Residency can be challenging. We are perpetually overworked, underpaid, and trying our best to make it through. Even those who aren’t resident physicians may be able to relate to this in some way. While this time has its ups and downs, we can’t lose sight of the bigger picture. We will soon be attending physicians and one of the best things we can do during residency is lay the foundation for the life and career we desire. This means doing a few things during our time in training to set ourselves up well financially. Here are 5 of the money goals I set when I started residency:
1. Figure out what’s going on with my student loans. When I graduated from medical school, I had a substantial amount of student loan debt. I remember being called into the financial counselor’s office and being told that I had over $200,000 in student loans. I don’t know about you, but I had never seen or made that much money in my life. I knew I needed a plan. I began to read about the different repayment options and tried to pick one that would give me the lowest monthly payments in residency, provide some government subsidies, and still qualify for loan forgiveness once I finished my training. I didn’t want to be stressed about student loans in residency, so I signed up for an income-driven repayment plan and had my residency coordinator sign the form needed for me to enroll in Public Service Loan Forgiveness.
2. Pay down my credit card debt. I had credit card debt before I started residency. Most of it was accumulated before I was med student, back when I was struggling to make ends meet as a post-grad student in Washington, DC. However, I had also racked up some debt when I was starting residency. Moving from one state to another, paying the deposit for a new apartment, and affording basic expenses like food while I was waiting weeks to get my first residency paycheck was tough. I didn’t have the benefit of a working spouse or cash from my parents to lighten the burden. I didn’t realize doctors could get low-interest personal loans, so I instead charged the expenses on my credit card. My goal was to pay off this debt within the first year of residency, so I set aside money from each paycheck to pay down this debt until it was gone.
3. Save money for vacays and emergencies. One of my goals as a resident is to be able to take full advantage of my vacation time by traveling and visiting friends in other areas of the country. Before COVID, I had visited friends in Seattle and Chicago. In a few months I’m planning to attend a destination wedding. In order to afford those trips without taking out additional debt or charging the expense on a credit card, I knew I needed to plan ahead. Thus, one of my goals was to save a few hundred bucks from each paycheck into a “vacation fund” so that I could afford to take nice trips during my time off. Along with saving money for vacations, I also wanted to make sure I had money in an emergency fund so that if an unexpected expense occurred like needing new brakes for my car, a new phone, or a new laptop, I had the money to pay for them. So in addition to my vacation fund, I also had a few hundred bucks from each check put into a separate emergency fund via automatic savings.
4. Protect my income with disability insurance. As a resident physician I know my income will increase when I become an attending. (And as someone who feels underpaid right now, I cannot wait for that to happen). But even as I near the finish line of my training, I realize that a lot of the goals I have for my life—to buy a nice home, spend quality time with my family, have memorable international travel experiences, finance my [future] kids’ education, and build wealth for future generations—depend on my future attending income. Because the life I envision is so heavily dependent on my future high salary, I knew I need to protect it by getting disability insurance.
Having disability insurance means that if something unfortunate happens (like getting in a car accident, being diagnosed with a chronic medical illness, or suffering from a mental health disorder) I will still have an income high enough to help me reach my financial goals. Getting disability insurance as a healthy young resident allowed me to not only protect and insure my resident salary, but it also allowed me to lock in a lower rate with guaranteed coverage so that I would be insured as an attending physician as well.
5. Start Investing Money. With the goals I had above and an initial salary of $60,000 as an intern, I wasn’t sure I could afford to have any more money goals as a resident. Fortunately, I still decided to invest. I knew that I couldn’t save my way to wealth and that if I wanted to meet my financial goals sooner, I needed to start buying assets (things that increase in value over time). I also knew that one of the best things about investing is that my money can make even more money via compound interest and that compound interest would be more effective the earlier I start investing. So yes, even though my income would increase as an attending and money was tight when I started residency, I still made a goal to invest.
Because of the tax, student loan, and asset protection benefits, I prioritized investing through retirement accounts (like a Roth IRA and my residency 403b). I also knew that I wanted to invest money in a way that maximized the chance I would make money and minimized the risk I would lose money which meant I invested in index mutual funds like the vanguard total stock market index. Because I wanted to prioritize paying off my credit card debt, I started off as an intern investing only 3% of my income into my residency 403b. I gradually increased the percentage every few months as I paid off my credit card debt and stacked up my emergency fund until I got to my target of investing 10% of my income.
