Showing posts with label money. Show all posts
Showing posts with label money. Show all posts

Monday, February 24, 2014

Stop scaring the "fresh meat"

I volunteered recently at a meeting for Latino high school, college, and medical students as a member of my hospital’s Residency Diversity Initiative. I had gotten the announcement a few months prior and realized I would be on a pretty straight-forward month with weekends off. I checked with the hubby that I could take about 3 hours during his prime studying time to volunteer and he agreed.

The students were engaging. The high school students asked silly yet endearing questions. One absentmindedly asked another resident and myself our specialties three different times because he kept forgetting what we said. He was sweet, but goodness, I hope his focus and attention span increase before starting college.

Several of the medical students asked very educated questions, ones that showed they knew where they were going. One particularly prepared medical student, dressed smartly in an off white blouse, flattering pencil skirt, and pearl necklace asked a series of questions that we answered. She thanked us and left. Then she came back later to chat some more. She began her new string of questions with “I don’t mean to sound, ummmm, superficial or anything, but even though I’m interested in all types of medicine, I am worried that if I go into Family Medicine instead of Internal Medicine that I won’t be able to pay off my loans.” I shared a quick, knowing smile with the Family Medicine resident sitting next to me and we began to talk to her about following ones passion. We also reminded her several times, indirectly and directly that regardless of what type of medicine you practice, each of us will be in the top 1% of US income-makers. The top 1%.

Yes I know $120,000 instead of $200,000 (in a surgical subspecialty) seems like a huge deal, but honestly, every single Family Medicine Attending the other resident knew and every single Pediatric Attending I know is living very well. Yes, they may have a ton of debt they are working to pay back, but every single one has a family that is well taken care of. Everyone I know has a nice house (mostly owned and not rented), a decent if not really really nice car. And none appears outwardly to be struggling to afford their basic needs. I apologize if these are material things, but that’s what she was asking about and we answered because it’s a very real concern.

And that’s the Attendings, not the Residents. Every Resident I know, including myself, lives in a nice apartment. Many Residents in my program own houses, not rinkey-dink jacked up houses, but really nice grown-up houses with nice yards. We can afford to go on vacations and we buy what we want at the grocery store including at Whole Foods (which my father-in-law refers to as Whole Check). My husband and I budget our limited money well and hope to buy a house in the first several years out of residency. And we are already well on our way to having my student loans paid off within 10 years using the income based repayment straight out of medical school. Don’t get me wrong, if we didn’t have my husband’s graduate school scholarships, our family of 3 with a single working adult (me), we would be very close to being eligible for public benefits (Section 8 housing, food stamps, WIC, you name it); some of our neighbors are on assistance now.

So, seriously, I know many of us including myself are in debt. And I know we need to do things to overhaul “the system” so that serving patients and saving lives is compensated in a common sense and equitable way. One that values innovative, smart approaches such as preventative care and comprehensive services. One that doesn’t cause very capable and compassionate students who are interested in our field to go running the other way as they eye the ever-mounting price tag. But even at the lowest-paying end of the spectrum, we all will make more money than the majority of our country. And if we help each other to become more business-savvy, we should never have to struggle to live well.

The medical student left smiling. I left more inspired. Hopefully we encouraged her to pursue what will ultimately make her the happiest so that she can bring her “best self” to work every day; she owes it to herself and to her patients. Yes, it’s a daunting task and the realities of practicing medicine in our country are scaring the crap out of many of us and our future colleagues, but again, we are still positioned in one of the best fields that exists. I am committed to reminding myself, my colleagues, and the “fresh meat” that this is the reality we find ourselves in. A bit daunting, but not too scary.

Thursday, September 4, 2008

Shoes: the other Elephant in the Room

So. There‘s pair of $200 shoes sitting on the floor of my closet.

They are beautiful. The smell of their leather sends chills down my spine.

When I tried them on in the store, I actually felt giddy. I’ve put them on twice…. But if I wear them outside the house I can’t take them back, so I haven’t yet.

I tell my self I deserve them. All those long nights at the hospital and hard work should be rewarded. Really, I don’t need them. My closets are full. I’m blessed. Truth is: time is money. As we prepare to hopefully adopt baby # 2, I see each purchase as time. The less I spend, the more time I’ll be able to take off to spend with the new baby when it comes. (No announcements yet but I'll keep you posted.)

I own my own practice. I’m one of 4 partners. My overhead is killer. My malpractice premium alone could buy one fancy Lexus. I do well, as long as I’m working. Taking much time off leaves me seeing red for a few months. Last year when I had to take my boards, I didn’t get a paycheck for 2 months. I accept this because it gives me complete control of my schedule. My partners are great. We get along personally and professionally remarkably well. We are all moms and we cover for each other a lot. Financially though, we “eat what we kill”. We work as little or as much as we want, take equal call, and pay equal overhead. Overhead includes salary, FICA/taxes, and benefits for two dozen employees.

I try to remind my self that the more money I spend, the more I have to work, the more time I spend away from my family. So I think the other elephant in the room is money. At least for me, since I’m the breadwinner in my family. It‘s physically painful to write out a check every 3 months for $15,000 and mail it to uncle SAM. It’s hard not to also see this as time stolen away.

I was looking at everyone’s profile in our group and it seems that myself and perhaps MWAS are the only Physician’s in private practice. Is anyone else self employed? Are taxes less obvious when you’re an employee and it just gets deducted. Is malpractice less obscene when some else foots the bill?

I don’t plan to vote with my pocketbook. I actually don’t plan to vote. (My state is so red even Gore couldn't take it.) But as I said, time is money. Every dollar more I pay in taxes and malpractice is less time spent with my family. Since the Dems came a little too close to having a malpractice lawyer on the ticket, and because I am both a corportaion and nearly "rich" some have promised to increase my tax burden, twice (don't tell my staff, but we could have to cut back). So yeah, I’m eyeing the Dems with more than a little suspicion.

Gottogo. Need to return some shoes.