Financial Literacy Is Self Care

What exactly constitutes self care? It's different for everyone, but one thing's for certain: it's not just pedicures and massages. It's much more foundational than that.

Self care is...

• Recognizing that you must know yourself and pay attention to yourself before serving others - at work and at home. It's being attentive to YOUR particular physical, mental and emotional needs.
• Maintaining your health by keeping up appointments with a doctor, dentist or other wellness practitioner.
• Ensuring your ability to tackle challenges each day by gaining energy through nutritious food, exercise, and adequate sleep.
• Preventing defaults on your emotional bank account. And one type of withdrawal that could easily lead to a default is having problems with your real bank account.

Self-care frees you up to focus on what's most important to you

About a year and a half ago, I published this post about financial wellness. Well, I'm back on the soapbox after being motivated by a great group of financially-minded physicians in the social media sphere. We all descended on the FinCon Money and Media Expo last month, and it was an awesome display of what community can do.

I don't consider myself a financial blogger; my focus is wellness with an emphasis on how we should better know and take care of ourselves as busy women physicians. Money is a huge source of stress for many of us. Just like gaining self-knowledge, gaining financial knowledge will improve your self-care and in turn your overall health and happiness.

Figuring out how to do this in a time-efficient and effective manner is the crux. There's a TON of information out there, and it can be confusing. Here are some resources that I've found useful for learning more about finance, especially at pertains to women physicians, from some awesome ladies that I met at FinCon:

• BC Krygowski writes about downsizing and avoiding the dreaded lifestyle creep that seems inevitable as physicians transition from residents to attendings and grow their families. Ever felt like you're outsourcing everything in your life because you have no time, which in turn means you have to work more to afford the outsourcing? She and her husband (both doctors) transformed their lives over the years from New York McMansion owners to a more simple existence for their family - which translates to both of them working much less than they used to and traveling + writing much more (she also writes fantasy books).

• Eliza Minimal MD "retired" from medicine before she even turned 40 to pursue the things she's most passionate about: educating her children and traveling to far-off places. She's now back seeing dermatology patients in a clinic 1-2 days a week because she missed the mental challenge of medicine, but she exemplifies a life of minimal, intentional living. She recently published a very powerful post about stories we tell ourselves, that we're "haves" or "have-nots", and how they're completely up to us.

• Barbara Hamilton blogs at Tired Superheroine about financial wellness and navigating work-life balance as a female physician in a male-dominated field (interventional radiology). Check out her blog for practical tips about time management and simplifying life as much as possible with a young family and a leadership role in her practice.

• Bonnie Koo of Wealthy Mom MD spent years working at Morgan Stanley before attending medical school and training as a dermatologist. Her blog focuses specifically on money issues for women physicians - considerations for high income earners, blended families, couples with a significant earnings differential, etc. I've been interviewed for her "Real Women Physicians" series, and I've also guest posted on her blog to discuss parenting issues around money.

Bonnie happens to be offering a new course this fall called Money for Women Physicians*. It's an 8 week, live interactive course that marries financial education with mindset coaching only open to women physicians. A big bonus: completion of the course also awards 5 CME credits, which means you can use CME funds or pretax educational accounts for the tuition. Enrollment is only open this week (October 7 through October 14), so if this is of interest to you, please check it out!

I consider all of these ladies to be not only blogger colleagues but friends. They're examples of women employing financial empowerment as a means of self care. I hope you find as much inspiration in their stories as I have!





* The link for the MWP course is an affiliate link, which means that if you purchase the course through this link, I receive a fee. You are welcome to go through other means, but using this link in no way changes your purchase price or course experience.

Learning how to self advocate for wellness and career advancement

I've recently been meditating on personal and professional development and in a lot of ways, maintenance. Part of it aligns with recently discussed concepts of wellness and work-life balance. Part of it also has to do with this intrinsic unsettled feeling I'm experiencing with work. I attended an academic conference recently which I believe was clarifying and is helping me to frame my approach.

