The Doctor’s Golden Handcuffs

family-56a492e73df78cf772830afb“I can’t pursue careers outside of clinical medicine, we need the income.”

Golden Handcuffs are incentives provided to executives designed to discourage resignation or ensure loyalty after departure. Some doctors, like Jacob Marley, forge their own handcuffs link by link, developing a lifestyle that requires frequent fueling by lots of greenbacks, trapping themselves in an unhealthy spend-earn cycle. Such financial pressures can become a potent source of discord in our private or professional lives. Marriages unravel, professional partnerships fall apart. Even if no outright rupture occurs, a great deal of underlying misery may exist.

Why would anyone wish that on themselves?
Why would any physician with the great range of choices available to them get themselves so trapped?

A medical degree opens up a huge range of career options. You can practice in many parts of the world and in a host of specialties. Antarctic scientific experiments, professional sports teams, and famine relief agencies need doctors. The possibilities are pretty well endless.

For all the choices, all too often we arrive at middle age, and:

* The endless career possibilities we saw in medical school seem to have shrunk to one.
* Your original career choice may no longer have the allure of 20 years ago.
* You income is high, but your ins and outs just about equalize; fine if we’re discussing cardiac or renal function, not so hot if we’re talking about the family finances.
* College tuition looms.
* You’ve got used to the couple of nice vacations you take each year, and they give you something to look forward to when the office feels like a grind.
* You daydream of other career possibilities, but when you research them, you realize the income you could hope to realize would be significantly less than you are making now.

All physicians know that a 5-10% difference one way or the other can be huge in any illness. A similar level of change in our lifestyle and consequent economic circumstances might unlock those handcuffs.

As you examine your lifestyle, bear the following in mind:
* It is never too late to make adjustments. You don’t tell those of your patients who smoke that at this stage they might as well keep on puffing, do you?
* 5% is huge. Think of the difference between inflation rates of 1% or 6%. Think of the difference between getting a 3% or an 8% rate of return on your investments. You can live very well and still shave 5% off your expenses.
* Remember your mean Uncle Sam. To balance $100,000 in expenses you need to earn ~$144,000 gross.
* If 5% is huge, 10% is enormous. This applies both to your revenue and expense sheets, and your professional and personal lives. In the context of the latter, spend 5-10% less time at work and put that time into your family and personal interests. Everyone will benefit, including your patients.
*If scaling back now led to greater career satisfaction and a more harmonious personal life, do it. It might a) have you still joyfully contributing to your profession at age 70, and b) that contribution you make in the final 20-25 years of your career being a more valuable one to those whom you care for.
* Develop personal interests now that a) could be sustained if your health was somewhat compromised; b) are relatively inexpensive; c) can be done many days of the year, and d) some can be shared, some can be independent of your spouse or partner. Travel to exotic locations, fabulous once-a-year extended weekends in New York etc. do not qualify.

Jacob Marley’s warning to Scrooge paid off for old Ebenezer. If any of the above applies to you, make a change and watch for the long-term payoff. It may well be substantial.