People will tell you the most intimate details of their relationships and their medical problems, but they zip their lips when it comes to their finances. It is ingrained in our culture, but this lack of transparency creates some unnecessary and surprising problems. Lawyers, CPAs and financial advisors whom I have interviewed all tell me of previously undeclared "surprises" that spring up later to bite people in the behind. Things like undeclared income, illegal activities and even secret second families.
So with this all in mind, I set out to talk to a series of mid-career and late-career doctors to find out (what they would actually tell me) about their positive and negative financial and organizational experiences that I could pass on as advice to younger doctors. And, because of the subject matter, I can share with the voyeur in all of us.
To get these folks talking, I proposed a series of questions to see what might creak open their memory vaults to the light of day. You, dear reader, might think about these questions as well and submit any interesting or useful stories, anonymously of course, to add to the discourse.
So I asked, in no particular order, questions like:
What did you do right?
What did you do wrong?
What was your biggest financial challenge?
What would you do differently today?
What was your smartest or luckiest move?
What was your dumbest or unluckiest one?
What would you recommend to others?
What has helped you and what has hurt you?
And other questions like that, to open "Fibber McGee's closet." Those of you long in the tooth who remember will smile at the metaphor. For you younger cats, look it up. It's instructive.
The answers that I got from these docs in a variety of specialties ranged from the expected to the prosaic, the wistful to funny, and even to the inevitable silence.
The most forthcoming was from a CPA who became a doctor, and a psychiatrist at that. He was more conversant and comfortable both with financial knowledge and talking about it. He also appeared (because no one was forthcoming enough to actually know) to have done the best financially outside of medicine in this randomly selected group. He acknowledged that his former profession was of considerable value in doing so, and that by comparison none of his medical colleagues seem to have much know-how to deal with financial issues.
The CPA-turned-psychiatrist’s observation was echoed by other doctors, who wished that they had "taken a course" at the outset of their careers to help shape their understanding of finances — how things work and what they could and should do. The one doctor who had the wherewithal to actually take such a course early on considered it one of his smartest moves.
And now a word from our sponsor: Followers of this column will acknowledge that for years I have been beating the drum for medical training curricula change, particularly to include some fundamental financial and organizational literacy. Not doing so is wasteful, hugely expensive to doctors and patients alike and ultimately impairs the quality of care in a major way.
Ok, that acknowledged, there is also a moral aspect to some of this. One doctor pointed to an inflection point in his career where he had to make a decision between changing his practice direction from patient-focused to making a lot more money by becoming procedure-focused. He chose not to follow the siren song of Big Bucks in favor of focusing upon what he calls "good medicine" (i.e. not financial self-aggrandizement as his primary professional objective). For him, this was an expression of moral character and he has had no regrets. We all know others who chose differently, some for laudable reasons, some not so much.
Most however said that overall, they did "more things wrong than right." One example I was able to pry out was a doctor chasing higher returns by buying into limited partnerships (that failed) touted by an insurance salesman on commission. On the other hand, this doctor was very successful with oil and gas leases sold by "a friend."
The underlying lesson that I extracted from stories such as these is that, in our naive ignorance, many of us are vulnerable to opportunistic situations just based on people's recommendations rather than having a disciplined plan and knowledgeable analysis from an objective advisor.
On the subject of "smartest moves," these included: "I focused on getting out of debt;" "Joining a large group that already had a financial plan and structure in place;" "Giving ownership of my office lab to my kids, which paid for their college educations;" and "Setting aside money early."
Advice to other doctors included: "Do not go into practice without taking a course;" "Don't discount your fees;" "Make patients pay for their second no-show;" and "Learn how to talk to patients about money."
Oh, and for their dumbest moves, I heard doctors admit they neglected the financial said because “doesn't interest me” and “I don't care” (!).
But my favorite dumbest move was "Marrying my first wife." I can't top that.