MD Living in Poverty

        I have received several inquiries on a recent posting where I mentioned that I live under the poverty line.  According to the 2009 poverty guidelines, for a single person in my state one needs to make under $10,830 to qualify. I am here to tell you that I do indeed live in “poverty” as my annual expenses throughout my working career since graduating from medical school have been under this amount. How is this possible and even if true, how could I allow myself to suffer like this?
        I do concede that living so frugally is not for everyone. For starters, it is very anti-American to not spend spend spend. I will be perfectly honest with you when I say what you read on this blog you will rarely see elsewhere. Why is that? Well I am not getting payed to sell you something that you really don’t need! When you live in a capitalist consumer throw away society where advertisers are working hard to part you from your hard earned dollars, it can be hard to say NO. Wherever one looks, we are being constantly bombarded with images of how we should be living the “American dream”. It is as if the media and society are programming us on HOW we should live. Everything from the kind of car we drive down to the brand of underwear that gets to caress our ass has now become some sort of status symbol.  Are we that unhappy or insecure that we need to buy “stuff” to fill an empty void?  Rather than looking at others for approval through the silly tokens of importance that we buy or the degrees after our name, we should instead realize that it is by being a good person at heart that inevitably leads to contentment and fulfillment.   So part of the reason why I live this way is out of protest.  The protest of turning into a person I do not want to become.  I do not need “things” to validate myself to others.  I will leave that to my actions, contributions, and the way I treat others.   If you are throwing scalpels across the OR or belittling med students on rounds, I guess buying a lot of stuff is the only way you get to make yourself feel important.
        Everyone has their threshold for what they can tolerate.  As I’ve mentioned in the above posting, a major impetus for living below my means is to achieve financial independence.  The cornerstone of my plan to get out of a highly toxic career is to break my golden handcuffs (aka student loans).   If one is able to live below their means, one is able to live the life they always wanted.  Think about that for a second.  Ironically, it is almost tantamount to asking yourself if you won the lottery, what would you do for the rest of your life?  It is incredibly liberating to know that you can spend your time doing whatever it is you wish if you are able to live in this manner.   And this is the reason why I am happy as a clam living in poverty.  I do not see it as suffering at all.  Every dollar that I am able to save  is one minute less that I have to suffer in the hospital.  If this isn’t motivation than I don’t know what is.  I know that one day soon I can walk away from medicine forever and pursue an alternative career that I will greatly enjoy.  As if this wasn’t enough of a reason, by continuing to live under my means (spending less than what I make), over the course of time I will SAVE more money than I could ever imagine simply by refraining from buying into the American lifestyle trap.  One day I hope to find myself in a position to upgrade my lifestyle (if I so wish) while many of my fellow Americans will drown further into debt.
So how do I exactly live under the poverty level? I will keep this brief as I don’t think the numbers are as important as the reasons which I discussed above. If you take the $10,830 annual amount and divide it up over 12 months, you are left with approximately $900. Here is the rough breakdown of my monthly outflow as a resident:

RENT: $550 -for an old small, but perfectly adequate, studio (found off craigslist) in a good part of the city 3 blocks from the hospital. Needless to say this is not NYC or LA but still a major culturally vibrant city in the top 20 in terms of population. Housing is the number one expense in anyone’s budget and this is the one place where anybody can save the most. If you are willing to live small in the right location, you can save big. Europeans already do this, I don’t know why we can’t???
TRANSPORTATION: $5 -I purposefully chose my apt near the hospital so I didn’t have to get a car and pay $9400 a year which is what the average American pays a year to own a car. No monthly car payment, no car insurance, no gas, no paying for a monthly parking spot. Everything I needed was within walking distance of my apt since it was literally in the middle of everything. I could always drop a dollar here and there to take a bus if I needed to hoof over to the opposite side of the city. I never took taxis. Taxis are for lazy people or those who don’t know how to use public transportation.
FOOD: $150- spent roughly 35 dollars a week at the local major chain grocery store. Whatever is on sale is what I eat that week. Online coupons help somewhat. I also got about 50 bucks a month to eat on call which also helped. I eat healthy and didn’t starve. Would eat out maybe once a month, and usually for lunch. Prefer cooking myself.
UTILITIES: $35- water and cable were free in my studio. Since my place was small, my electric bill was only 15 bucks on average. In summer, I would open the windows and turn on the fan- I only turned on the window AC unit if it went over 90 degrees and only for like 15 minutes since again my apt was small (notice a trend here). Another 20 bucks for gas to cook.
CELL PHONE: $42 with employee discount. My contract is now up and considering going pay as you go to save here.
INTERNET: $30 This is the one NEED in my life. I can’t live without it.
GRAND TOTAL:$812 which is well under 900 dollars as you can see.  This left me with an extra 90 dollars a month that I could use as I pleased for MISC EXPENSES.  I would usually bank this into my “vacation fund” so I could put as many miles as I possibly could between me and my residency program during my four weeks of allotted vacation time. Here’s an actual pic from a recent domestic excursion to illustrate this point ==> [Yes, I felt more relaxed being a mere earshot from communist Cuba than remaining within a thousand miles from the hospital] 

