Taking (Financial) Responsibility

A plea for doctors to wake up and come to grips with the necessities of a personal financial life.

Sometimes, sitting back, feet up, with a good cabernet to hand and friends around, one could take the point that many/most of man's ills are due to a refusal to take responsibility. Be it political-, health- or financial-related, there seems to be in all of us — to varying degrees — this need to deny the rational proactive step toward the needed task.

In health matters, doctors face the issue squarely every day with our patients. We know that roughly half of what makes us ill or kills us is our own doing, or lack of doing. So we educate the ones who need educating and then try to persuade them to either start doing something good or stop doing something bad.

How many times have you had a patient ask, "Doctor, why do I have to take these pills?" After you explain that the alternative is a healthier lifestyle, they pause and then say, "Okay, give me the scrip!" What's worse is that we know approximately one-third of all prescriptions are never filled and even then good compliance is also a regrettable fraction. Why do we live our lives in so much denial? Fear certainly factors large.

The same is true for financial matters. As I continually point out, we get no training at any level of our schooling about how to organize and live our financial lives. So mostly we learn the “hard way.” Why do we wait until forced by circumstances to get even basic knowledge about how to get on with things monetary? And we're the only ones who suffer when we dally. Denial, and its evil cousin procrastination, carries far too much sway in our lives.

How many of us have methodically gone about learning what we need to do in our financial lives, especially early enough to make the best difference? Mea culpa, I learned in fits and starts and on my own, dragging my feet for longer than would have been best. I guess I was not ready to hear the kind of expert who could have helped the most early on. What's the old saying, "Too soon old, too late smart?"

It's ironic that the less you know, the less you know about how to know more. And in feeling either guilty or embarrassed we inadvertently put other roadblocks on our irregular march to financial awareness. And once we get off the dime to get hold of our financial lives there is often the aha! moment followed by a bit of chagrin. If only I knew and/or acted sooner....

Physicians are forced by training and necessity to become stark realists or else we could not best serve our patients. To say nothing of the practical calamities like not making a living, avoiding legal problems and advancing our careers. And the days of being able — nay, encouraged by circumstance — to let financial matters slip in the face of unquestioning, unregulated, bountiful economic success are now remote to us in our lore. We just have to pay attention and get real. The "Golden Age of Private Practice," as I used to call it, is no more.

But there is a silver lining to this seeming cloud of doom. To survive, let alone thrive, we are being forced to become more rational and educated about our functional place in the ever more complex medical and personal marketplaces. Some will grouse or drag their feet, but this is really all for the best. Our carefully groomed sense of entitlement as doctors has been overdue for a reality check. Financially if not otherwise, or so my friends tell me.

The other reality encouraging responsibility is that the new generation of young doctors has a considerably different set of expectations and experiences. They haven’t just observed what happened over the last few decades to the previous generation of doctors as a result of managed care and the rising tsunami of health care cost burdens. Younger doctors have their experiences of personal debt reaching well into six figures. Funny how big debt can wonderfully clear the mind of financial fantasies. Except in politics, it would seem.

Young doctors are being forced by these historically changing circumstances to financially grow up faster than the previous generation did, but largely by necessity. They have fewer options, as is documented by the seismic shift away from hanging your own shingle to large group employment. They aren't being professionally prepared to meet these new financial challenges any more than we previous doctors were. But they no longer have the "luxury" of denial.

In sum, this is a plea for doctors of whatever generation to wake up and proactively come to grips with the necessities of a personal financial life. Get advisors to help you get a financial plan if you haven't already. Make sure that you cover estate planning, wills, advanced directives — surveys show doctors are no better than anyone else about this, although we should be — insurance, retirement planning, tax code awareness, college planning and etc. And review them on a regular basis. If asking ourselves to be less emotional and more rational about these things makes us sound like Vulcans, well so be it. Mr. Spock would gravely approve. "Live long and prosper" was also meant for doctors to Take Care of Business.