Physicians should blame themselves for why they are unhappy in medicine

by Setu Mazumdar, MD

Everywhere I go I see unhappy doctors.

All everyone does is complain about rising malpractice premiums, more paperwork, declining pay, and 60 hour workweeks.  This includes physicians just graduating from residency and physicians who’ve been practicing medicine for several decades.

All of those complaints are legitimate, but one question I always have in my mind about the physicians who are in their 50s is, “Why are you still practicing medicine full time?”

I keep hearing about the “golden age” in medicine. I don’t know what that means, but I assume it has something to do with making more money than we do now.

Suppose you’re a 55 year old physician and you’ve been practicing medicine for 25 years full time.  If you absolutely love it, that’s great. It’s your passion so go for it. But for the rest of you (which is the majority I think) who are in your 50s, who experienced the “golden age” in medicine and are still practicing full time and complaining, I’ve got to be blunt: you have failed miserably in your investment career.

What do I mean by this? Let’s say you graduated from residency in June 1985 and started making some money. Suppose you socked away on average $25,000 per year in the US stock market each year for the past 25 years starting in January 1986.  The US stock market as represented by the S&P 500 index had an average annual return of 9.9% in that period.  So over 25 years your investment portfolio should be at least $2.5 million.

And that’s with putting away only $25,000 a year on average. Bump that up to $50,000 every year — which is an entirely reasonable and attainable amount for a physician to invest every year — and you should have at least $5 million in the bank.

Even if you invested only in bonds you’d have about $1.7 million saving $25,000 a year and nearly $3.5 million saving $50,000 a year. This is based upon the US aggregate bond market index.

How many of you actually have that? Sure a few you might, but I’d bet that the vast majority of you don’t. And I also bet that the reason you’re working full time right now is because you realize you didn’t save enough and invest well. Common reasons why you have a meager portfolio value are:

  1. You spent every penny you made
  2. You didn’t save enough because you overspent
  3. You took way too much risk and got burned
  4. You hired a commission based financial advisor who put you in inappropriate investments
  5. You invested in speculative investments like restaurants, limited partnerships, or hedge funds, and they tanked
  6. You got divorced.

Now you feel trapped in your current situation.

So if you are a physician in your 50s or older and are complaining about your situation, you completely blew a phenomenal time to invest and really don’t have anything to complain about except your missed opportunity. You should have enough to walk away if you want. If you don’t and unless you jump up and down in joy every time you go to the hospital or when you’re on call, it’s time to crack the whip and get moving because the next 25 years are going to be a challenging environment to practice medicine to say the least. And if the chatter I’m hearing is accurate, I don’t think you want to practice medicine full time until you’re 80.

Setu Mazumdar is an emergency medicine physician and President of Lotus Wealth Solutions. This post originally appeared in Freelance MD.

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  • http://www.drdarrellwhite.com drdarrellwhite

    Whoa! Some pretty big assumptions there, big guy. There’s a big ol’ buncha docs out here in patient land who simply love what happens in the exam room and the OR who are just beaten down by the incessant negativity directed toward physicians, whether or not they have a portfolio for the ages/aged.

    If I won a huge lottery tomorrow I would, indeed, practice part time, but not because I would be seeking to avoid medicine. Nope…I would do so only because I liked being a Jr. High football coach more.

  • http://about.me/michaelbmoore Mike Moore

    Wow. Using “Social Media’s Leading Physician Voice” as a place to shill for a physician’s “wealth management” company. Pretty cheeky.

    Does KevinMD really think that “failed portfolios” are the source of the current increase in physician discontent?

    That this is all about money?

    I’m less than impressed by this self-serving post on KevinMD. I agree, financial readiness and stability is important in life, but this post is just too much.

  • http://onsurg.com/about Chris Porter MD

    I notice a surplus of complaints, too. But I suspect they have as much to do with loss of autonomy, loss of public esteem for the medical profession, and the Uncle Charlie factor http://bit.ly/kARWg5 , as with money.