My point? Even as a resident, it’s important to have money goals. Maybe you want to pay off credit card debt and start investing. Or, maybe you want to save for a wedding or set aside money to buy a home. Regardless of what your desires are, the first step in becoming money savvy as a resident and setting yourself up well as an attending is to clearly define what you want and make some money goals that you can work toward while you are in training.
9 Reasons Doctors Aren't as Rich as You May Think
Many people think doctors are rich. While many physicians have high salaries, I can tell you firsthand that a lot of doctors are not as rich as everyone thinks. Here’s why:
1. Med School Debt. Like other young professionals, many doctors have student loans. But unlike undergrad, medical school is expensive. In fact, most med students take out at least $30,000, per semester of medical school. The average medical student loan debt is over $240,000 by the time we graduate and this balloons to over $300,000 by the time we finish training and account for the interest that has accrued. It’s a lot harder to become rich when you start off with a net worth of negative $200,000 or $300,000 after graduating from medical school.
2. Prolonged Schooling. Doctors spend many years in school. Many of us start school at age 5 and don’t finish all the schooling and training needed to be a doctor until we are in our late 20s or 30s. Because of this prolonged schooling, doctors don’t start earning money until much later in life. While people in other professions have full time jobs with benefits and guaranteed salaries in their 20s, many doctors are living off of student loans. This means we can’t earn money, save money, or invest money in our twenties like many other people can. As a result, we have a delayed start to building our net worth.
3. Residency and Fellowship. After medical school we spend years in additional training working as residents physicians in which we are paid an average of $60,000 a year to work 60-80hours per week. In other words, we are full-time doctors, with full medical licenses getting paid a little more than minimum wage per hour. And this is mandatory. Every practicing physician must go through residency. The length of residency depends on the medical specialty, but it ranges from 3 to 7 years. Once residency ends, many physicians go through additional training called fellowship which means they spend another 1 to 3 years getting paid this lower rate.
4. Specialty Hierarchies. There are wide variations among physician salaries after residency. Pay can range from $120,000 a year to $600,000 a year and beyond. The amount of money a physician makes is heavily dependent on one’s primary medical specialty. Specialties that do more procedures (like surgery and radiology) tend to generate more RVUs (revenue value units) which results in higher insurance reimbursement rates than specialties that do fewer procedures like family medicine and pediatrics. Specialties like plastic surgery and dermatology that are more cash-based and offer cosmetic services tend to generate higher salaries as well.
5. Taxes. Once doctors finally finish training and start making higher salaries, they are often in the highest tax brackets. This means a large chunk of their earnings is deducted from their pay before it ever hits their bank account. Unlike many of the rich, who are able to shield a lot of their income from taxes by making real estate investments or business dedications, many doctors are employed as W-2 workers which is taxed at a higher rate. Along with higher tax rates, and fewer tax shields, doctors are often phased out of many of the subsidies that benefit the middle class and are ineligible for tax breaks and refunds enjoyed by the rest of the population.
6. Overspending from Delayed Gratification. After spending many years in school and training, doctors have a great deal of delayed gratification. Many of us want to buy a home, start a family, purchase a new car, take a nice vacation, and make other large purchases. After so much delay, it can be hard to resist the urge to do all of these things at once. Many physicians finance expenses, take out debt, and purchase things before they have all the money needed to do so. This exponentially increases the debt we already have and delays our ability to build wealth.
7. Mid-level Influx. Physicians cannot ignore the impact of mid-level providers. While nurse practitioners and physician assistants are valuable providers who can help increase access to care, they have been used by healthcare corporations as a cheaper alternative to care. Although physicians and mid-level providers are both immensely valuable, the influx of mid-levels has decreased the job options and lowered the pay range for some physicians. For example, instead of hiring two physicians to work in an urgent care, a company may instead hire one doctor and one mid-level provider.