        Interest earned off my savings helped supplement this expense but I am quite the budget traveler as you could probably guess.  Per year, I averaged one international trip, one domestic trip, and two visits home which was about 200 miles away.   I love to travel and this is where I will be spending more and more money in the future as my debts begin to quickly erode away. 

        On one last note- someone suggested that I must moonlight in order to be able to do this. Absolutely not!  No amount of money was enough to entice me back into the hospital after already being there 60-70 hrs a week.   My coresidents who lived in their 1500 a month one bedroom apts and had expensive car leases had to.  I felt sorry for them while I ate bons bons in my pajamas watching a free movie on hulu.com.  Only if they knew about this blog.

Enjoy the Journey & Don’t Be Like Sally!

Music and Life – Alan Watts

“In music, one doesn’t make the end of the composition the point of the composition”

Stumbled upon this really great video posted this week over on the millionairemommynextdoor Blog. I think it so nicely encapsulates how one ought to enjoy the journey of life rather than focus on the supposed destination. It has been said that after climbing the tallest of mountains, it can be pretty damn lonely at the top. In medicine, which is ONE hell of a long road, you can easily find yourself wondering if it was all worth it when you come out on the other side. After years of being buried in medical tomes, abused by senior residents and attendings, and deprived of your sleep and time, you may just come out on the other side yelling, “I went through all THAT for THIS!!!”   Don’t be like Linus and Sally who wasted their entire Halloween night out in the Pumpkin Patch waiting for the Great Pumpkin.  While everyone else was out having fun trick and treating, they could’ve been as well.  Here’s Sally flipping out after she finally realizes what a crock the pathway to becoming a doctor is-

As you can see, sometimes the endpoint doesn’t turn out exactly how one initially envisioned it to be. This is why it is so imperative that one spends their time on this earth pursuing something that they are passionate about and brings them joy rather than zooming from one goalpost to another in a field of misery. Your hours on this planet are a limited resource. Once they are spent, they can never be gotten back. I would personally rather spend those hours “dancing” than wishing them away or just plodding along and trying to just get by all to reach some nebulous end.

Wouldn’t You Rather Go To OUTER SPACE?

(photo by skookums on Flickr)

As I was reading through the comments section on a student advocacy site I frequent, I came across the following. Apparently the cost to attend medical school in the United States has risen so “astronomically” that it is now cheaper to go to outer space!   Unbelievable isnt’ it? For a cool $200,000, you can secure a spot on Virgin Galactic and go where few have gone before. How can anyone turn down the opportunity to experience several minutes of celestial bliss and zero gravity versus spending year after year getting tortured in our healthcare system? Furthermore, when you are old and gray you will have one awesome story to tell your grandkids rather than explain how you got to disimpact the 90 year old nursing home admit when you were a lowly intern. Need another reason? Victoria Principal has booked a seat and could be your co-astronaut! Anyone interested in putting down a deposit?

Doctors and “Power”

Over on SDN today , someone asked “what specialty will give you the most power?” I would have to say NONE. Some doctors project an image as if they are the coming messiah. Don’t be fooled. Trauma attendings can beat their chests all they want and intensivists can gallant through the ICUs but it is all just a charade. Need you ask why? Well, you will be the govt’s bitch, HMO’s will dictate how you practice medicine, administrators and regulating agencies will ride you, malpractice lawyers will be circling above, patients will freely tell you what they want and will sue you at the drop of a hat, allied professionals will continue to needle their way onto your territory, and Sallie Mae will want a piece of you too. Sounds almighty powerful to me! If you are looking to go on a power trip than don’t become a physician. If so you are in for a rather rude awakening. Otherwise you will turn into that surgeon who pitches a fit in the OR like a 2 year old when they don’t get their way.

What a Thread ==> Should I Quit Medical School?

