Not that Anyone is Counting

30 days:

• 16 days of work (5 on call)
• 8 days of weekends (2 on call)
• 6 days of holidays 

And then I'll be a real doctor.

Moments When I Love My Job

It has been an absolutely perfect weekend here, which of course means that I have been on home call and working on a presentation that I have to give on Wednesday.  (Grumble, grumble)  To make sure that I didn't completely miss out on the beautiful weather, I made plans to take a break from work this morning to meet my Mom for breakfast and a walk through the largest park in my city.  Unfortunately, while I was showering in preparation for my outing, my pager went off.

"Hi, this is (Surgery Resident who is surprisingly cheerful despite working at least twice as hard as a Hepatology Fellow).  We just admitted (Very Medically Complicated Liver Patient), who is going for emergency surgery today.  We need you to come see him."

(Grumble, grumble)

After phoning my Mom and telling her to delay our plans, my empty belly and I drove to the hospital, staring glumly out the windows at all of the happy people frolicking in the sunny, 25 C weather.  Arriving at the hospital, I went into my best doctor mode, pretending that there was nowhere in the world that I would rather be on a beautiful day than inside a dimly lit hospital ward that smelled of harsh disinfectant mixed with bodily fluids.

When I walked into the patient's room, prepared to re-introduce myself with my standard line of "You may not remember me, but I'm Doctor Solitary Diner", I was met unexpectedly by the most enthusiastic of greetings.

"Solitary!  So good to see you!"

What followed was part medical interview, part in-depth discussion about our respective plans for an upcoming music festival.  Despite not having seen the patient in a number of months, he remembered that I was planning to attend the same music festival as him, and he was eager to confirm that I'd purchased my advance tickets.  (I'm actually volunteering at the festival, so it's free!)

It seems like such a small thing, but this brief interaction was a major bright spot in an otherwise tiring weekend.  It was so nice to feel like I'm not just another random face in a patient's medical team, but that I'm seen as a real human being with my own interests outside of medicine.  And it was important for me to be reminded that the patients for whom I care are distinct people with lives outside of the hospital, not just a collection of lab reports and physical exam findings.  This is why I do what I do.

Not bad for an early Sunday morning page.

Gifts

My birthday was yesterday, which means that I have recently gone through another round of my annual ritual of telling the people who love me "No, seriously, I don't want you to buy me anything".  As soon as I became an adult, with a job and the ability to buy myself the things I want, I stopped enjoying getting gifts.  The reasons for this are many.  I hate getting things that I don't like and having to pretend that I do.  I hate having more things to store in my apartment, which was already full when my girlfriend (who is a hoarder less of a minimalist than I am) moved in.  I hate knowing that the people I love have spent time, which they usually don't have enough of, in a shopping mall instead of with me.  And I particularly hate that gift giving perpetuates our debt-fueled, environmentally destructive consumer culture.

"Surprise! I love you! Here’s a part of the planet I wrecked for you, Hooray!!"*

A few weeks ago, when my Mom asked me what I wanted for my birthday, I tried again to tell her that I didn't want any gifts.  Unfortunately, any time I suggest that she not buy me a present, she looks at me as if I have suggested we go out and murder babies.  The gift-giving mentality is very strong with her.  So I tried to suggest a) alternatives to gifts and b) practical gifts that I would actually use.  I suggested that she give me a certain amount of her time, which she could use hanging pictures and putting up blinds and doing other things in my apartment that are outside of my skill set.  I suggested that she make me a nice dinner at her place and we spend a few hours catching up on each others' lives.  I suggested that she get my medical degree framed, so that I can take it out of the cupboard where it's been collecting dust for the past five years and display it in my fancy-pants new office.  None of these things was acceptable to her. 

So what did I get?  A cheque.  My widowed mother, who is on a fixed income, gave money to me, who will soon be earning ridiculous sums of money as a physician**.  How does this make sense?  How is this better than her hanging the pictures from my trip to Cuba that have been taking up space behind my couch since I moved in five years ago?

Gift giving is insane. 