8. Big City Saturation. Physician salaries vary widely in certain parts of the country, but not in the way one might think. In most jobs, people in larger cities get paid more to compensate for the higher cost of living. The opposite tends to be true in medicine. Because larger cities usually have more entertainment options and educational opportunities with large hospital systems that have more jobs for physicians in niche specialties, many doctors want to live in or near a major city. This creates physician oversaturation in these areas. Because the supply of doctors is so large in big cities, the demand for doctors in those areas decreases which results in lower salaries. As a result, doctors tend to get paid less when they move to larger cities. Along with taking a pay cut to live in a desirable area, many of these big cities often have a higher cost-of-living and tax rates which further decrease a physician’s take-home pay.
9. Lack of Financial Literacy. Despite our intelligence and skill when it comes to medicine, many physicians are never taught about money. Physicians spend years in school, often without ever having a salaried job, then go through residency where they are overworked and underpaid. They then finish training with a massive pay increase and zero guidance on what to do with their money. Many physicians spend too much too soon, and fail to save or invest enough of their income to build wealth over time. Unfortunately, many who doctors who seek professional help by hiring a financial advisor are often taken advantage of. Many are charged high prices for bad advice and are often tricked into purchasing inefficient financial products or investing money in subpar ways which further delays their journey to building wealth.
Thus, doctors aren’t as rich you may think. Some of it is our own fault, some of it is a system failure that impacts us greatly.
Tell me, what are some reasons you think doctors aren’t as rich as everyone thinks? Do you have any ideas on what we should do to overcome these hurdles?
5 Truths Every Resident Needs To Know
July 1st is just around the corner and for those who are new to medicine or unfamiliar with residency life, July is the start of the new resident physician year. A resident physician is a doctor who graduated from medical school and is getting specialized training in his or her field of choice while still seeing patients. Residents are doctors who are still actively learning (like a student in school) while they are also working and earning money.
Besides experience, the main difference between a resident physician and a regular physician (like an attending physician who is done with his/her specialized training) is that resident physicians work a lot more and get paid a lot less. I’m still a resident myself, so as you can imagine, it’s a busy time in our lives. There are a lot of things we have to worry about, but finances shouldn’t be one of them. Here are 5 money-related truths every resident physician, and young professional with high earning potential, needs to know:
You are not guaranteed to be rich. Just because you are a doctor and will have a high salary, does NOT mean you don’t need a plan for your finances. Most people who make more money, get into more debt. Your time as a resident is not an excuse for poor money management and credit card accumulation. Many doctors’ net worth is not nearly as high as it should be considering how much they get paid. Make some financial goals for yourself now and try to avoid some common pitfalls. Learning a few finance basics as a resident can go a long way.
Spend less. Save more. Minimize debt. Things can be challenging during residency so try to live below your means or at least avoid living above your means. You don’t have to have a detailed budget but creating a basic spending plan to prevent yourself from accumulating [more] debt during training might be helpful. Save money in an emergency fund so that small, unexpected expenses like a car repair, urgent trip back home, or new cell phone doesn’t derail your budget or financial goals. Vacations can serve as a much-needed break from the stress of residency, but try to pay for them in cash by saving a couple hundred dollars from each paycheck. If you can, invest some money in index mutual funds via your work retirement plan or your own Roth IRA. The goal in residency is to keep your head above water financially and avoid getting into more debt.
Have a plan for your student loans. Choosing to “deal with it later” is NOT a plan. Read about the different student loan repayment options and choose one, likely an income-driven repayment plan, so that your payments are affordable in residency. Most residency programs qualify for public service loan forgiveness so take a couple minutes out of your day and sign up for this free program so that you have an option for your student loans to be forgiven after 10 years. When choosing a student loan plan recognize that the optimal student loan plan for you as resident may change when you become an attending. That’s okay. Just figure out the best federal repayment plan for you now, likely PAYE or Re-PAYE and consider hiring a company like Student Loan Advice or Student Loan Tax Experts once you finish training so they can run the numbers for you and help you determine the best repayment plan for you as an attending.
You need Insurance. As a resident physician, there’s a good chance you have health insurance from your employer that is either free or low cost, but health insurance isn’t all the insurance you need. Every resident physician needs long-term disability insurance. You may get a small amount through your residency program but that is unlikely to provide enough coverage. Most residents and attendings will need to purchase an additional individual long-term disability insurance policy. If you have a spouse, kids, or family members that you support financially, you may also need to purchase term life insurance. If you have a side business, you may also need extra liability insurance coverage. Figure out all of the insurances you need and make sure you get them.