The Student Doctor Network (SDN) continues to hate on me. Apparently, the cartoon that I featured on my last blog posting was considered to be too “sexual” since “naked women” are not allowed on SDN. I was asked to remove it. I don’t even think the Puritans were this prude! And than today, a really great thread that I stumbled upon for the first time that I posted in the Allopathic Forum was pulled down without explanation. So what was my response? To post it here so even more people can read it! Anyways, right below is the involved link.  Apparently, everything is supposed to be peaches and cream in med land. Clearly, it is not.

SHOULD I QUIT MEDICAL SCHOOL?

In case you are short of time because you have to begin a six hour study session, I thought I would give you some of the highlights-

“i feel stupid multiple times a day and i want to punch my resident in the face”

 “I liked the first two years of med school, but then it was downhill from there”

 “Basically finishing my fourth year at Pritzker, UChicago. And am going to quit” 

“i want to quit so badly, but the loans scare me so much.”

 “I have just completed my first year of medical school, and I am quitting”

 “I feel relieved, I’m now free to do whatever else I want, to explore, to spend time with family, friends, and to start building a life instead of burying myself in debt and spending the majority of my 20s in a library.”

 “Med school has turned me into an extremely anxious and depressed person, when I used to be such a smiley optimist”

 “I hate the fact that i’m too afraid to quit right now. My heart is not in it.”

 “I live for weekends off and vacations. I hate that. I feel like I’m wishing my life away.”

 “I’ve got a taste of life out school and I don’t want to ever feel trapped gain. It takes more courage to leave med school than to suck it up.”

Geez Louise!   And we haven’t even entered residency yet!  I was simultaneosly amazed yet not surprised at the volume of posts from disgruntled med students. By posting this link I was hoping to convey to others having doubts that they are not alone. I can’t tell you how many emails I get from pre-meds all the way up to attendings well into practice asking for advice on how to “get out”. Sadly, there is somewhat of a shame in the medical community to openly discuss such thoughts which is nonsense. You know what is shameful? How our healthcare system mercilessly abuses those in it. I can fully relate to many who generously shared their innermost misgivings and concerns in the above link. I never thought it could happen to me as I can always remember wanting to be a doctor going back to elementary school. However, I found that my dissatisfaction with medicine started to emerge third year of med school and only grew from there. Residency is where my feelings REALLY began to sour and I got to see medicine in all its horrid glory. I somehow made it through residency graduating several months ago. As I’ve recently shared, I am diligently working on my escape plan and hope to be out of medicine forever someday. I have compared this to almost like being in a marriage that has gone horribly wrong that is beyond repair. As each day goes on, it only gets worse and I want a divorce. Especially since I found something else I fell madly in love with (yes, I confess that I had an affair with another career for a year in between switching residencies!) There is only so much physical and mental abuse one can take. Why stay with a zero when you can be with a hero?

You Better Love Your Job. Here’s why ==>

(Needless to say this mug is not in my kitchen cupboard)

Of course, work should not be the core of one’s life where you love it to the exclusion of everything else. Medicinesux is all about striking a balance between work and personal time. However, work IS an important component of one’s life and does provide one a sense of purpose. To deny that fact is outlandish. As a physician, you will easily spend more than half your waking hours on the job. Let’s do the math to drive this point home:

There are 168 hours in a week. You “should” spend 33% of that time asleep to maintain sound body and mind (56 hours a week), roughly 36% “on the job” (60 hours a week for avg physician), and 31% “off the job” (52 hours a week). Please keep in mind that when you are pulling ten hour days, you have to factor in such things as waking up at the crack of dawn, showering, shaving, primping, getting dressed, making breakfast, COMMUTING all which can take away 1-2 hrs every day out of your precious 52 hours of “off the job” time. And then you need to factor in time at the end of the day where you get to languish in traffic again or take the train (“meat cart”) and also the countless hours you need to recuperate after going to battle for the day. This is yet another 2-3 hrs that you can subtract from “off the job” time. And let’s not forget all the extra hours where you need to be constantly reading medically relevant literature to keep yourself up to date on your field and not turn into a medical numb nut. Now revising our numbers, we can STEAL 20 hours out of “off the job” time and ship it right on over to “on the job” time. Doing this new math we have the following:

80 hrs involved with “job related activities” (48%)

32 hrs of “free time” (19%)

56 hrs asleep (33%)

If we just count the time we are awake, then you are roughly spending a whopping 71% of your time (80 out of 112 hours) performing physician related activities!!!

