As my practice beings a tentative return to normalcy with the resumption of normal clinic visits and interventional procedures, I am starting to feel a little bit more comfortable with the idea of putting more time into this blog and making more of an effort to write beyond my monthly financial checkup posts.
To that end, I’m going to try to do a better and more consistent job of sharing my thoughts on some of the books, services, and other resources I have found helpful along the way. My hope is that this will not only force me to reflect and synthesize their lessons for my own benefit, but it may also spark an interest among the folks who stumble onto this blog.
To be perfectly honest I almost didn’t pick this one up, having already accepted my first job and contract as a hospital employee. I felt like there may not be much at this point for me to get out of it, and that it might be geared only toward docs joining or starting a small private practice . However, I have the kind of personality that doesn’t let me just skip the first book in a series – and good thing too, because I would have missed out on a thoughtful piece of writing on one of the most important transitions in the career of a physician.
In brief, the book serves as something of a checklist for new graduates to make sense of and prioritize the various action items that will mold the start of their career. It uses the frame of two physicians who begin in the same place, but whose decisions lead them to two very different end points thirty years down the road. One of the things that I like about the book is that it doesn’t present either set of money/lifestyle choices as ‘right’ or ‘wrong’, only that they are choices that should be made intentionally, with the understanding that everything involves a tradeoff. These include taking a job as an employee vs eventual partner, renting a home vs buying, and divvying up income amongst student loans, investing, and vacations/toys.
The book offers some concrete advice, especially in the chapter on contract negotiation, which out of everything is a must-read and something that I wish I had thought more about during my job search. Given that I’m working for a very large (and purportedly inflexible) institution and was still able to negotiate a $20,000 signing bonus and a 5% higher base salary, I think I did alright. But I probably could have gotten even more I had gone in with the confidence of having studied a resource like this.
Much of the latter half of the book is spent on establishing good financial goals and habits, including housing, asset protection, student loans, and saving/investing. There’s not much here that’s going to blow your mind if you’ve read the White Coat Investor book or blog, but it holds its own as good introductory text for these concepts and encourages some really good big picture questions and introspection.
My absolute favorite chapter is ‘Setting Personal Lifestyle Goals’, specifically the emphasis it places on the importance of family and personal time. It is so so easy in the medical pipeline to always put things off, to always be looking ahead to the next stage of training, the next job, when you’ll have more money and free time and everything will be better. The reality is that your life is what you make of it, no matter what stage. If you do not carve out time for the people and things in life that are important to you, they simply will not happen.
Part of this is embracing the fact that you will never be ‘done’ with your other commitments. A selection from the chapter:
“The sooner you realize that you will never catch up, the sooner you can relax about those things are your to-do list. There will always be a stack of journals, a stack of books, a list of movies, a garage to clean, an attic to sort, and charts to do.”
Life is a dance, not a finish line, and we have to create joy along the way.
Finally, I wasn’t totally wrong in my initial assessment of the book; it does a seem a little biased toward private practice ownership rather than being an employee of a hospital or health system. Probably for good reason – this is the model that gave Dr. Fawcett a satisfying and prosperous career and allowed him the freedom to live a full life outside of medicine as well. I do feel like it handwaves away a bit the difficult reality of finding a stable and ethical small private practice in this day and age of national medical groups and private equity. But perhaps that is just a limiting belief and post hoc rationalization, given that I do work for a large system.
The Doctors Guide to Starting Your Practice is a quick and easy read, and a worthy addition to the bookshelf of any resident or young attending. I’m looking forward to checking out the rest of the series.