Health

This all started with a dive into self care, specifically, trying to make sure that I was taking better care of this 41 year old body of mine. I had not been to a dentist in 15 years. Yes. You read that correctly. I had not seen a dentist since before medical school. Part of it was because I'm irrationally terrified of the dentist... part of this fear probably came from all those times my mother forced me to sit with her and hold her hand through many root canals and extractions while she squirmed, wiggled and held a vice grip on my hand. The other part of it was the silly thought, "If it ain't broke, don't fix it." The final factor was the disease of busy. I flossed. I brushed. I have a nice smile. I'm fine.

It wasn't until my little one bravely sat through the first couple of dental appointments during which we found out he had multiple cavities between all of the molars, necessitating 8 crowns, a failed attempt at in office nitrous and subsequent trip to same day oral surgery center with a pediatric anesthesiologist that I finally made an appointment. So I did it. I had a couple of cavities, needed scaling (which is a special kind or torture) and am now getting teed up for a root canal. I suppose it's not bad for 15 years. At least I'm keeping all of my teeth, for now.

Let's move on to fitness. I'd topped off the scale at 5 pounds over my full term pregnancy weight. I hated what I saw in the mirror. Inside I was happy. My outside didn't match my insides... maybe I wasn't happy. Regardless, I've spent the last year trying to make sure to make time to do tedious things like plan healthy and nutritious meals and get some exercise. I found a colleague and now friend who was an online health coach. I found a supportive environment of other busy, professional women who found time and prioritized this portion of self care and found that they ended up being happier, more patient and feeling more fulfilled all around. I found tools which were easy to implement (albeit requiring some behavior change), accountability partners and fun exercise options. I enjoyed it so much that I myself became a coach.

With everything we give to our patients, our learners and our hospitals, we absolutely must prioritize ourselves in there somewhere. Working out may not be your thing, but you have to identify what it is that recharges you and make time for it. Put it on your schedule or it will not happen. It will ebb and flow, but you've got to take care of you before you can take care of anyone else.

I still need to schedule that Pap and Mammo... I'm a work in progress.

Personal Development

Part of the company's philosophy is ensuring that you spend some time each day on your own personal development. This created an opportunity for me to read some personal development books (the former four letter "self-help" category). Below you will find the books I've gone through over the last 6 months (good grief, whoever created audiobooks is literally the best because I become narcoleptic while reading).

I've read (or listened to in audiobooks) "You are a Badass: How to Stop Doubting your Greatness and Start Living an Awesome Life" by Jen Sincero. She's not a physician, but she's been through some things and many of her struggles and insecurities resonated with me. She is also remarkably sarcastic and funny and I had many a laugh while listening to her book.

I followed that with "The Compound Effect: Jumpstart Your Income, Your Life, Your Success" written by Darren Hardy. This dude for all intents and purposes is a self made gazillionaire and did it all with hard work and discipline, specifically with small changes every day. He had an authoritarian for a father, so we have that in common. It focuses more on the business world, however if I ever consider entrepreneurship, I'll probably revisit it.

I followed that with bits and pieces of several books from Brene Brown... "Rising Strong" and "The Gifts of Imperfection," both of which hit chords with me. Let's figure out how to pick ourselves up after we fail at something because that is what bravery truly is. It takes no energy to stay down after you take a hit. Facing the day, reflecting on how you may have been responsible for whatever you've experienced is an important lesson. Reading her book is like sitting in a therapist's office, without the $200 price tag. She's a shame researcher and she hits the nail on the head when she discusses the mountains of self imposed guilt we shoulder unnecessarily. She's also witty and sarcastic from time to time.

Next was "The Subtle Art of Not Giving a F*ck" by Mark Manson. Now, if you can move past the fact that this guy is a bit like a frat boy in his use of language, there are some important lessons to be learned. Some things just don't deserve our energy. Seriously.

My latest read is "Feminist Fight Club: A Survival Manual for a Sexist Workplace" by Jessica Bennett. I came upon this book on my way to the aforementioned conference. I knew I was specifically attending a workshop designed to appeal to women interested in leadership in academic medicine. I was looking for something which would light my fire and help me think outside the box a bit. Jessica Bennett is a journalist who specifically writes about issues of gender, sexuality and culture. In her book, she highlights the research which discusses not only how institutions may unknowingly or overtly be preventing growth of their female professionals, but also behaviors we may be demonstrating which hinder our own progress.

