As A Physician Do You Have Adequate Financial Expertise?

Book Review – Physicians (and dentists, nurses, nurse practitioners, and other health care providers) need to understand money but most have limited financial expertise. No wonder and it’s not your fault. Four years of college, four more of medical school and three or more of residency left little time for personal financial education. But you still need that education and now is the best time to start.

The financial playing field is definitely not level and so you need to do what you can to level it. You are probably encouraged regularly to invest in various money making schemes that sound too good to be true. Making good financial decisions over time means the benefits can compound over long time periods – to your definite advantage.

Unfortunately, medical school and residency programs have essentially no time devoted for personal financial education and little if any time for learning the financial implications of starting a medical practice. You are on your own. Your natural mentors – professors, senior residents or senior colleagues in your practice – are probably no better equipped than you. Some medical students are obtaining combined MD/MBA degrees but this is overkill for just your own personal financial educational needs.

I was encouraged by consultants at Sage Growth Partners to meet Dr. Yuval Bar-Or. Dr. Bar-Or comes from a medical family (father and brother are physicians) but he entered the finance field, obtaining a PhD in finance from the University of Pennsylvania’s Wharton School. He is now a faculty member at the Johns Hopkins Carey Business School. His own family’s circumstances led him to realize that medical families need access to clear, objective, expert financial knowledge. He has written a set of two books, called Pillars of Wealth I and II, to address this need.

The books are straight forward, easy to read, thorough, yet not mired in financial jargon. In short, you can learn and do so easily. He begins with what he calls three axioms (reminds me of high school math!) 1) Your most valuable asset is earning capacity (not lucrative sounding investments); 2) Your most precious resource is time (saving now will pay off handsomely in retirement); 3) Your greatest enemy is procrastination. From there he reviews the basics of stocks, bonds, real estate, business ownership, insurance, annuities, 529 college savings plans, etc. He puts an emphasis on getting out of, and not entering into, debt (except a mortgage for a reasonably priced home.) This is followed by a discussion of risk and risk anticipation as a front line of financial defense. This leads to insurance – what you need and what you can avoid in terms of life, disability, liability and of course malpractice insurance.

It is an important principle that sound financial decisions early in your career have a big impact down the road – and so too do suboptimal decisions. You are probably bombarded by sales people that assume you have money to spend; some will have good ideas and products and many will not. Should you have a personal financial advisor? Or can you learn enough to make sound decisions yourself – for your own financial well-being, for your family and for your career?

A personal financial advisor would be worthwhile but you need to find the most appropriate person whom you can trust to offer sound meaningful advice and who charges appropriately. Pillars of Wealth gives suggestions on making this choice.

Bar-Or is articulate and passionate to meet. He thinks of himself as a financial risk management “physician”, i.e. to keep your finances healthy and functional while you help your patients stay healthy.

Your practice priorities are always uppermost but for some limited time and on a regular basis you deserve to consider your own financial health. Pillars of Wealth might be a good place to start. A chapter every few days will put you in a much better position over time to benefit financially from your education and training. These books are very well written and thoughtful. I will go so far as to say they should be must reading for all medical students and residents.

Note – Dr. Bar-Or and I met for lunch; we each paid our share. I bought his books before we met. I have no financial relation with him or his book sales.

 

 

A Humble Opinion

Book Review - Readers of my posts know that I am a strong advocate for primary care and especially a primary care physician (PCP) that provides each patient with sufficient time. Time for the PCP to listen, to think, to treat and to prevent. This allows the patient and doctor to reclaim relationship medicine, a standard tenet of care in the past but now largely lost in our financially driven medical care system.

Dr Jordan Grumet is a primary care physician in Ohio who tries to assure his patients of a strong relationship, one in which they can build trust. Recently he has reduced his practice to about 600 patients and become “concierge.” Now he has more time for his patients and even some time for his family. For years he has written a blog entitled “In My Humble Opinion” in which he records his thoughts of events in his practice, in his home life and in his wide ranging mind. His posts are thoughtful, thought provoking, engaging, emotional and educational. Recently he published book curated from his posts and arranged into meaningful sections such as “The Grateful Death” or “In Sickness or in Sorrow.”

Dr Grumet’s book is a must read for anyone who cares – cares about their health, cares what they or their family receive from medical professionals, cares about what the doctor or nurse offers to  their patients. I have read Dr Grumet’s blog intermittently for the past few years. Always it leaves me with the sense that here is a real human being doing what he does best – caring for patients, one at a time and in the process trying to care for himself and his family. His book title - “I Am Your Doctor” - implies not a fact but a responsibility that he accepts when you come to him. The cover picture is equally powerful – a hand holding another’s, a clear and compelling symbol that this is a physician who wants to have a real relationship with you, his patient. Relationship medicine has largely been lost to today’s business and economic imperatives but doctors like Grumet are trying their best to retain it in their everyday practice. Dr Grumet brings us back to the true calling of what it is to be a physician and in his humble manner but compelling writing style reminds us that physicians are human with of the frailties and foibles as everyone else – the longings, the joys and the sorrows. But especially they want to be there with you as you experience those joys and sorrows, those exhilarations and frustrations that come with life, living and eventually dying. Here are two excerpts:

“Two weeks from now I will tell a man he is going to die. He will sit calmly in my exam room as he shifts his weight from side to side. Although his hair has grayed and his body has weakened, his face will sparkle with youth and vibrancy. He’ll stare deeply into my eyes and I'll detect a hint of mirth. "We're all dying, my friend." He will draw in a deep breath and put his hand on my shoulder. "The trick is learning how to live!" 

“It's not exactly Dr. Jekyll and Mr. Hyde, but everybody knows my level of patience varies from time to time. So I was surprised to find myself happily telling the emergency room that I would assess the patient shortly. The kids were horsing around on the playground, and I knew I would have to call my wife and ask her to come home. It would be my second 45-minute trip to the hospital on an otherwise busy Saturday afternoon. For some reason today, I was able to sublimate the automatic annoyance and return without emotional drama. I slowed down, calmly listened to the patient and reassuringly put a plan into place. Driving home, I felt both relieved and saddened by the joy that overcame me. Why didn't my life's work make me feel this way all the time? I guess it starts with one simple fact. I blame myself for every heart attack, stroke or new diagnosis of advanced cancer. As disturbing as that sounds, how could I not?”

 

Read this book and you will want him to be your doctor. Or at least you will want to find a primary care physician like him who practices real relationship medicine the way he does and who assures you that you will have his or her  undivided attention