Budgeting Without Being a Dick (or an Asshole)

 A few years ago, I read a vacation post by a blogger-who-shall-not-be-named that really pissed me off.  Said blogger retired in his 30s, has a net worth in the millions, and prides himself on being uber-frugal.  In this post, he described taking his rather large family to a museum that let visitors set their own admission price.  His chosen price?  $2.

Not even $2 per person.  $2 for his family.  And he didn't just list this as a budget line item - he bragged about the "good deal" he had gotten.

 I think I vomited a bit in my mouth when I read that.  I love the idea of pay-what-you-can attractions and events, because they enable people whose means are limited to participate, without having to ask for a special discount or feeling ashamed about being unable to afford the full price.  But the flip side of this is that the people who can afford to need to pay more.  Not brag about being an asshole who only pays $2.

When I was revamping my budget recently, I kept thinking back to this post.  And even though I feel frustrated and financially vulnerable at the moment, I really want to ensure that I don't start behaving like a dick just to save money.  As I get used to putting some limits on my spending, there are a few things I'm doing to try to avoid being a dick.

Recognize my privilege:

I'm not budgeting to survive or even to live comfortably on a small income.  I'm not even doing it to make sure I have enough to retire when I'm 65 - I'm doing it in the hope of being able to save enough money to retire as much as 10-15 years earlier than the traditional retirement age.  I am incredibly fortunate to be in this financial situation, and hopefully it will get even better "after COVID", if there is such a thing.  So I do not need to, nor should I, make morally questionable choices to cut my spending*.

Keep tipping:

People who work in the service industry are pretty universally underpaid and are often treated really shittily by customers and employers.  When I started working as an attending, I made a commitment to do a tiny bit to help people in the industry out by upping my tipping game.  I started tipping for takeout, which I had never done before, and I increased how much I tip for delivery and table service.  I increased my tipping rates further when COVID hit, and I try to remember to keep some actual cash on me at all times so that I can still tip at places that only accept cards and don't have a tipping option on their machines (I'm looking at you, Starbucks).   

It is reeeeealy tempting to cut back on this right now.  It's an "easy" way to save money, and it doesn't affect me in the least.  Except...cutting back on tipping at the same time as the service industry has been devastated by COVID is the move of an asshole.  So whenever I don't cook for myself, I maintain the same tipping rate as I used before.

Keep donating:

The charitable donations line in my budget is also a really tempting thing to cut.  Spend less without having to give up anything?  Sounds great!  Except...asshole.  I know that my local charities need the money now more than ever, so I'm treating that line as a fixed expense and not touching it**.

Keep supporting the businesses I believe in (and avoiding the ones I don't):

I recognize that the Walton family and Jeff Bezos aren't affected by whether I support their companies, but it feels good to boycott the businesses that seem to be the worst "corporate citizens".  (You will also never catch me eating at Chick-fil-A.)  And when I avoid the giant multi-nationals, I have more money to spend at local bookstores, the farmers market, and other small businesses.  And my dollars actually do matter (at least a little) to local businesses.

What else should I keep doing, even as I try to cut back?  

*To be clear, this is where I am right now.  For people who aren't earning enough and are legitimately struggling to get by in our brutal capitalist society, do what you need to do. 

**Honestly, I should probably actually increase the amount that I donate, but I'm not quite mentally at that point yet.  Eventually.

Return of the Budget

                                                 

My relationship with budgets has varied a lot over the course of my adult life.  When I was an undergraduate and then graduate student, I sort of had a budget, but it wasn't a very detailed one:  my approach to spending was essentially "OMG I have no money, don't buy anything that isn't food or shelter".  Once I started working, I had a basic budget for my regular expenses and savings, but I was also doing a lot of contract work, which allowed me to spend on luxuries without having to carefully track my spending.

And then I became a medical student, and any frugal habit I had ever developed was abandoned in an LOC-fueled spending frenzy.  It was absolutely delightful in many ways, but it left me with a $200,000+ debt hangover at the end of nine years of training.  So I put myself back on a budget during my last year of fellowship, and I mostly stuck with it to about the end of my first year as an attending.

It's been five years since I started working, and for the past four I've abandoned the budget.  I've still tried to be mindful of my spending, but I've definitely let a lot of small and not-so-small expenditures creep back into my life.  I hadn't been worrying about this lifestyle creep at all, because as a single physician still living in my apartment from residency (10 years and counting), it wasn't having a huge impact on my ability to save.