I take each of these books with a respective grain of salt, but it's really kind of opened my eyes to some self reflection and highlighted some things I may want to work on within myself. When we spend so much of ourselves in tending to other's needs, our own needs and need for growth can get lost in the mix.

Professional development

So, I'm an academic. I teach medical students, PA students, residents, fellows, faculty. I have sought opportunities to develop my educational niche, my ability to provide feedback, teach a skill, develop a curriculum, pitch an idea to my department chair. I teach a lot of things... probably too many things, which is why I find myself feeling stale and unfulfilled here. I feel like I've spread myself so thin that I'm doing an ordinary job at all of the things for which I'd prefer to be doing an extraordinary job. I feel like an octopus juggling knives which are on fire. Is this imposter syndrome creeping in? Perhaps, but I know I could do better with my time and efforts if I peeled away from some things.

I officially mentor some and unofficially mentor others. I've not received any training per se in mentoring, save observation of folks I hope to emulate. I don't know what the steps are. I don't know what skills to hone. It's kind of like teaching, but also very different from teaching. There should be a program for mentoring the junior mentor. There probably is, but I've not yet had the bandwidth to seek out or discover it, but it is something I need. What I found most interesting in the sessions at this conference was the focus on not necessarily seeking out the most sage mentor. Sometimes peer mentors are actually better for you as you navigate different challenges in your career.

I've been at this academic gig for 6 years now. At the conference I attended, many of the female leaders commented on "cycles" and feeling unsettled after a certain amount of time doing each of the jobs they did. That hit home for me. I feel unsettled. I want to do what I'm doing differently and I need to advance my position from my current title to the next. As such, I've been meeting with my closest mentors, having heartfelt talks about what I thought I wanted when I started, what I've done and where I see it going. I see now that I've invested a tremendous amount of time and emotional capital in one path. It was my hope that by working hard and contributing, I'd be rewarded with position. Boom!!! Words from all of the books came to mind and highlighted for me that I in fact cannot do it all and I should be asking for compensation in some way for what I am doing. You will not get 100% of the things you DO NOT ask for. I must focus my efforts on those things which are most meaningful to me in my professional life. I need a new goal. I need a promotion. So, I'm going to spend the next couple of months working on my dossier, writing papers, reviewing and revising the curricula that I am responsible for and pouring the energy freed up by letting go of tasks held by one of my octopus tentacles.

It's exciting and anxiety provoking to have this new approach and challenging in that I've never before created a dossier or gone up for academic promotion. Why didn't someone tell me about all of the stuff that goes into this? Why didn't someone tell me to keep better track of all of the lectures I taught, programs I developed, mentees I invested in, meetings I attended, evaluations I received??? This wasn't part of orientation when I became faculty. It was discussed as an afterthought in my annual meetings "You should be ready for promotion in a couple of years." After reading my most recent book, I wonder if the experience is the same for my XY colleagues. Is the assumption that because I'm a single mother, I must not be interested in promotion or advancement, so I don't really need the guidance or personal investment? To adapt a quote from Jessica's book, "No one gets shit done like a mom."

I'm trying to figure out what my professional and personal mission statement is. What are my values? What do I hold dearest to me? Do my actions align with my values and my mission? How do I parlay these reflections into actions moving forward and be sure I'm looking out for my own professional interests, professional development and advancement?

Financial Wellness?

Do you know how social security works? Are you maximizing contributions to your retirement accounts? Have you ever heard of a 529 account, or a backdoor Roth IRA?

I combed the archives of this blog, and while there are a smattering of posts on money and costs of being in the field of medicine, I didn't see much about money management and financial planning. It's not a topic people commonly like to discuss, and yet it's so important to our overall well being. Physicians are notoriously horrible at managing money, and yet many in our profession shoulder a huge debt burden, one that can amount to hundreds of thousands of dollars by the time all the training is over. And at that point, the last thing most people want to do is continue "living like a resident", so they commence with lifestyle inflation and remedies for their delayed gratification.