Think twice before you buy a house. Owning a home can be a major milestone and lifelong dream, but it may not be wise to do so in residency. You cannot just compare the monthly mortgage price to the monthly rent price and make your decision. There are additional fees and costs associated with home ownership that can be challenging to deal with as a resident. Do what is best for your family, but make sure you consider all of the pros/cons of buying a home before you make the decision to rent vs buy.
3 Main Ways the Rich get Richer (and you can too)
5 Pro Tips I'd Give My Younger Self:
Realize personal finance is important. Despite what we may have been told about our careers and future high incomes, how we manage our money now matters a lot more than we may think. A lot of us are falling into a danger zone of being okay with rapidly accumulating student loans, credit card debt, and never-ending car payments which is a very VERY scary place to be.
How we spend our money today, can drastically alter our quality of life a few years from now. The last thing you want to do is be in your mid-40s still complaining about the student loan debt your friends and family forgot you had, picking up extra shifts at a job you hate to avoid racking up even more credit card debt than you already have. DO BETTER.
Figure out how much you spend each month. I cannot stress how much my life changed when I actually set down and tried to create a monthly budget. Regardless of how “simple” it is, I can tell you that 90% of my med school classmates didn’t have one.
As a med student life was so stressful studying for organ systems tests, clinical rotation exams, or Step 1 of the US Medical Licensing Exam that you barely have time to wash dishes, let alone try to understand finance. Most of my us just filled out a FAFSA form each year and magically received money from the government that covered our tuition and basic living expenses. We’d pay our rent, buy the food we wanted, and then realize we’re suddenly broke when the semester was about to end and our account balance dwindled. We’d sweat it out for a month trying to make ends meet, then fill out another finance form (aka FAFSA) and “magically” more money appeared in our bank account. Rinse. Wash. Repeat.
No one told me not to over-spend my loan money on the post-board exam vacation I felt I deserved. No one stressed the importance of resisting the urge to “treat yo’self” during happy hour or a colleague’s birthday dinner.
I am not saying you can’t do these things, but I want to stress making a budget because I’d bet that most graduate students and young professionals have no idea how much money they are actually spending each month. I know I didn’t. I mean I knew I was broke because I kept filling out loan applications every year, but I honestly couldn’t tell you my overall loan balance. Heck, I couldn’t even tell you my debit card balance. Don’t be as naïve as I was, DO BETTER.
Minimize the interest rates on the loans you have. The money you borrow now will cost you much more in the future. Let that sink in. The higher the interest rate, the more money you will pay back later. When you borrow $30,000 for school, you pay back closer to $40,000 later (assuming a 7% interest rate that you pay back over 10 years). That’s $10,000 extra you’re paying just in interest.
You can minimize this by not borrowing as much in the first place and by lowering the interest rate on the loans you currently have. If you have credit card debt, simply call your bank and ask if they can lower the interest rate on your credit card. Yes, it really is that easy.
Spend less! We all want to look good, feel well, and vacation like a champ. Trust me I get it. I get envious when I see the Instagram photos of my med school classmates or work colleagues taking another extravagant vacation I cannot afford. It’s hard not to let the positive balance in my bank account distract me from the big fat NEGATIVE sitting in front of my net worth.
As a med student, the student loan money sitting in my debit account was fictitious. It tricked me into believing I was richer than I was or that I can afford things I knew I couldn’t. When I finally had to face the big fat loan balance alongside my car payment and expanding credit card debt, I realized I needed to make a change.
I knew I didn’t have much self-discipline so I had to stay far away from the malls. I deleted the text alerts of new “sales” from my favorite clothing stores, resisted the urge to buy a new outfit for weekend outings, and started cooking more meals at home. Before I knew it, I had changed my spending habits and paid off my car.
Practice self-discipline and delayed gratification. For the love of God and all things man please break your expensive habits. Mine was wine and lots of it. I liked it red, aged, and expensive. It just tasted better. But man was it costing me.
I was spending at least $15 a week on wine, which doesn’t sound like much but when spread that across 52 weeks a year that amounts to $780. I mean I was spending nearly $800 on alcohol! This was going to cost me closer to $1000 when I paid it all back, since I was buying the wine with my student loan money. What a waste.