    Malcontents are not limited to medicine either, I’m sure. Would expect the break-rooms across the world, regardless of job description, to have their grumblers. Change is hard for most.

  • http://drpauldorio.com Paul Dorio

    Good comments, though drdarrel is correct that you of course make some assumptions.

    Bottom line is, where do I sign up so I can make sure I invest wisely enough so 25 years from now I CAN go part time or retire if I want to?

    I like what I do. I like taking care of people who care about themselves and appreciate being cared for. But it’s hard work. And at the end of the road I still hope to know that thing called financial security.

  • http://petereliasmd.com pheski

    Not so fast.

    First, very little of the unhappiness I see around me is related to money. It is much more about autonomy, changed roles, increased complexity, and fear of change. The rose-colored lenses in the retrospectoscope play a huge role, as well.

    Second, you are simply wrong with your financial assumptions. Or perhaps you didn’t bother to collect data before you pontificated. What makes you think that $25K (let alone $50K) was an attainable annual retirement investment for a primary care physician in private practice 25 years ago. I am a family doc and have been in practice since 1978. It took 5 years to push my after expenses income over $50K, and I never reached a point where $50K could be invested annually. Of course, if I had not been paying off debts, married, with children whose college I paid for, and if my spouse had also been earning a large salary, perhaps your description would be closer. Or if I had been a radiologist or neurosurgeon,of course.

    Third, your post comes across as an advertisement for a private sideline business. Though, for that, I blame Kevin and not you. Zebras and zebras and tulips are tulips and they do what they are destined to do.

    (Note: I am actually at a point where I might be able to retire. I could certainly drop to half time quite comfortably. I am overtly and publicly unhappy about a number of things in medicine, as well as in the larger universe, but it is not financial. I LOVE clinical medicine and plan to continue for the foreseeable future. And I am struck that you see the issue as unhappy physician = physician angry about failed investment strategies. This tells me a great deal about how you see the world of medicine, and what is important to you. For your sake, I hope your clinical colleagues and supervisors don’t interpret this the way I do. And, for your patients’ sake, I hope I am wrong.)

    Peter Elias, MD

    • http://drpauldorio.com Paul Dorio

      Thanks, Dr Elias. Excellent perspective.

    • http://about.me/michaelbmoore Mike Moore

      Thank you Dr. Elias.

      You put into words how I felt when I read that post quite eloquently, and you certainly are more effective than my “place to shill for a physician’s company” comment.

      Well done, Sir.

      –Mike

  • Mt Doc

    I have to agree with the above comments. In the “golden age” of medicine most doctors as a whole made less than they do now and probably worked longer hours but had a lot fewer hassles and more professional satisfaction. Dr Mazumdar needs to spend a little quality time with primary care doctors – he is off base with regards to what their income and expenditures are but also about the roots of unhappiness, which have little to do with income. An unhappy doctor might gripe about his or her income but that’s not why they are unhappy.

  • http://thoughtbroadcast.com SteveBMD

    Dr Mazumdar, what’s next, are you going to chastise me for not investing all my spare money in Netflix stock? After all, it has appreciated ~600% in the last two years. If I missed out on that opportunity, I guess I only have myself to blame, right?

    I agree with the above comments (esp. Dr Elias).

  • solo fp

    I have saved up enough to retire and currently put six digits in the market annually. I do medicine because I enjoy seeing the patients. The list price on my malpractice premium for never being sued but practicing in an expensive state is $40,000 annually.

    That said, I think the golden age of medicine was when no HMOS/Insurance companies were telling us what to do, which ended in the 1980s and gets worse every year. As a primary doc, why I am the one looking up CPT codes for MRIs to get prior auth for a patient? Jumping through hoops for prior auths and dealing with mail order companies are part of the time wasting daily activities of primary care. Why am I scrambling for copays and deductibles? Thankfully I keep my overhead so low that I can still exist comfortably in the current system and spend time with my patients.