                             

Last weekend I had the pleasure and opportunity to attend the first Physician Wellness and Financial Literacy Conference, aka the White Coat Investor Conference. It took place in beautiful Park City, UT with two days of CME talks, broken up by mid-day skiing time. The conference featured valuable information presented by physician experts in the areas of finance, financial independence, and burnout, along with some financial professionals (who did not have an interest in charging huge fees to physicians for their services, an issue common to many physician-targeted financial advisors). There was even a talk by one of the only female physician financial bloggers, Miss Bonnie MD, who also happens to run the very active informational goldmine Women Physicians Personal Finance Facebook group.

On day two of the conference, I represented both PracticeBalance.com and Mothers in Medicine on a panel of six bloggers for a Q&A session. Despite being the only blogger there who does not primarily blog about finance, it was a lively discussion with lots of inquisitive attendees. It left me with inspiration to blog more, and blog more about financial issues that I deal with!

Over the course of the weekend, I met so many inspiring people - especially women - who are taking control of their finances so as to not become an "underwater doctor" statistic. We often say in my household that debt = slavery, and that sense of lost control is what often leads to burnout for many professionals. While debt is for most people unavoidable on some level during medical training, we physicians have the power to manage it and at the same time plan sensibly for the future. I felt so much more empowered after attending this conference, and I highly recommend that you all check it out the next time it comes around. At the very least, take a look at the blogs (linked above) by the White Coat Investor, Physician on Fire, and Miss Bonnie MD. They are a great starting point on the path to proactively managing your money.

Money Talks

I've been reading The Grumpy Rumblings of the (Formerly) Untenured blog lately. Their personal finance posts make me kind of uncomfortable because I don't think we've done a good job of planning or saving. We're not frugal and we haven't paid down our mortgage (although we did refinance to shorten our term) and we won't be able to retire early. Which mostly I think is fine...except when I read their posts.

But anyway, I read this post about how we communicate about money and I commented. Sam and I communicate fairly easily about money; we discuss major decisions, we have similar values, we have enough money so that we can each buy the things we want. I'm not surprised to read that money is a source of conflict for a lot of couples, or that one member of the couple manages the money. I was astonished to see how many commenters say that they give their partner an "allowance". 

I give my daughter an allowance. I had an allowance when I was a child. I don't give my husband an allowance and he doesn't give me one. I understand the value of having money you can spend without accounting to your partner for every penny, and I can see the reasons for deciding ahead of time how much that will be each month. But an allowance? As an adult? That just rubs me the wrong way.

Is it just me? Do you have an allowance? Do you give your partner an allowance (if you have a partner)? Am I completely over-reacting to a perfectly reasonable word?

Stop scaring the "fresh meat"

I volunteered recently at a meeting for Latino high school, college, and medical students as a member of my hospital’s Residency Diversity Initiative. I had gotten the announcement a few months prior and realized I would be on a pretty straight-forward month with weekends off. I checked with the hubby that I could take about 3 hours during his prime studying time to volunteer and he agreed.

The students were engaging. The high school students asked silly yet endearing questions. One absentmindedly asked another resident and myself our specialties three different times because he kept forgetting what we said. He was sweet, but goodness, I hope his focus and attention span increase before starting college.

Several of the medical students asked very educated questions, ones that showed they knew where they were going. One particularly prepared medical student, dressed smartly in an off white blouse, flattering pencil skirt, and pearl necklace asked a series of questions that we answered. She thanked us and left. Then she came back later to chat some more. She began her new string of questions with “I don’t mean to sound, ummmm, superficial or anything, but even though I’m interested in all types of medicine, I am worried that if I go into Family Medicine instead of Internal Medicine that I won’t be able to pay off my loans.” I shared a quick, knowing smile with the Family Medicine resident sitting next to me and we began to talk to her about following ones passion. We also reminded her several times, indirectly and directly that regardless of what type of medicine you practice, each of us will be in the top 1% of US income-makers. The top 1%.

Yes I know $120,000 instead of $200,000 (in a surgical subspecialty) seems like a huge deal, but honestly, every single Family Medicine Attending the other resident knew and every single Pediatric Attending I know is living very well. Yes, they may have a ton of debt they are working to pay back, but every single one has a family that is well taken care of. Everyone I know has a nice house (mostly owned and not rented), a decent if not really really nice car. And none appears outwardly to be struggling to afford their basic needs. I apologize if these are material things, but that’s what she was asking about and we answered because it’s a very real concern.

