Money, Medicine and Aging

It was my birthday this week, a classic time to take stock. If you had asked me years ago how my attitude toward money might change with age, I probably would have said very little. But events, and especially time, have a way of remolding our certitudes and we realize few money truths are eternal. That's especially true now for young physicians facing an extremely uncertain financial future.

It was my birthday this week, and of course it is a classic time to take stock. If you had asked me years ago whether or how my attitude toward money might change with age, except in the abstract, I probably would have said a little. But events, and especially time, have a way of remolding our certitudes, but with wisdom (and a little luck) we realize few truths are eternal.

I once mentioned that my brother, the radiologist, had said about retirement that his financial biggest issue, and surprise, was not in the mechanics of changing from a savings mode to a distribution mode. It was, rather, more of a problem to make the emotional change from a saving mindset after so long. It’s tough to make financial adjustments when we have difficulty ever conceiving of them.

We also need to be mindful of the advent of gender parity in medicine, the staggering increase in average medical student debt, and the developing reorganization of the traditional medical model of the independent physician into a larger framework. These and other barely imagined future changes in payment models and tax structures -- let alone our own individual goals -- represent considerable uncertainty for our current mindset, as well as future planning.

Young physicians, most with long years of penury ahead of them, typically have a certain predictable set of attitudes toward money. Generally, we are too absorbed in our work to think much about saving, or spend much time consuming what’s left of our disposable income. After training, when we start practicing medicine and our cash flow loosens up, we are sometimes too overwhelmed with a new setting -- building a practice and getting established in our new, hard won, lives -- to have the time and emotional space to get our arms around our financial situation.

The drum I always beat is that we get no financial or business-management skills to complement our medical training. So we have to find time to learn about these matters ourselves — often, the hard way. Most of us do eventually learn them, at our own speeds, to various degrees, both probably not enough nor soon enough. And as we gain awareness, we also often discover how important this financial and organizational knowledge is to the best practice of medicine in this age.

But a true financial focus usually doesn’t occur until perhaps early mid-career. By then, we have gotten ourselves organized and are able to see that we need to be smarter about money. That includes the realization that beyond the new house, the new car, the dwindling med student debt, and the beginnings of retirement savings, we have to add a college program for our developing families.

We are approaching peak earnings at this point, but are scrambling to keep up with our obligations -- financial and personal. We want more time with our families than our predecessors thought they could -- and possibly should — afford, as well as more time for community activity and other personal interests. What do we do?

Many of us will now begin to do the heavy lifting of learning how to manage our money in earnest. We hire advisors, we read, we make expensive mistakes and, eventually, we learn. We become more efficient and we ramp up our savings, in sensible tax-deferred vehicles. (Just a few of us, thankfully, will push the envelope of attaining wealth, sometimes via questionable means. Unfortunately for the physician community, some will succeed and be noticed, for good or for ill.)

As we near the end of our careers, there are no guidelines for physicians as to when or how to retire, or what that means in terms of our practice activities. The big wild card is health; that is why we have disability, health and life insurance. For those who feel (and, surprisingly, I do mean feel) the easing of financial pressure -- debts paid, kids educated, money in the bank -- many will just cut back hours to a less-hectic schedule. Less fatigue, more time for leisure activities. Some will narrow the scope of their practices, such as the classic OB/GYN dropping the OB.

This is the time when doctors’ life choices diverge sharply; some due to health issues, some because they can afford more leisure time and some because they simply long for career change.

Some docs stay fully engaged in the saddle. I know some who love what they do and remain competent and wouldn't think of voluntarily doing anything else. Their economic positions are strong and of decreasing concern. Others work late into their careers because they cannot afford to stop. They never managed the wherewithal to secure themselves financially, or through the mischance of divorce, malpractice loss or the like, find themselves still in either in a rebuilding or paycheck-to-paycheck mode.

So now we find ourselves at the endgame, back where my brother had to make his major financial adjustment. Oh, except for the financial prospect of the future weddings of his daughters and the indulgences to the grandchildren of his imagination. But that's a tale for another cold night around the fire. Happy Thanksgiving, and we do have so much, so much to be thankful for at whatever stage we currently find ourselves.