After my family went through bankruptcy as a kid
, we moved to Georgia. At this house near Augusta, there was a pond. And guarding that pond, there was a Goose named George. He would walk the grass in between the pond and the street leading to my house.
George was an angry goose who liked to hiss at you as your car drove by. He would snap at the tires and – as a kid – I always wondered what would happen if George ever caught that tire he was chasing. It might explain why George was missing an eye.
This isn’t quite the same as “the dog who caught the tire,” but it serves the same point. Sometimes, we chase after things in life that we really want and – when we suddenly get them – we don’t know what to do next.
Recently, I caught my tire.
The Need and The Desire
We all know that there is a huge need for financial literacy in the medical profession
. I also have a pretty much insatiable appetite for teaching personal finance
to anyone who will listen.
Combining these two things (the need and my desire) seems like a recipe for major success.
I’ve been outspoken, opinionated, and passionate about creating a financial curriculum within the anesthesiology residency where I work. It has taken two years of discussions and disagreements to get to the point where that might
In essence, I’ve been chasing the tire for two years, and the opportunity has alluded me for various reasons.
When one of the deans of the medical school recently approached me about making a financial curriculum for the fourth year medical students and senior PA/SRNA students, I felt like George – the angry tire chasing goose.
I finally caught the tire. Now what do I do?
Making a Personal Finance Curriculum
The readers of this blog will know that I have written a book on The 20% of Personal Finance Doctors Need to Know to Get 80% of the Results
. I’ve got a keen idea of what I think most medical students ought to know.
Yet, teaching personal finance in a different medium (e.g. a curriculum) seems daunting. It is not the thought of creating a curriculum. (I am married to an educator who will be willing to help me with that.)
It is daunting for two other reasons.
First, like many people who are honest enough to admit it, I suffer from some pretty major Imposter Syndrome
A day doesn’t go by where someone doesn’t ask or text me about something personal finance related these days. Yet, despite answering all of those questions, doubt lies just beneath the surface.
This brings to light the second reason this seems so daunting. Now, that I have people who are willing to open the blank canvas to me to create the best possible curriculum I can imagine, I am petrified.
Why? Because I don’t want to fail the same people who are providing me the opportunity I’ve desired.
The last three months have done wonders for my job satisfaction. Support and autonomy are two of the key contributors to work satisfaction
I’ve experienced support from my chair that led to this blog becoming non-anonymous
. Now, I am getting the autonomy I’ve wanted to help increase financial literacy in the medical community where I work.
What Do I Do With the Tire?
All of this leads me to one big question for you, my audience: If you were to travel back to your training days (medical school, PA school, dental school, anesthesia school, etc), what would you have wanted someone to teach you about money in a formal curriculum? If you are in your training days currently, what do you want to know more about?
I’ve asked this question and had it answered on the White Coat Investor podcast
. So, to get your gears turning, here were some of the answers from WCI, Physician on Fire, and Passive Income MD:
- Student Loan Management
- Asset Protection
- Cash Flow/Budgeting
- Real Estate
Other ideas were mentioned as well, and I’ve discussed this with a colleague who has been successful at creating such a curriculum (Jason Mizell out of UAMS).
Now, I want to hear from you guys! What would you have wanted to hear? If you could turn back the clock, what do you wish that you had known?
I’m leaving this post intentionally open-ended, because I am hoping that my audience will show up in the comments.
Let me know what you think.
I’m picking all of the brains that I can about what they would have wanted to hear. Put your name down as “anonymous” or “George the Angry Goose.” I honestly don’t care, but I do want open and honest answers.
Help me out making a personal finance curriculum.
After what you now know, what would you have found most meaningful in a financial curriculum while in training? What do you wish you knew then that you know now? Help a brother out. Leave a comment.
I recommend you teach medical students and residents about the financial realities of being a low earning physician. Most of us are in this category.
I am a mid-career female physician. I initially practiced Family Medicine and then switched to Occupational Medicine. I am basically a married primary care physician who has 3 children and has worked 4 days/week for most of my career. I am now going down to 3 days/week due to saving money for the past 15 years. My net worth is about 1 million dollars. I shop at used clothing stores and am a cheapskate but have a great life.
Although I work for a “high paying” HMO, my maximum yearly income has been about 200 k. I consider myself to be a low earning physician. Most of us are low earning, especially among women.
I think you really need 2 financial curriculums: one for high earners and one for low earners.