And then COVID hit.

Before I talk about the impact of COVID on my finances, I will say that I am incredibly grateful to be someone who still has a secure and well-paying job.  I am thankful that I don't have to worry about my ability to put a roof over my head or food on my table.  And living in a country with universal healthcare - praise Tommy Douglas.  I know I am very fortunate...but COVID has still hurt.

To protect myself, my patients, and my community, I mostly "see" patients over the phone right now.  I do have some in-person clinics, which allow me to actually see the sickest patients, but close to 90% of my work is virtual.  Which is great!  Reduce the spread of COVID while wearing sweatpants and avoiding a daily commute?  I'm in!  Except...the government is paying me about 40% less for phone visits*.  So I'm working just as much, with the added stress of WORLDWIDE PANDEMIC THAT COULD KILL YOU AND EVERYONE YOU CARE ABOUT, while getting paid significantly less.

(Again, I will pause for a moment of gratitude that I am alive, thus-far COVID-free, and still earning more than I need.)

In the beginning, I lived in this lovely delusion that COVID was a temporary thing and that we would resume our regularly scheduled programming within a few months.  Within that delusion, even a significant decrease in my earnings felt okay, because it was finite.  I even ramped up my charitable giving, because I recognized that there were a lot of people and organizations who were much more seriously impacted by the pandemic than I was.  I didn't feel worried, because I fully anticipated that I would be back to generously feeding my retirement accounts before the end of the year.

Sigh.

Apparently COVID isn't going away.  And apparently the pay cut is going to be a long-term thing.

And while I am thankful to have enough, I am also a whole host of negative emotions about the impact the pandemic is having on my earnings and the vision I had for my future.  Where I previously thought I might be able to retire in as little as six years, now retirement is waaaay farther away.  (How far?  I don't really even want to think about it.  Nor do I totally know.  Just much farther than six years.)  I feel a huge sense of loss, but also an emotion I haven't felt about money in a long time:  fear.

As a single person, there is no backup plan.  If I don't earn money**, eventually my savings run out and I don't eat or have a safe place to live.  And while I know that this is unlikely, and far off even if I were to lose my job, I have an anxiety disorder that is quite happy to turn the remotest of possibilities into a reason not to sleep at night.  

So what to do?

I could work more, and I am considering trying to pick up some extra call shifts, but I also recognize that working more will make me more stressed and anxious, which I'm trying to avoid.  Buy lottery tickets?  Marry rich?

Budget.

I sat down this week and took a serious look at how much I've been earning and spending since COVID started.  And then I cried.  And then I made a budget for myself.  It isn't actually all that strict, particularly given that I only have to care for myself and one geriatric cat, but it is a definite reigning in of my spending.  There is some anxiety associated even with this, as the mere act of putting limits on my spending creates a further sense of scarcity for me.  But I'm hoping that this will fade over time and that the bump in my savings rate will help to make me feel (and objectively be) more secure.

It's worth a try.

*Why, you ask?  Me too.

**Yes, I have disability insurance.

Trading Money for Happiness

Like any good HSP, I don't like to be too busy.  Long to-do lists and piles of unfinished work make me anxious.  Extended periods on call break me a little mentally.  I'm not entirely sure how I survived residency, in retrospect.

As an attending, my happiness is affected a lot by the call schedule.  When the 2018 call schedule came out last year, I was initially ecstatic:  no less than a month between blocks of call*, all of my requested days off, and Christmas off for the second year in a row.  I was a tiny bit disappointed to see that I was working a lot of the long weekends, but that was a small sacrifice for what was otherwise pretty much the best call schedule I could ask for.

And then a revision came out.  And suddenly I was doing two extra weeks of call, with only a two-week break before I had to do my next stretch of call.  And the second stretch of call was immediately before my trip to France, meaning that I would be going into vacation tired and inevitably behind at work.

I was not happy.  I angrily** emailed the person in charge of making the call schedule to try to get it changed, but she had clearly had enough of dealing with demanding physicians, and she told me that I would have to find someone to switch with myself.  She was done.

So I studied the call schedule, looking for someone with whom I could switch one of my dreaded call periods.  There were a few options that would make things better, but all of them had at least one drawback:  during my beloved theatre festival, right before a major presentation, too close to another call period.  No matter how I switched them, the two extra weeks were going to make some stretch of my year miserable.