    I do stay away from the hospital lounges, where middle aged docs sit there drinking coffee and griping about practicing medicine. I do what I do for the patient. I see the younger docs mostly working for large hospital-backed corporations as salaried employees, and I see medicine moving toward an employment model for physicians. This failed miserably in the 1990s, with many hospital-owned practices going bankrupt.
    There is another blog at there that I wish docs would follow about the solo doc dinosaur. To paraphrase, if it is no longer fun, don’t do it.

  • Fam Med Doc

    Primary care docs in my city are earning bout 140-160 K. Some less. I know cuz I ask around.
    Most new docs have well over 100 K in debt. Many are paying nearly $1000/month in student loans. Or more.

    No way could a doctor starting out put aside 25 K a year. And save for a down payment for a home. And save for their kids college education.

    Yeah, for the primary care doc it’s at least partly about the money.

  • http://briarcroft.wordpress.com Emily Gibson

    As an employed family physician almost all of my 30 year career, I also must take exception to the outrageous assumptions in this post. As a mother of three, I did not work full time for the first fifteen years. We have a farm, taken few vacations, owned nothing exorbitant, tithed 10% to our church and charities, paid entirely for our childrens’ private school and college expenses, and after that tucked away what we were able for retirement, but it could not approach the figures cited here.

    I am not a mid-fifties unhappy physician by any stretch, but I am indeed stretched as most physicians are these days, working more hours seeing more patients in less time. I’m not ready to retire, not because of financial need to work, as we can grow our own food and live very inexpensively. I’m not ready to retire because quality family docs are desperately needed in this broken medical system. It is not all about me. This post offends any doctor whose servant attitude is still intact.

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      Great reply Dr Gibson. Keep doing what you love and helping others as you have done the last thirty years !

  • Kate

    Wow.
    I agree with the comments of Family Med Doc. As someone out of my fellowship training in 1986, I made nowhere near enough to put 25 K away into investments and did not until well into the mid 1990′s. It IS NOT ABOUT THE MONEY. What about savings for children, college education which runs up to 50 K a year?

  • http://www.TheHealthCulture.com Jan Henderson

    Glad to read such excellent comments in response to this post. Mt Doc is right about the “golden age” of medicine. It does not refer to a time when doctors earned more money. Historically, the practice of medicine was not well paid and not even highly respected as a profession, with the exception of an elite group of physicians that catered to wealthy patients.

    The “golden age” coincides with a period of general economic prosperity in the US following WWII – a time that saw many medical breakthroughs, such as the widespread introduction of antibiotics. It had ended by the late 1960s/early 1970s. Financial incentives, largely the result of Medicare and Medicaid, led to the corporate commercialization of health care and ultimately to the dissatisfaction expressed by many physicians today.

  • http://www.BocaConciergeDoc.com Steven Reznick MD

    . I came out of residency with a business plan and a personal budget for my wife and I constructed by a financial advisor and the AMA’s practice management group. Practicing general internal medicine I did not anticipate many of the changes brought upon my ability to generate income through a practice plus a cooperative lab and imaging facility that the original Stark Laws made illegal before any of the investors had paid off the startup costs fully. When I entered practice my office was staffed with a RN, receptionist and office supervisor. Patients were seen for a visit, they were handed a bill in triplicate, they paid for the visit in cash or check and the receptionist made a hand written entry on ledger cards and the fee ticket and gave the patient one copy. Two years later the Federal government required us to transmit our claims electronically or else wait another four weeks for payment at 5% less. The receptionist now had to become a data entry person, computer literate and knowledgable in two foreign languages ( ICD 9 codes and CPT codes). I had to install a computer billing system , pay several middlemen at the electronic clearing houses and pay vendors to maintain the hardware and software. Medicare, the major payor in my area, then decided to pay 5% more if you accepted their fee schedule as opposed to becoming a non participating provider. Private insurers were signing up my patients into PPO’s and HMO’s and paying the doctor 75% of what Medicare paid for the same service. To combat this the local practices in primary care formed a group practice without walls. This 45 doctor entity was successful for several years until the local hospital systems under cut us. We were bought out by a private management company that went bankrupt two years later and turned the practices back to the doctors .
    I love practicing general internal medicine and having long term relationships with my patients. I enjoy being their advocate and guiding them through the pitfalls of the health care system. I built a sane business plan with financial experts and consultants from the MGMA and the rules changed in the middle of the game and changed continually.
    Most of the doctors I know still found a way to earn a fair living. Their complaints and unhappiness are due to government and insurance companies creating scenarios that take them away from patient care and increase their overhead without creating opportunities for them to recover these increased costs.
    I wish Dr Mazumdar the best of luck in his professional career and wonder if he will be preaching the same gospel if the practice and financial rules he built his business plan around change as often as the post ” golden age of medicine era” doctor’s plans changed.