I will never make 300+k/year. The majority of physicians make a lot less than an anesthesiologist. There is a huge difference between 200k/year and 350k/year. I don’t consider a physician have a super high paying job. The residents and medical students need to hear that first and foremost. They have to hear that they have to be very careful with money and can’t be big spenders or they will not do well financially. This is hard to hear but must be heard and understood.
Best of luck to you. I really support what you are doing,
Anne, that is a great point. I do think the principles are the same regardless of your income level, but the importance of each of them is only heightened by having a more constrained budget. I think it is important to mention that and to focus on what we can teach them to control to set themselves on the best course, particularly if they are behind the 8-ball.
New grad PA here with high loans and no path to loan forgiveness. I would definitely be interested in some advice for the new grad in a situation where they’re trying to pay down loans as quickly as possible while saving. It seems like tuition keeps increasing like crazy, so I’m sure there are plenty of people who could use the advice!
Yeah, it is not a great situation. The rising debt is really hurting people. It puts many in a place where they need to focus only on the debt until it is gone (if they are not pursuing PSLF or some other kind of loan forgiveness). It’s sometimes the right thing to just put enough into retirement to get your 401K/403B match, and to put the rest towards the loans until they are gone.
Being in that situation is really tough, though.
I think the big financial mistakes doctors make are getting divorced and getting the big doctor house. Maybe the first one isn’t a good subject for a financial course, but breaking Real Estate into: 1) investment vs. your domicile, 2) owning vs renting and 3) hidden costs of ownership.
Doctors buy these $600K houses all the time, and then they might be turning around trying to sell it in a few years for a lot less than they spent… My wife and I are looking at possible places to move and we saw at least one $1M dollar house selling for under $800K because someone clearly overbuilt in their area. I’d give pretty good odds it was a doctor or similar professional who built that house that way and I bet now he or she is regretting it. The Doctor House is the big mistake that even financially savvy doctors make, I think.
Home ownership has to be in the curriculum. I absolutely agree. Great thought, and we are on the same page with that being the most common “big mistake.”
There were a lot of things I wish I knew back in med school but probably even more so in residency would this have been more practical and useful. Also I think you’re mentally more prepared to think honestly about your future while in residency. Med students are lost in the grind of studying.
For medical students I think the #1 topic that needs to be covered is student loans. Examples of compounding interest that is working against you (loans) and how taking out more than you need can really hurt you in the long run. I don’t think anyone I knew in med school thought any of that money would make much of a difference once they’re making the “big bucks.” Also maybe for 4th year students a curriculum on refinancing and PSLF and all options for their loans in the future will be helpful as they reach graduation and are starting to think about this more realistically.
Also some basics of saving and investing and different vehicles for investing will be good to have some basic knowledge of. As well as helping them understand how all the financial professionals that are trying to get face time with them are trying to sell them something that they will regret (our med school actually brought in those representatives from the top whole life sales force disguised as an insurance company).
Those are the topics that I think can make the biggest difference to medical students who aren’t really at a point of being able to invest much yet. The more detailed teachings will be best for in residency.
Agreed. A great curriculum would have a 1st year med student component, 4th year med student component, and then one for graduating residents. For now, I only have the curriculum for fourth year students (and some of my residents).
Like your topics:
-Student Loan Forgiveness (PSLF, etc)
-Basics for saving and investing
-Interacting with the financial industry.
I think all of those need to be in the curriculum. 100%.
Thanks for the thoughtful response, Doc G!
Congratulations on catching the tire.
I wish as a med student/resident someone hit me over the head about contributing to a ROTH IRA as my income was low enough to qualify and my tax bracket was incredibly low compared to now.
Avoiding housing mistakes (rent for at least a year or more when getting your first attending job, etc).
How to maximize revenue with proper billing codes, etc.
What to look for in a financial advisor if you choose that path.
Laddered insurance policies.
Yeah, billing and coding is tough. I’ve thought about that one. But what you need to know is different than what I need to know in anesthesiology and likely different than what either of us would need to know for IM.
Not sure how to tackle that issue.
Housing mistakes will definitely be covered as well as investing (Roth IRA in particular). Great ideas!
Sounds like you’ve picked some of the biggest brains out there. Kudos to you for persisting, Sisyphus.
I might suggest you offer a lecture devoted to how to spend that first attending paycheck. What to automate, what to throw at debt, essentially how to train yourself to hide money where you won’t spend it on a granular, actionable level. A side by side PoF style comparison a la “Tale of two docs” might help bring it all home.
Also emphasis on a Roth conversion during that first attending year. Minor but it helps.
Finally getting them to track their money as the first step, using personal capital or mint, would plant the seed of future action.