And then it occurred to me that I could just get rid of them.  Call is as lucrative as it is unpleasant, and there are other physicians who value money more than I do.  A few quick emails, and two weeks of call were gone.

The moment I got the email confirming that someone else was taking my call, I felt light.  I hadn't even realized how stressed I was feeling about my schedule until suddenly it was reasonable again.  I felt the tiniest bit of regret about the money I would lose out on, because I still have a line of credit to pay off and retirement savings to build, but it was tiny.  So tiny.

Having just come off a two-week stretch of call, I am currently even happier than I was initially about my decision to give up the extra weeks.  Even though I like the inpatient work that I do, I have spent the past two weeks counting down the days (and sometimes hours) until I would be able to turn off my pager.  I have hated the constant anxiety that comes from not knowing when I would get paged or what new challenge I would have to deal with next.  I need my downtime to be happy and healthy, and two weeks with none of it is hard.

This is what financial freedom means to me.  The ability to say "This is not worth the money" and walk away from something that makes me miserable.  Two weeks with no call is sweeter than any big house or fancy car will ever be.

*We do 1-2 weeks of call at a time for a total of about 10 weeks per year.

**Not really.  I am not an angry person.  At worst I am slightly passive-aggressive, and even then I'm mostly passive.

Living Now Instead of Ten Years From Now

I don't think I knew just how focused I was on my FIRE date until I started actively trying to not think about it.  Since adopting the "set it and forget it" approach to money, I have noticed that I think about FIRE all the time.

Waking up in the morning:  "In ten years, I won't have to set an alarm clock."
Seeing a difficult patient:  "After I FIRE, I won't have to see any patients at all."
Editing trainee dictations:  "I hate my life!  Woe is me!  This is the worst thing ever!"

(Also..."I will never have to edit another poorly written trainee dictation after I retire.")

It's...sad.  Here I am doing what I have trained most of my adult life to do, and I'm dreaming of what comes next.  And it isn't because I hate my job; it's because I have this idea that retirement is going to be so much better.  I've internalized the belief that work is just something you do to earn money before you can quit.

I'm trying really hard to stop.  Any time I catch myself thinking "I just earned enough to not have to work for three days", I am pausing, noticing the thought, and letting it go.  I'm trying to mentally be here, now, instead of when I retire in ten (or more) years.  Because constantly resenting the now and dreaming of later doesn't make anything better.

Set It And Forget It

I am really lucky to have had a Dad who was an insurance salesperson and later a financial advisor.  From the time I was a kid, we had long talks about money and economics and saving for the future.  I had a university savings account from the time I was five, and half of my $2 a week allowance got put into it.  When I turned 18, my Dad gave me a $500 RRSP and a copy of The Wealthy Barber for my birthday, complete with the advice to always put 10% of my earnings directly into savings.

"Even when I'm a university student and I can barely afford to pay my tuition", I asked?

Yes.  Even when I was a university student and I could barely afford to pay my tuition.  Always.

Along with the recommendation to save at least 10% of my earnings, my Dad advised me to "set it and forget it".  Pick a good investment vehicle (or vehicles), set up a monthly direct deposit, and then almost never look at it.  Check it every 3-6 months to make sure the investment strategy is still sound, adjust as necessary, and then ignore it.  Don't get caught up in the day to day fluctuations in the market, which cause people to make damaging emotional decisions, and just focus on long-term wealth building.

This strategy served me well.  I followed his advice through my 20s, and by the time I started medical school at 29 I had a nice chunk of savings, which I kept for retirement instead of putting towards school.  And I kept up the 10% rule through medical school and residency, so even though I became a wild spending machine, I was still building some savings.  (Although not nearly as rapidly as I was building debt, sadly.)  The best part of the "set it and forget it" advice was that I could do just that:  forget it.  I included savings in my budget, they came out automatically, and I could rest comfortable in the knowledge that I was preparing for the future.

All of that changed when I became an attending.  As a fee-for-service physician, I was no longer earning a regular paycheque.  The amount I took home fluctuated wildly depending on whether I was on call, how busy my clinics were, and whether I took vacation.  This year, for example, there was a four-fold difference between my best and my worst paid months.  I'm not complaining at all about how much I am paid - it's wonderful to earn enough to save over 2/3 of what I'm earning without having to adopt Frugalwoods-level frugality - but I have struggled a lot with the variability of my income.