    • Fam Med Doc

      Dear Dr Reznick,
      Thank-you for your comment. Quite illuminating, but all your comments are. You are just a sage doctor I WISH worked in my medical community. I would just sit at your feet & soak in all the wise years of experience you have to share & teach. For real.

      I hope you are involved formally or informally with mentoring advising us younger doctors in your area. We need your guidance. These waters are treacherous. Sometimes I feel the water is up to just below my neck, & if it goes up any higher I’m gonna gurgle.

  • http://fertilityfile.com IVF-MD

    Happiness is determined in great part by 1. meaningful purpose 2. financial security 3. health and energy and 4. meaningful relationships.

    We all went into medicine pretty confident it would provide #1 and #2 and many are trapped today because while it no longer provides #1 for them, the fact that it also doesn’t provide #2 makes it impractical to quit and try something else. Double whammy.

    Personally, I happily plan on working forever as long as I am capable because my work still provides me with abundant #1, but I also realize that can be taken away from me in an instant if for example, they decide to pass a law banning or terribly restricting reproductive technology as they have done in some other countries. Or if they turn me from a independent free-thinking physician into a glorified government employee, but I don’t think that will happen any time soon. Meanwhile, I’ll count my blessings and share my insights with whomever wants help.

    • http://www.TheHealthCulture.com Jan Henderson

      IVF-MD – It’s really sad that in the year 2011, in a highly developed country, you have to worry about the practice of your specialty – so valued by the patients who benefit from it — being taken from you for politic reasons.

  • http://fertilityfile.com IVF-MD

    As for why most doctors have not saved enough to retire, the two biggest cripplers are TAXES and INFLATION. Without those two things, 99% of physicians could happily retire after 20 years of service without gambling even one single dollar in the shark-infested waters of Wall Street.

  • http://SteinWellness.com Sara Stein MD

    LOL – I must have missed the bliss of people working in the finance sector.

    Most of the doctor unhappiness I see is related to external forces interfering with doctor work (like caring for patients).

    Oh and one glaring omission needs underscore again – clearly your parents paid for your medical school education. You neglected to mention the student loan albatross that goes on for 20-30 years. Silly me, all those fancy cars and expensive dinners I bought!

    So…where you going to give us some investment tips?

  • http://Caduceusblog.com Deep Ramachandran

    As a young(er) physician, I notice that the physicians who do complain the most tend to be those who have been in practice for a few decades. Most of their laments are understandable, they practiced in a time of better reimbursements, less paperwork, less regulations, and less oversight, as others here have elluded to. I’m not sure that financial hardship is the reason that they continue working, I imagine that it comes down to a simple formula; the gratification continues the trump the ever increasing hassles.

  • Aoife McDonnell

    I found this post quite shocking. I am almost finished with medical school, following in many family members footsteps, and the frustrations I hear from my relatives have nothing to do with some ‘golden’ era of making money that has suddenly ended, making their profession not worthwhile. The impetus to study medicine came from my grandmother’s belief, ‘In the old days in Ireland if you wanted to be closer to God there were three professions: a priest, a teacher or a doctor.’ The idea being that by dedicating your life is important, a life dedicated to the service of others (whether or not this gets you closer to God, I don’t know yet) will in many cases serve you (how many times is the patient the teacher); the intangibles that cannot be invested, the joy and pain of being so heavily involved in other people’s lives. Nobody becomes a teacher or priest to make huge amounts of money. No teacher or priest I know is ever completely off the clock, and as a practicing physician of five children (another possible reason for no golden egg), my father would agree the same is true for him. The complaints I hear, and what I fear, largely comes from how medicine has become a business, with middle management, paperwork, words like ‘incentives’ and ‘targets,’ ‘patient turnover,’ working its way into what I still believe at its best, is an art.
    Finally if professional servants behaved the way most of Wall Street did quite recently, with children’s education, spiritual guidance, patient care, its fair to say most of them would not be walking away with a golden handshake or receiving a bonus.