Every year for Lent I tried to give it up and the day Lent ended I picked back up the habit. Don’t be me. Curve your habits. Do not waste money you don’t have on things you don’t need. Granted there is a balance, but graduate school is not the time to be treating yo’self to wine and fancy dinners every other week. Face it. We aren’t rich…yet. Quit pretending you have more money than you actually do. Practice self-discipline so you can get out of debt and start building your net worth.
Tell me, what ways have you started practicing self-discipline? What things are you going to try to spend less on this month?
Yes I’m a Doctor, yes I still live on a budget: 4 steps I took to change my spending habits
To the outside world, I’m a rich doctor who can buy what I want. In reality, I’m a sleep-deprived resident physician struggling to keep my head above water. No one told me life would be like this, at least not before I started taking out tens of thousands of dollars in student loans each semester, but I digress. The point is that even [future] high-income earners like myself need to have a budget. Without one, our money disappears faster than a post-call resident leaving the hospital.
Unfortunately, realizing I needed a budget and actually creating one were two different things. Like a diabetic struggling to shed those unwanted pounds, it takes time to actually move from one step to another. Coming to terms with the fact that I work super hard and still can’t afford all the things I crave is its own beast that has taken me several attempts to tackle. Just in case some of you are in the same boat, let me shed some light on my own come-to-Jesus moment.
Step 1: I had to let go of my pride and accept that I was spending too much money.
I’m almost ashamed to admit, but a few years ago I didn’t think a budget was necessary. I thought they were for poor people living paycheck to paycheck. Now that I’m a doctor living paycheck to paycheck I have a lot more sympathy (and humility too). It wasn’t until 6 months ago that I finally let go of my pride and began to accept that my habits needed to change. I was tired of running out of money at the end of each month. I was tired of relying on my credit cards for basic living expenses or holding my breath every time I had to pay for an oil change.
Step 2: I had to sit down and actually write down my budget.
Honestly, I think the only reason I finally sat down and tried to make a budget was because I had this incredible distaste for debt. I had heard horror stories of older doctors whose student loan burden was sapping all of the happiness they once had with their jobs. It’s as if their lack of financial independence had turned the job they once loved into one they despised. I didn’t want that to happen to me. I wanted to know that my bills were paid on time each month and that my credit card debt was getting smaller and smaller. I wanted to make sure all my bases were covered. Creating a budget was one of the first steps I took to get on the right track.
Step 3: I had to download a budget app to track my spending, and actually check it.
Sounds simple, but for me, this was not an easy feat. The anxiety I had even thinking about opening Mint.com is one I cannot even begin to describe. But...I got through it. Slowly but surely I began to look at the numbers. I saw how much money I was actually spending on food each week. How my impromptu trips to the mall resulted in unnecessary clothes and holes in my budget. How the Uber rides, overpriced drinks, and club fees from weekend shenanigans added up to much more than I anticipated. I finally opened the app, stared at the numbers on the screen, and faced the fact that my spending was out of control.
I was barely staying afloat and knew I had to do better. I couldn’t use the fact that I was a med student living on loans as an excuse. The spending habits I had wouldn’t magically change once I started getting paid as a resident physician or even as an attending physician. I needed to get rid of the bad behavior now, so that when I do experience an increase in pay in the future, I don’t just squander my wealth.
Step 4: I had to put boundaries in place and stick to them.
It wasn’t enough for me to track my spending each month. I needed to put some protections in place to “save me from myself.” I opened mint.com and set up budget notifications that send an alert to my phone whenever I’m nearing my weekly allotment for food or entertainment. For example, if I limit myself to $100 every two weeks for transportation, the app will send me an alert whenever my Uber rides approach the $80 mark. That way I know when I need to forgo that weekend party invitation and maybe host a game night at my place instead. I was well-intentioned before, but setting boundaries through budget apps and spending notifications has really challenged me to stick to my goals.
Full disclosure, I am still a work in progress. There are times I ignore those alerts only to face regret when I log into my bank account afterwards. Thankfully, those times happen a lot less frequently than they used to. When it comes to my spending habits, I am far from perfect. I still struggle, but by simply making these 4steps my spending habits have improved exponentially.
Tell me, what steps have you taken to improve your spending habits? What was it like when you first tried to make a budget?
Becoming a doctor helped and hurt my ability to build wealth
I just graduated from medical school and will begin my first job as a doctor in a few weeks. Yay! Unfortunately, I am not about to hit the jackpot or start making the salary people google online, just yet.