I encountered another example of this insanity when I was talking to my Mom about my cousin's upcoming wedding.  I am spending money that I don't have to fly halfway across the country for the wedding, so I feel like I am justified in being a bit cheap frugal with the gift.  I suggested to my Mom that I was going to get a $50 gift card to the store where my cousin is registered, and she once again looked at me like I was heading out to murder babies.  She thought I should be spending closer to $200 on the gift!  What?  Why should I, who am trying to dig myself out from a giant pit of student debt, be spending ridiculous sums of money on a gift for my cousin (who has a job) and her soon-to-be husband (who also has a job)?  Why is this the expectation?

Rant over.  Thankfully it's another seven months until I have to deal with Christmas.

 *I've been obsessively reading Mr. Money Mustache for the past month or so, and it is transforming my approach to spending and debt.  The article that I linked to is one of my personal favourites and describes my feelings about gift giving much more eloquently than I can.

**Admittedly, I will be using these ridiculous sums of money to pay off my equally ridiculous debt...but that's not the point.

The Mechanics of Budgeting

Liana left some interesting questions in response to my previous post about budgeting, and I thought I'd turn my answers into a blog post, as I think budgeting isn't something we talk nearly enough about, especially in medicine.

There's a common perception that physicians don't need to budget.  The assumption is that we will all make a shitload of money over the course of our careers, thus enabling us to buy whatever giant homes and ridiculously overpriced cars and designer handbags we desire, without any thought to how much things cost.  In reality, we often start our careers with a shitload of debt (approximately $200,000 in my case*), and after more than a decade of training (16 years for me), we may not want to work as hard as is required to earn a shitload of money.  So budgets are good.

In my case, I started the budgeting process by figuring out how much I was making and how much I was spending on "fixed" expenses (rent, utilities, insurance, parking, housekeeping**, etc.).  I then figured out what my financial goals were - specifically, to pay the interest on my line-of-credit every month, to save $500 per month for retirement, and to not spend more than I was earning.  I then entered everything into an Excel spreadsheet, and I was left with a certain amount of money per month for all of my "variable" expenses (groceries, travel, eating out, clothing, cats, etc.).

To track my "variable" spending, I use an iPhone app called "Visual Budget".  I chose this one because it doesn't link to my bank accounts, and it's pretty user friendly.  It also allows me to create multiple "accounts", which enables me to separate my spending into different categories.  It's taken me a while to come up with a good way of dividing up my spending, but my current (pretty good) setup is as follows:

1)  General Expenses:  This is the account I use for all of my day to day expenses.  It is set up to give me a daily "allowance", which is all the money I can spend on food, entertainment, etc.  Every time I buy something, I immediately record it in the app, and the cost is deducted from my "allowance".  Anything that I don't spend gets carried over to the next day, allowing me to obsessively track all the money that I'm not spending.

2)  Vacation:  Kinda self evident.  I give this account a monthly "allowance", which accumulates until I decide to buy plane tickets or book hotel rooms or do other fun things.

3)  Time Off Fund:  After much internal debate, I decided to reward myself for finishing 16 years of training by giving myself seven weeks off from work.  Unfortunately, I don't have a generous benefactor, so I actually have to fund this on my own.  I was initially planning to dip into my line-of-credit to pay for this, but as I get further along the path of debt repayment/financial responsibility, the thought of increasing my debt becomes more and more appalling, so I decided to save up for my time off instead.

I give this account a weekly "allowance", which I generated by decreasing the "allowance" on my General Expenses account.  Every once in a while, I throw in some extra money from my General Expenses account if I've been particularly frugal and accumulated some surplus.  I'm currently on track to be able to fully cover my expenses during my seven weeks off, which makes me irrationally proud of myself and my ability to not spend money.

And that's it.  The mechanics of my budget.

Initially, sticking to a budget was hard, as I was transitioning from a life of carelessly indulging in everything my heart desired (ooooh....$100 dinner at my favourite tapas restaurant....yes please!) to actually behaving like money is real.  I felt really deprived by not being able to buy whatever I wanted, and I got stressed out when I needed to make a large purchase.  (Such as cat food.  One of my cats has a skin condition that only gets better with $60/bag cat food, and I have a minor heart attack every time the cat food runs out.)