Thrilled you spoke to Jason, he was very impressive on the WCI podcast.
Completely agree, CD. I actually think all of that is related. I do what’s called “backwards budgeting” which automates saving and giving. The money is gone before I see it. What is left is what I get to spend.
I think the first attending paycheck ruins people because they don’t have a plan or an idea of what the big picture looks like. Preventing that is key.
Congratulations on working on this worthy cause.
I’m hopeful that there is finally some momentum in all these voices improving doctors’ money management.
I don’t think there are too many hidden secrets you need to uncover. They mostly need to learn the basics of saving, investing, earning, taxes, and insurance. It will be great.
I do wonder how many are ready to hear the message early in their career though. I was interested back in the 80s and 90s and figured out all this on my own. When you are ready to learn the teacher appears. You are the teacher for some. But realize others are not ready to hear the messages.
Completely agree that some won’t be interested. This will be an elective experience for them. So, hopefully, those that aren’t interested will not come. I bet after a year or two it will be wildly popular as people learn more about it, and it grows.
A focus on the basics will be essential. Agree 100% with you.
You could have a part about the philosophy and math that under pins FI. Pursuing FI is very different than being financially educated.
What is enough and how do you know when you found it? What’s is work? The time money tradeoffs. 25x and 4%.
Also a section on some of the other”big mistakes.” i.e. fancy cars, expensive schools, lifestyle inflation, etc
The Trinity study and “enough” will absolutely be discussed.
I think a talk on Lifestyle inflation will be key. And that should cover the fancy cars, schools, etc. Good idea!
The most important thing I did as a med student was keeping a Very strict budget from the beginning. I was an out of state student and what I was allowed to take out in government loans covered only barely past the actual cost of schooling. Instead of going into private loans, I decided I’d have to cut every corner I could to keep my non essential expenses low. My family helped me out a little the first year, but then I was on my own. I believe that learning about buffering and really having an idea of NEEDS vs wants is important for minimizing the debt to start with. And it made it much easier for me in residency to just stick with it. I paid down principle at times during residency, even while making enough retirement contributions to get match from employer. This was partly because I was single with no one to support at the time, but still, if I hadn’t had the early need to be very frugal (probably a cheapskate, really….) I wouldn’t have been able to keep loans so low.
Anyways, I think that having a budgeting course within the first weeks of med school and discussion of the impact that can make on student loans totals when one graduates is important.
Absolutely. Making a budget is key! Though I am not the biggest fan of a line item budget (I prefer taking care of the I important items and then going what I wish with what is left) I think that making a line item budget and then tracking spending is crucial in training.
Needs versus wants are so hard to tease out, but it is such an important exercise for all of us to go through.
Congratulations on this opportunity, TPP.
I think budgeting is a really important topic for this audience, many of whom have not had a real income before, so the advice of “living within your means” has not been particularly meaningful.
Learning about the underlying principles, and emphasizing how to apportion your paycheck, will be helpful for some; much as talking about carb counting, or maintaining a good balance of proteins/CHO/fat helps my patients with diabetes.
However, some patients just need a diet plan, whether they follow it slavishly, or customize it to suit their tastes. Similarly, some people are just going to need a rough budget. Showing them how to figure out what their take home pay might be, and how much they should plan on spending in various categories could keep a lot of people out of trouble. A few different scenarios (single, married, married with kids, +/- smaller or larger loans) could be very helpful, much as we have diet plans for 1200, 1800, 2000 cal/day.
You know. That’s a great idea. Tailoring the budget to various situations. I’ll have to chew on that a little more. See if I can tease that out, but either way it’s a great idea.
Thanks for your comment!
I concur with above and do think that divorce or death of spouse needs to be discussed. Live beneath your means. Don’t buy the fancy doctor car. Don’t buy the fancy doctor house. Start saving for retirement with your first paycheck. Day care is crazy expensive, especially when you factor in need to cover call and weekends. For our family it cost more than their college years. You really do have to budget. You can have anything but not everything. So can your kids. They can deal with it.
Also it is not a shame to work as a lower paid doctor or not have a 5 million dollar retirement fund. You just need to adjust to realistic goals and lifestyle.
What are the topics you covered in this? I’ve learned a lot but I too suffer from imposter syndrome and am still learning so much! Would love to make a curriculum for the med students/residents I will be working with next year but not really sure where to start or how to form it!
1) Pyschology of Money
2) Investing x 2
3) Student Loans x 2
4) Asset Protection
5) Working with the Financial Industry
6) Buying a house versus renting
7) Budgeting and cashflow
8) One other I am currently blanking on 🙂