Also, ask yourself if you are able to keep those 32 hours of “free time” unadulterated, where you are able to completely divorce your mind and NOT think for a second about work? Good luck on that one.

So the driving point from this analysis is that you damn better pick a profession that you are going to enjoy and be happy doing. Is any amount of money worth being miserable, discontent, or just biding time 70% of your waking hours for the next 30-40 years??? Or to put in other words, how much a year would you be willing to pay to be happy 70% of your waking hours? Everything in this world has a price. How much is happiness worth to you?

US Govt’s Answer to Primary Care Shortage: Increase Residency Slots!

“If Hippocrates was alive, he would shoot himself first before seeing what medicine has become.” -Robin Djang (from the comments section)

A regular reader, Cryn, whose blog I highly recommend checking out here, tweeted me and pointed out this article from the Wall Street Journal regarding our govt’s answer to addressing the Primary Care Shortage.   

How about addressing the core of the problem why primary care is such an unpopular choice among med students? Increasing the number of residency slots is only going to entrap more poor souls into such a thankless overworked specialty. How about doing something about the out of control student loan debt levels and workloads? I recently wrote how an entering med student at Tufts University Med School in 2009 will graduate in 2013 owing $315,000! And that doesn’t include the interest! Payed out over 30 years at 7.5% interest and that is 3/4 of a million!!! Throwing a 50K pittance to defray these costs is utterly insulting for the immense importance of such a job. Leaving primary care after my internship and going into another specialty was a decision I don’t regret in the least. I don’t miss for a NANOsecond the days where I would preround on 15-20 very sick inpatients starting at 6AM, collecting critical lab values and reports, requesting endless consults from irritated fellows…an old lady moaning is rolling down the hallway in a stretcher…who is that????…..going to morning report, rounding again with the attending for another 3-4 hours till noon, getting pimped, not knowing the answer and getting assigned a presentation for the following day, devouring down lunch while attending an “educational noon conference”, co-intern is now in clinic so now I get to cover 25 patients! YAY for me! …..back to the floors to follow up on ordered tests and consults, discharging patients, discharge paperwork, medical student ran away- “where did he go? dammit!….does this mean i now have to draw blood from the IVDA whose veins the nurse can’t find?”, Ms. Clark’s husband wants to know why “nothing is being done”, finishing 15-20 daily progress notes, admitting new patients, ………Mr. Smith pulled his NG tube out!…..transferring one of my sicker patients who is suddenly crumping to the ICU, Mr. Jones is constipated…oh and by the way that old lady fell in the bathroom and you have to fill out an incident report, being dumped a new patient from Ortho whose problems are now considered more “medical”, Mr Smith’s IV is out too and he needs his afternoon IV ABX!!!, answering pages every 10-15 minutes from nurses, ortho patient is now having chest pain! IS IT TIME TO GO HOME YET? Not tonight because you are on call!!!! Hey Hippocrates, give me that gun so I can shoot myself before you do.

Want to be the US Govt’s Doctor Bitch?

I am sick and tired of hearing about older docs telling premeds how “most doctors pay off their student loans in ten years”.   These old timers have no idea how the student loan landscape has changed.   Physicians who graduated in the past had MUCH lower student loan debts. It is like comparing apples to PIGSH!T. This 10 year figure no longer applies when many entering med students for 2010 will be graduating with 250K+ debt loads upon graduation. Also the interest you guys will be paying is mere INSANITY! 7.5% interest (avg of Staffords and Grad Plus) on a 300K debt load on graduation adds 21K a year to your principal. So someone doing a five year surgery residency or a five year IM-fellowship track will see that their debt has ballooned to 400k when they finish!!! Pay that off over 30 years and you are easily paying back a million dollars. Actually $1,006,000 but whose counting. You will be paying $2800 a month for 30 years (basically over your entire professional career). This is like being taxed 30% for 30 years IF you are able to NET 8-10K a month (assuming this number does not tank too much further because of Obamacare)!!!!!! You will be the US govt’s doctor bitch for sure.
You’ll be tied to the hospital as much as the 45 year old homeless drunk in delirium tremens who you admitted the night before whose now tied to the bed in four point restraints on a one to one watch. As if this weren’t enough, you may just find yourself suffering even more!

Why Make $150K when you can make $75K?!

