses being working doctors, i probably wouldnt bother. I cant imagine the odds of an event where both of you becoming disabled, but not dead. I'm sure its possible, from a mathematical/theoretical point of view.
Car accident? Not that unthinkable.
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Old 10-31-2006, 02:21 PM   #19
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Re: Advice from physicians...

Quote:
Originally Posted by brewer12345
Car accident? Not that unthinkable.
Both injured so bad that they're both permanently debilitated, but not dead? Of course its possible. Would I pay monthly to cover the likelihood of that unlikely event? No.

I'll admit, i'm not a big fan of insurance though. I have the major ones covered (health, auto, and a basic term life). Being a fed employee, i get a basic disability Package too, but then again my wife only makes a very modest salary compared to, say, another medical doctor. We're not big travelers/vacationers, so its not a common thing for us to drive around together.

With that kind of income though, i'd get an umbrella policy to cover the possibility of massive lawsuits that could wipe you guys out. They're really affordable, and pretty important for high income/high net worth earners.
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Old 10-31-2006, 02:29 PM   #20
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Re: Advice from physicians...

Quote:
Originally Posted by Azanon
With that kind of income though, i'd get an umbrella policy to cover the possibility of massive lawsuits that could wipe you guys out. They're really affordable, and pretty important for high income/high net worth earners.
An umbrella would be a good idea, but the bigger risk is from malpractice lawsuits (for which OP is undoubtedly insured).

Az, believe it or not, it is far more likely that an adult will be disabled than die in the time between ages 21 and 65. Yet many more people have life insurance than disability insurance. I think DI for O and his spouse is more about protecting the value of their human capital than protecting their standard of living.
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