(I represent 10% of my mom's "variable" expenses budget.)

Over time, though, sticking to a budget has gotten vastly easier.  I've started to figure out which expenses are necessary (food, gas, personal hygiene items), which items improve my quality of life (budget travel, eating out at less expensive restaurants, hosting pot lucks at my apartment), and which items I can entirely live without (cafeteria food, cable tv, books that don't come from a library, silly $5-10 self-indulgent purchases that add up really quickly).  It's actually become an entertaining challenge to see how much fun I can have for little to no money, or to come up with the tastiest meals possible from the leftovers in my fridge***.  I expected that sticking to a budget would be an act of white-knuckled self deprivation, but in reality, it has opened me up to all kinds of things that make my life better.  If anything, I'm happier for having less money to spend.

*Ugh. 
**Yes, I am a spoiled "rich" person who has a housekeeper.  I love it, and it is one of the last expenses that I would ever cut from my budget.
***The girlfriend is an expert at this.  Give her flour, milk, eggs, and cheese, and she'll make crepes or quiches or any other number of amazing things. 

Budget

Before I started medical school, I was a pretty financially responsible person.  Since the age of 18, I had invested a minimum of 10% of my income in long-term savings, even when I was an undergraduate student living off of scholarships and low-paying summer jobs, or a graduate student earning a stipend that was too small to permit "extras" like clothing or bus fare to the grocery store.  My only travel was home for Christmas and maybe my birthday, paid for with my Dad's Aeroplan Miles from his job.  I didn't even own a car until I was 28, when I had saved enough money from a contract job to pay cash for my mom's 10-year-old beige Chevy Malibu.

(It was basically an ugly boat with wheels.  I called her Mabel.)

The polite way of describing the person I used to be would be "frugal", although it would not be inaccurate to say "cheap".  But it served me well; when I started medical school, I had over $60,000 squirreled away towards school costs and my eventual retirement.

And then medical school started.  And suddenly, I was no longer friends with graduate students who brought peanut butter sandwiches for lunch and had pot lucks on weekends because no one could afford to eat in a restaurant.  Instead, I was going to school with people who had grown up in rich families and who thought nothing of dropping $200 on a night out or of flying to South Africa for safari over Spring Break.  I was also surrounded by the mentality that debt didn't matter, because someday we would all be making so much money that our $200,000 (or more) lines of credit would just disappear without effort.

So I changed.  Slowly at first, but with increasing speed as I got more and more comfortable with debt, I let go of my frugal habits and started to spend like the people around me.  I stopped bringing lunches to school and started spending $10 a day on terrible cafeteria food.  I went to Cuba (my first international trip since finishing my undergraduate degree in 1999) for Spring Break.  When my beloved Malibu got totaled by an idiot who was texting while driving in the rain at night, I got a shiny new Toyota and started making lease payments.  And the debt piled up.

I barely paid attention to my debt until September 2014, when something terrible happened at work.  As I was trying to put the pieces of my professional life back together, I thought a lot about what would happen if I couldn't practice in medicine, and I realized that I had so much debt that I would probably never be able to pay it back.  And it terrified me.  Night after night, I would lie awake in bed, thinking about the imposing six figures of doom on my line of credit statement, wondering if I should start buying lottery tickets, because I couldn't think of any other way to get it under control.  Eventually, the stress got so bad for me that I did the unthinkable; I put myself on a budget.

I had thought about sticking to a budget prior to the terrible work event, but I never seemed to have the motivation to give up on all the fancy dinners and concerts and exotic vacations that had somehow become my life over the previous eight years.  After the terrible work event, visions of myself moving back in with my mother because I couldn't make rent and loan payments simultaneously became that motivation.  And it worked.  For the past nine months, I've stuck to a budget, and I'm now $12,000 ahead of where I was at the start of this whole experience.

And my stress level?  So much better, knowing that I'm finally chipping away at the imposing six figures of doom.  And that I likely won't ever again have to share space with my Mom.