  • Alan

    The following deconstruction is intended for humor purposes only:

    “I keep hearing about the “golden age” in medicine. I don’t know what that means, but I assume it has something to do with making more money than we do now.”

    Fanciful Interpretation: Hey, I’ve been hearing sentimental reflections from the graybeards about a simpler, more gratifying time in our industry. I haven’t taken the trouble to find out what those guys are really talking about, but you should be a good listener yourself, so listen up! Any golden age must have something to do with earning money. Makes sense, right?

    “So if you are a physician in your 50s or older and are complaining about your situation, you completely blew a phenomenal time to invest and really don’t have anything to complain about except your missed opportunity.”

    Fanciful Interpretation: You see, that ‘golden age’ that I don’t know anything–it must have really existed–and it did involve making money. So if you’re in your 50′s by definintion you lived through that golden age. Since living through the golden age means you used to make more money relative to today, shame on you for failing to foretell the future and not monomaniacally putting your relatively higher earnings into stocks and bonds. Hindsight bias, own bias, and oversimplification aside, you really ought to be more down on yourselve. It’s about dollars and cents after all, and if you had been paying proper attention, you could just walk away from the whole scene today, in which case you’d have nothing to complain about. :-)

  • http://skepticalscalpel.blogspot.com/ Skeptical Scalpel

    I am appalled by this post. I agree with most of the comments above. By the way, one reason I am still working is that the stock market collapsed a few years ago. Maybe you missed it. It was in all the papers.

  • Kristin

    So–I know exactly nothing about this, by the way–the impression I’m getting is that doctors feel this post is wrong in two respects:

    1. Doctors are unhappy about a lot more than money.

    2. The poster is wrong about the money anyway.

    Seems like 1 is a more emotionally convincing argument than 2. It may be easier to refute 2, but it makes it sound like that IS what the fuss is about.

    • http://fertilityfile.com IVF-MD

      Yep. Furthermore, in many cases, it might be wrong with respect to the claim that “doctors are unhappy”.

  • http://drpauldorio.com Paul Dorio

    So let’s see:
    The original post is appalling to some readers and elicits visceral responses from most.

    Then we have Kristin who says “I know exactly nothing about this,” but proceeds to make conclusions based on her presumptions with an underlying lack of knowledge (her words) of the situation/experiences of the readers.

    Two things I take away:
    1- Doctors actually DO care about more than just money as exemplified by many comments here (Kristin – THAT is the correct conclusion)
    2- Dr Setu Mazumdar may rethink his strategy and approach if he wishes to entice readers to his website in the future. Medicine is much more than just a money-maker to most of us. If you haven’t noticed that by now….get out quick.

    Oh, and I think this whole stream is unbelievably amusing. Kevin Pho you are a genius and I wish I could figure out how to get such enthusiastic commentaries on MY blog! lol

  • ninguem

    The financial types are the ones who drove the economy into the ground.

    They were bailed out by the Federal Government.

    They even got their bonuses.

    No wonder they’re so optimistic.

    • http://fertilityfile.com IVF-MD

      As usual, ninguem, you are right on the money.

      There is a difference between getting wealthy by improving other people’s lives. It’s a whole other thing to use political force to get wealthy.

      One is more fulfilling spiritually, but the other might be more profitable in our current political system. If that is not changed, the overall quality of life will suffer, especially for the common worker and all those who are less politically connected.