Although it is true that doctors make a high income, we have to complete residency first. This is a period of 3-7 years in which we are paid a government salary of around $60,000 while working 80 hours a week--not exactly the best lifestyle. In fact, there are several ways in which going to medical school and becoming a physician helped AND hurt my ability to build wealth.
Ways it helped me build wealth:
1.) I will have a high income. Most doctors make at least $200,000 a year, once they finish residency training. Since everyone needs access to physicians and reliable health care, doctors have a high level of job security as well. Mathematically speaking, it is much easier to pay off debt, save for retirement, and build wealth with a high income, especially when it is virtually guaranteed.
2.) It gives me access to exclusive perks and profitable investment opportunities. Some lucrative real estate deals, such as large multifamily homes and syndications (in which people combine their money to invest in an apartment building), are only available to people who have a high net worth and/or make at least $200,000 a year. Many physicians qualify for these deals. Doctors are also favored by banks (since we have a high income and rarely default on loans). As a result, we have the ability to purchase homes with no down payment or private mortgage insurance and are exempt from paying some of the added fees associated with the home-buying process.
3.) Many people in my network have a high net worth. As a physician, I completed medical school and thus know at least hundreds of other doctors and high net worth individuals that were once classmates or colleagues in the hospital. Having friends and associates who are well-educated and also earn a high salary is advantageous. There is a greater chance that people within my social circle have a high net worth. Not only does this give doctors like myself greater insight on how to build wealth, but it also increases the number of people with whom I can share ideas, pitch investment opportunities, and depend on for various levels of support.
Ways it hurt my ability to build wealth:
1.) I could not work in medical school. As a medical student, I went to class all day then went home to study all that material at night while also trying to squeeze in time at the gym, cook dinner, and maintain some semblance of a social life. Just in case some of us could miraculously do all of this with time to spare, the administration forbid us from working. That’s right. I gave my word that I wouldn’t work a job and would instead focus all of my energy and attention on medical school. This is well intentioned, but the simple fact is that medical school is 4 years long. That’s 4 years of my life that I couldn’t work, 4 years in which I didn't contribute to retirement accounts and work the magic of compound interest, 4 years that I was unable to save up for a car or a down payment on a home, and 4 years of potential wealth building and lucrative investments that I missed out on.
2.) I have less time to establish additional streams of income. Unlike many of jobs that require their employees to work 8-9 hours a day with nights and weekends off, med school and residency (our first 3-7 years as a physician) are the complete opposite. We often work 12-hour days, have several periods in which we work night shifts for weeks at a time, and are often scheduled to work holidays like Thanksgiving and Christmas that most other professions get off. While I absolutely love medicine, it monopolizes my time. Because I work so much, I have less time to devote to passion projects, side hustles, and the creation of additional revenue streams. People typically build wealth by actively investing their money or creating a lucrative business. Both of these avenues require a substantial amount of time and can be difficult to pursue when the vast majority of my time is spent working in medicine.
3.) I acquired lots of debt. Perhaps the biggest reason going to medical school hurt my ability to build wealth is all the student loan debt I accumulated. The average medical student has $200,000 in federal student loan debt and unfortunately, I was not an exception to this rule. In case it isn’t obvious, having $200,000 worth of debt at a 6% interest rate that started accumulating well before I could even finish medical school is not a winning formula for wealth creation. Plus, there is a good chance I may accumulate even more debt from a [future] wedding, have increased monthly expenses from having kids, buy a newer car, or finally give up apartment-style living to purchase a home. Either way you spin it, having increased monthly expenses with a high debt burden can make building wealth quite challenging.
Overall:
As someone who wants to build wealth, I recognize the ways my love for medicine has impacted my ability to reach financial freedom in a timely manner. Nevertheless, I don’t regret anything. With good money management, I can overcome the obstacles set before me and still reach my financial goals. Even with its disadvantages, I’m glad I choose to go into medicine.
Money Tips You Didn’t Learn In College
Be strategic about using credit cards. While having access to credit cards can provide added “protection” during emergencies, it also can be quite dangerous. I don’t know about you, but knowing I can use a credit card to pay for almost anything I want tests my self-control in ways I could have never imagined.