Americans are drowning in debt and our country continues to go down the tubes. Came across these numbers and was quite frankly blown away. Assuming a 7% interest rate, to service 300K of debt costs 21K a year! This requires roughly 30K of gross income to pay just the interest. And if you consider that the avg income in this country is around 40K, that means 75% of one’s disposable income is used to pay interest on debt. Unbelievable! Is it no wonder why the banks run this country?
If you apply this to physicians, you can throw in an extra 200-300K to account for super sized student loans which is now becoming the “new normal”. Now let’s say you are making 150K a year in good old primary care. According to paycheck city, that leaves roughly 95K for a New Yorker (90K if you are in the city), 92K for a Californian, and 102K for someone in Illinois. Deduct out your 40K in interest payments and let’s say another 10K for property taxes and you are left with 50K to live on. Digest those numbers for a moment. Do you realize that you are now in the same boat as the person making a mere 75K, HALF of your annual salary, who has no debts and eschews living a life of being in debt to others? How can this be? Let’s run some more numbers and see how. After taxes 75K in California is 49K, 51K in NY (48K in NYC), and 53K in IL. Subtract out ZERO interest payments and lower property taxes (by not living in a McMansioin) you are roughly even!!!
By owing money to the banks, you are not only flushing money down the toilet but you are also sacrificing your freedom. The freedom to have more leisure time to do whatever you wish or the ability to work in a job or industry that you would find much more appealing and satisfying. For those in debt, you can easily find yourself in a situation where you are working endless hours a week in a miserable higher paying job just to keep your head above water. So which would you prefer? 60-70 stressful hours a week seeing 35 cranky ass patients a day, filling out reams of paperwork, fighting with HMO’s over billing issues or waking up in the morning going to a job you love 35-40 hrs a week with weekends and evenings off for life? Sounds like a no brainer to me.

If there is any good that can be said of having major student loans like so many other med school grads it is that I have vowed to NEVER take out another loan again. NEVER! Fool me once shame on you, fool me twice shame on me. I am a firm believer that the banks in this country are an outright evil parasite draining this country of so much potential greatness. I also believe that CASH is KING. Everything I have purchased since graduating from med school was in cash and will continue to be in cash. This will include even cars and homes. I believe if you can’t afford it now, you have no business buying it despite what our culture and mass media tells you. Start off with a condo and move yourself up to a ranch and then ultimately buy that waterfront home as you save up money like mad not paying usurious interest rates. Don’t buy a McMansion straight out of the gate with a jumbo loan which is the American way. Need to have that Mercedes to complement your “prestige”. Unless you have 50K in the bank you can’t afford it. Rather than ogling with jealousy at the nice shiny Beamer or latest model Mercedes whenever I am sitting in my clunker at a traffic light, I instead find myself feeling so much richer than they are. It sure feels good having NO monthly payment rather than paying a mini mortgage payment every month. Americans want to live big…than they are going to pay big….with their time! Time away from family, friends, and most of all to yourself which you can never get back. We’ve all heard the saying how no one wishes they could’ve spent another day at the office on their death bed. Sadly for many physicians, we will ironically find ourselves in this very “office” even on our last day.

Stressful Jobs That Pay Badly

This recent article from CNN and some of the ensuing comments make for a good laugh! Here are the candidates:

Social worker: $43,200
Special events coordinator: $35,900
Probation/parole officer: $38,400
News reporter: $32,900
Music ministry director: $40,800
Membership manager: $42,600
Fundraiser: $42,700
Commercial photographer: $43,600
Assisted living director: $46,000
Minister: $45,300
Marriage/family therapist: $44,400
Curator: $46,500
Substance abuse counselor: $32,400
Film/TV producer: $47,600
High school teacher: $43,000

This list lost all credibility in my eyes when I did not see MEDICAL RESIDENT??!?! Film Producer? Are you kidding me! I wonder why I was the first to even mention newly minted doctors in their comments section. Maybe it is because residents are too busy working 80-90 hrs a week or are post call sleeping the day away after being up for the past 30 hrs to take the time to write just a couple words and comment. Even something like “CALL BLOWS” would’ve sufficed. With salaries hovering in the low 40’s, that comes to barely breaking minimum wage when you factor in the 3000+ hours you work a year! All the while your pager is going off at all hours as you try to cover 30-40 very ill pts, dealing with arrogant obnoxious senior attending doctors and ancillary staff, and worrying about not getting your pants sued off or inadvertently killing someone. Let’s not forget about the $200K+ in student loans you are going to have to pay off which will trap you in this career forever. I just finished such a residency and even though I am in my early thirties I am so burned out that I am ready to retire. Indeed a career in MEDICINESUX!