And that’s the Attendings, not the Residents. Every Resident I know, including myself, lives in a nice apartment. Many Residents in my program own houses, not rinkey-dink jacked up houses, but really nice grown-up houses with nice yards. We can afford to go on vacations and we buy what we want at the grocery store including at Whole Foods (which my father-in-law refers to as Whole Check). My husband and I budget our limited money well and hope to buy a house in the first several years out of residency. And we are already well on our way to having my student loans paid off within 10 years using the income based repayment straight out of medical school. Don’t get me wrong, if we didn’t have my husband’s graduate school scholarships, our family of 3 with a single working adult (me), we would be very close to being eligible for public benefits (Section 8 housing, food stamps, WIC, you name it); some of our neighbors are on assistance now.

So, seriously, I know many of us including myself are in debt. And I know we need to do things to overhaul “the system” so that serving patients and saving lives is compensated in a common sense and equitable way. One that values innovative, smart approaches such as preventative care and comprehensive services. One that doesn’t cause very capable and compassionate students who are interested in our field to go running the other way as they eye the ever-mounting price tag. But even at the lowest-paying end of the spectrum, we all will make more money than the majority of our country. And if we help each other to become more business-savvy, we should never have to struggle to live well.

The medical student left smiling. I left more inspired. Hopefully we encouraged her to pursue what will ultimately make her the happiest so that she can bring her “best self” to work every day; she owes it to herself and to her patients. Yes, it’s a daunting task and the realities of practicing medicine in our country are scaring the crap out of many of us and our future colleagues, but again, we are still positioned in one of the best fields that exists. I am committed to reminding myself, my colleagues, and the “fresh meat” that this is the reality we find ourselves in. A bit daunting, but not too scary.

Shoes: the other Elephant in the Room

So. There‘s pair of $200 shoes sitting on the floor of my closet.

They are beautiful. The smell of their leather sends chills down my spine.

When I tried them on in the store, I actually felt giddy. I’ve put them on twice…. But if I wear them outside the house I can’t take them back, so I haven’t yet.

I tell my self I deserve them. All those long nights at the hospital and hard work should be rewarded. Really, I don’t need them. My closets are full. I’m blessed. Truth is: time is money. As we prepare to hopefully adopt baby # 2, I see each purchase as time. The less I spend, the more time I’ll be able to take off to spend with the new baby when it comes. (No announcements yet but I'll keep you posted.)

I own my own practice. I’m one of 4 partners. My overhead is killer. My malpractice premium alone could buy one fancy Lexus. I do well, as long as I’m working. Taking much time off leaves me seeing red for a few months. Last year when I had to take my boards, I didn’t get a paycheck for 2 months. I accept this because it gives me complete control of my schedule. My partners are great. We get along personally and professionally remarkably well. We are all moms and we cover for each other a lot. Financially though, we “eat what we kill”. We work as little or as much as we want, take equal call, and pay equal overhead. Overhead includes salary, FICA/taxes, and benefits for two dozen employees.

I try to remind my self that the more money I spend, the more I have to work, the more time I spend away from my family. So I think the other elephant in the room is money. At least for me, since I’m the breadwinner in my family. It‘s physically painful to write out a check every 3 months for $15,000 and mail it to uncle SAM. It’s hard not to also see this as time stolen away.

I was looking at everyone’s profile in our group and it seems that myself and perhaps MWAS are the only Physician’s in private practice. Is anyone else self employed? Are taxes less obvious when you’re an employee and it just gets deducted. Is malpractice less obscene when some else foots the bill?

I don’t plan to vote with my pocketbook. I actually don’t plan to vote. (My state is so red even Gore couldn't take it.) But as I said, time is money. Every dollar more I pay in taxes and malpractice is less time spent with my family. Since the Dems came a little too close to having a malpractice lawyer on the ticket, and because I am both a corportaion and nearly "rich" some have promised to increase my tax burden, twice (don't tell my staff, but we could have to cut back). So yeah, I’m eyeing the Dems with more than a little suspicion.

Gottogo. Need to return some shoes.