  • Vox Rusticus

    It is one thing to believe it is my responsibility to do the things I must do to make myself satisfied with my career, but it is entirely a different thing to believe that those things that make me dissatisfied are things for which I have only myself to blame.

    The OP’s premises, conclusions and intentions are all suspect here. The income assumptions are wildly overdrawn, the short list of conclusions simplistically short, and the commercial purpose of the “article” transparently suspect and not objective. This is infomercial, not analysis.

  • Alan Troy

    How can anyone not understand the frustration physicians have with today’s demands? Here are good reasons
    More work hours, less free time
    Less time for each patient
    Less autonomy
    Insurance company denials of claim and drug coverage,and the physicians wast of time involved in correctint them
    More complex patients, with more complex and expensive options, and greater patient expectations, in the face of government attempts to reduce spending
    Misguided government policy: Move money from Medicare to Medicaid, increase reimbursement to hospitals and decrease reimbursement to physician practices for the same tests (forcing them into employment with limited personnel infrastruture), penalizing hospitals for more expensive care when it might actually save money in the total picture of the health care system, penalized hospitals and physicians for readmissions proven to improve survival, forcing expensive unproven EMR/EHR upon the medical profession, not allowing physicians to organize meningfully based upon selective enforcement of anti-trust laws which apparently don’t apply to big business and insurance companies, putting a tort lawyer in charge of HHS (fox in the hen house), having the FDA approve therapies which Medicare and Medicaid will not pay for, having JCAHO mandate extra work which Medicare and Medicaid will not reimburse, failure to enact meaningful tort reform, failure to regulate the gouging practices of pharmaceutical and device companies, failure to prosecute insurance company fraudulent behavior, failure to provide promised care to injured military veterans
    Too many trainees in certain subspecialties and not enough in primary care, endless recertification processes both board and nonboard regulated, draconian requirements for CME cerrtification on the part of NACCME For profit ownership of hospitals driving profits above patient care on behalf of executives and stockholders, on and on.

    Want some more reasons?

  • Alan Troy

    And I forgot one big one:
    Excessive and irrelevant E/M documentation requirements for coding purposes, a contrived and time wasting paper chase, which goes against the grain of medical training, wherein we are taught to stay relevant and be brief. More documentation, less time, longer data input with EMR… another brilliant idea from CMS. Nothing like coherent policies, is there?

    • tracy

      I would love to chat with Dr Reznick and Dr Troy. A group of docs in my community are talking about GPWW. How did the hospital undercut the docs in your group?

      • Alan Troy

        The for profit vultures come in with a don’t tell us how to run a hospital attitude, completely alienate the primary care referral base that took you 20 years to build up, and you are left with a lame referral practice. The billing practices of the hospital were unconscionable, and angered so many patients and docs that they too went elsewhere. The physical plant, nurse to patient ratio, public relations, etc all went irreparably downhill. Meanwhile the CEO got CEO of the year from corporate headquarters, but was fired less than a year later for some sort of inappropriate action. Go figure. These guys treat executives and stockholeders, not patients.
        The almost never respont to requests and suggestions to improve the hospital, but they always pretend to be interested in what you have to say. When you leave the executive suite after a meeting, the conveniently forget everything you discussed with them. Many of the middle managers become loyal to the corporation, because they want to move up the company ladder and make more money. So they only pretend to be on your side when it comes to solving problems. There have been flagrant violations of patient safety and HIPPA on their part at times. The list goes on and on…..

  • Alan Troy

    I’m really beginning to love this blog.
    We’ve got lots of ground to still cover.
    Regards to all my hardworking, dedicated colleagues out there.

  • imdoc

    The author states:

    “Suppose you socked away on average $25,000 per year in the US stock market each year for the past 25 years starting in January 1986. The US stock market as represented by the S&P 500 index had an average annual return of 9.9% in that period. So over 25 years your investment portfolio should be at least $2.5 million”

    Does this take into account taxes on the investment returns? Also, are you calculating the 9.9% like a simple interest equation? How do you arrive at this $2.5m number?

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