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After the Match

After the Match: Why Are Doctors Financial Idiots?

Cook, Thomas MD

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doi: 10.1097/01.EEM.0000436444.87300.16

    Prelude: There are stories upon stories about doctors mismanaging money. Fortunately, there are athletes and musicians who grab all the headlines so we can hide our incompetence.

    Act 1: Every resident now seems to have a “scarlet dollar sign” on his forehead. This burden grows with each intern class, and invariably it creeps into their collective consciousness as they try to grapple with decisions about their future. “How can I possibly pay down this debt and buy the house that I want and get rid of that crappy car my folks gave me in college?” “Where's the doctor's life I thought I was going to get when I started this process seven years ago?”

    Act 2: It's voluntary. I am in a committee meeting with our hospital's Office of Graduate Medical Education. The topic of discussion is educational programs for residents of all specialties (things like ACLS, PALS, and ATLS). With all the changes coming with the ACGME's overhaul of residency training (I'll write about that soon), we are trying to find ways to create educational courses that will help all the residents at our academic center and take the burden off each program to do it on its own. The usual suspects come up, like “fatigue training” and making sure all the interns get their “nap” time.

    But to our GME office's credit, they have put together a series of lectures over the past few years on personal finance and the business of medicine. The problem is that participation is voluntary, and classes are three hours long at lunchtime during the work week. The idea is that the resident will “get away” to attend the classes after rounds in the morning and before afternoon rounds at the end of the day. I ask the resident in the room (from surgery) if he has ever attended one of these classes. “I do not have three free hours in my day,” he said. You guessed it: attendance for the classes is not stunning. Residents are not into “voluntary” classes on finance. You might as well be conducting classes on speaking Mandarin.

    Act 3: I was a financial dope when I left residency training (and I'm not very sharp now either). I got pounded by my financial mistakes and crushed by the anxiety it created. It was nearly 10 years before I found folks I trusted to help me with my financial decisions and move toward what I hope will be a successful retirement.

    Most physicians do not struggle with practicing clinical medicine after residency; they grapple with how to live life with a starting salary that is six to eight times greater than what their college peers started with seven years earlier. Those peers had time to bumble around and make mistakes that might have been painful, but they did not involve the relatively large sums of money that a new EM graduate is likely to receive. It's like handing over the keys of a Porsche to a teenager. You know they do not know how to handle it, and something messy is going to happen.

    Everyone thinks you know everything about everything once you get the “MD” badge. But physicians are not trained in finance. They do not understand how mortgages work, the difference between a stock and a bond, how to use Quicken, or what types of insurance to buy and from whom. They do not have an accountant, financial planner, or an attorney, and they sure don't have any idea about how to find one even if they wanted to. They don't know squat, and they are scared to ask how to get started during residency when they are overwhelmed with learning about clinical medicine. Presented with alternatives about how they can educate themselves in personal finance, residents usually fail to initiate despite thinking it's a great idea. They will always think they have time to do it later (after all, you have soooo much free time after residency is over.)

    One of my first actions when I became a program director was to create a senior resident retreat that focused on life after residency. It was called “Transition to Practice,” and senior residents and their significant others would go out of town at a mountain resort for a long weekend. Each morning they would meet with financial planners, medical business experts, and a veteran malpractice attorney. The spouses participated so they would be fully invested in the process. The meeting was a hit.

    Now, as you might reasonably expect, there was a bit of flak from my partners back then. Questions about who would cover the ED and why we needed to go out of town were asked. But 12 years later it is a pillar of our residents' experience in this program. Our speakers have hung with us through all of these years, and a patchwork of resources including our hospital GME, my partners, and our residency alumni foundation help fund the retreat.

    We also have a personal finance curriculum imbedded in our weekly conferences during the academic year. Residents listen to a wide range of topics including tax planning, retirement planning, mortgages, insurance, and debt management for two hours every other month. No one falls asleep during these lectures. They are all ears once you bring up money.

    Residents cannot escape the need to learn about personal finance. Money is the tool in a market economy that everyone uses to accomplish what he wants out of life. Residents need to invest in this component of learning this as early as possible. They should seek out a savvy attending or financial planner if they do not have access to a formal curriculum in residency and begin learning about how money flows in and out of their lives. They will make mistakes, but it will hurt less now than when they inevitably play with larger sums of cash.

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