Why My Classmates Don’t Care to Learn About Money
There has been an explosion. The past 6 years has seen the rise of a niche market for financial information among physicians. I say 6 years because it has been 6 years since Dr. Jim Dahle started the White Coat Investor. Perhaps it was the Crash of 2008, or declining reimbursements, or something else all together that led to this movement. Regardless of why this may be, physicians by in large are coming to terms with their lack of financial prowess. Residents are catching the whiff and heads are turning. The age of letting someone else handle all of your money while you focus on being a great doctor is passing. Likewise, the peri-physician market has also been trending up as evidenced by the current controversy of MOC exams and the money trails that follow. Everyone wants the doctor’s money.
Where are medical students in this medical-financial revolution? Right where we left them- “drinking from the fire hose.” It is hard for me to find a classmate that wants to have an in-depth discussion regarding what they are learning about financially. In light of the subtle movement towards shift work attracting more medical students, students still don’t talk about money. Want to know how to quiet a room of medical students? Start talking about finance and how much student debt you have.
Perhaps I should rephrase that. Students do talk about money; they don’t talk about managing money. We dream of a “better life” where we do not have to count pennies. We quietly fantasize of reaping the rewards of at least a decade of hard work. I know that I do- my wife and I drove through the Porsche dealership the other day- and those dreams can be invigorating. The unspoken rule is that it will all work out in the end if you work hard, so don’t think about it, much less talk about it.
I think there is a tad bit of psychology at play here. I am not a psychologist; I have not taken a single class of psychology. So I am projecting from my own experience. In year 1 of medical school, I found Human Anatomy to come relatively easy to me. I really enjoyed dissecting and uncovering these hidden structures. What truly amazed me was the consistency of a structure’s presence from one human to another. Even though I enjoyed anatomy most that first semester, I spent the majority of my time studying biochemistry, notably my weakest subject prior to matriculation. I was forced to face my weaknesses in biochemistry and address them to move on in school.
Medical school self-selects for talented persons with perfectionistic tendencies. If we cannot perfect it, we just won’t do it. Perhaps we even underestimate how poorly we understand a subject because of the internal conflict that a glaring weakness would produce. Given the option, I most likely would have never studied biochemistry. Likewise, medical students avoid talking about money because they don’t understand it. We don’t understand how to get out from under this landslide of student loans, so we don’t bring it up. Such talk is seen as worldly. We would much rather focus on learning about our patients and their ailments, a much nobler pursuit. There will be time to sort out the money thing later. We will have so much money; we can pay someone to figure it out, right?
It is no secret that our healthcare system in the US is currently on very unsteady ground. Even before healthcare overhaul, physician practices went through an evolution. If you are not part of a national group, you are a dinosaur. Reimbursements are now a hot-button issue. The rise of mid-level practitioners has created its own set of issues to be addressed. As mentioned before, services offered specifically to physicians, what I call the peri-physician market, are expanding. Even before graduating from medical school, the study aide market for medical students is an example of just how many people are more than willing to take your money to provide a service. Doctor money is changing faster than ever before, and medical students are increasingly less prepared to make sound financial decisions, in my opinion, due to a lack of knowledge and desire to learn.
Hippocrates might say that part of you teaching the next generation about medicine would involve teaching them about the business of medicine and money management. A good while back, I stumbled across an article on Physicians Money Digest in my monthly email from Doximity. The article was called “Why Doctors Live Paycheck to Paycheck” by Passive Income MD. Mr. PIMD shared the story of a friend who was struggling to make ends meet with a physician’s salary. The tale unroofed my own occult financial sore, the one all med students carry, bearing forth the obvious conclusion that I was on a direct path to end up exactly like this friend. I was borrowing more and more money, telling myself it would all work out, all while neglecting to learn about the dollar.
There is an obvious solution here: start talking about money. I do not want my physician-teachers to tell me how much money they make in a year- that's not what I'm talking about. But what if a candid conversation can take place about student debt? I was recently talking to a premed student who will start medical school this fall, and she asked me for any advice that I might share. I recommended that she take a very conservative approach to borrowing money, apply for as many scholarships as she can, and live simply in medical school. My main point was that she shouldn’t have to face financial pressure to go into a “high-earning” field rather than a field she is passionate about because of student loans, a dilemma more and more students face every year. She said this was conflicting with what others had told her- to borrow the maximum amount, live it up, and go on vacations because she will eventually pay it all back. Who peddles this advice? We can all do our part to encourage those around us to be financially adept. Perhaps, if students weren’t saddled with $200,000-$400,000 in debt, they would be more apt to enter into the field of primary care, where we desperately need more physicians. It is time we start talking about money.