In good months, when I am earning and savings lots, I feel great.  In months when I'm not on call or I lose a lucrative Monday clinic to a long weekend, I feel anxious.  What if I don't save as much as I normally do?  What if this is the beginning of a decline in my income, and I'm not going to be in a position to retire in 5-7 years?  What if I burn out and can't keep working until I FIRE?

I hate it.  I hate that I'm earning way more than I need to live and yet I'm just as anxious about money as ever.  I've tried not looking at my net worth, and it did help to reduce my anxiety, but I'm not very good at ignoring my net worth on an ongoing basis.  I'm good enough at mental math that I can generally estimate my net worth even if I'm not looking at my spreadsheet.

I've been thinking a lot about this anxiety, and I realized that a lot of it stems from having set a very aggressive FIRE target for myself.  Based on the amounts I've been saving to date, I could retire on a reduced budget in about 5 years and retire more comfortably in about 7 years.  So January 1, 2025 has become my tentative FIRE date.  But that FIRE date requires that things stay essentially the same.  It doesn't allow me to buy a house, nor does it account for the very real possibility that physician payments may be cut, or at the very least will not increase at the rate of inflation.   It's an anxiety-provoking FIRE date, rather than a liberating FIRE date.

So this weekend, I came up with a plan.  I've figured out how much I would need to save to FIRE in 10 years, when I will be 50, and it is about 2/3 of what I've been saving to date.  I'm going to take that amount and put 75% of it into investments and 25% of it towards repayment of my line of credit, thereby reducing my remaining time to pay off the LOC to another 4 years.  (Initially it was supposed to take 10 years, but thanks to a lump-sum payment this year and increasing my repayment rate, I've cut that by almost half.)  In the past year, I achieved this level of savings in all but two months (both big travel months), so it is a comfortable amount to set aside.  And I know that it is enough, so hopefully I can relax more knowing that I am meeting good savings targets.

The funny thing is, it won't really change much on a practical level.  I'm not going to go out and blow the 1/3 that I had previously been saving, as I am pretty happy with my current lifestyle.  Any extra money will simply go into a high-interest savings account, where it will act as a bit of a cushion for the months when I'm spending more or earning less than usual.  When it gets too big, I can either put it towards more investments or use it to pay down the debt more aggressively.  I'm not really changing how much I'm spending and saving, but I'm hoping that a bit of financial hocus-pocus will allow me to stop thinking about it so much and just focus on enjoying life.

When Other People Screw Up

Once a month or so, I do an extra Friday afternoon clinic in a different location from my usual clinics.  It involves rushing out as soon as my morning clinic ends, driving 45 minutes across the city, and generally arriving 10-15 minutes late at the second clinic.  It isn't my favourite thing in the world, but it is necessary for a whole bunch of reasons, so I just suck it up and do it.

Today was one of those days.  When I was about halfway between locations, I got a call from the second clinic.

"Did you forget that you had a clinic today?"

"Uhh...no.  It's 12:55.  I'll be there in 15-20 minutes like usual."

"Oh.  Uhhh...there are patients here for you."

I didn't think much of it until I arrived at the clinic to find eight patients already waiting for me.  It turns out, for reasons that are unclear to me, the clerk had booked my clinic starting at 12:30.  Even though I've been doing this for over two years, and I never arrive before 1 PM.

Gaaaaaahhhh!!!

And this is just the end of a week of screw ups.  Misplaced requisitions, incomplete tasks, and other things done wrong.  It is driving me nuts.  We're professionals working in a healthcare setting - just do things right people!  I do not have the time to double check everything you are doing to make sure you're doing it correctly.

/end rant

Thankfully, my patients are all lovely, and I didn't have a single complaint despite being over an hour behind at the end.  But I just wish that I didn't have to be the person who is ultimately held responsible for everything, including the incompetence of others.

Have a great weekend everyone.  It's time for a book and some popcorn.  And wine.

One Year in the Black

It has been just over one year since I reached a net worth of zero.  After being in debt for almost ten years, it has been a welcome change to open the Excel file in which I track everything financial and see that my investments finally exceed the balance on my line of credit.

As a medical student and resident, I hadn't thought much about finances.  I was surrounded by people who came from wealthy families, and it didn't take me long to adopt their spendy habits and to accumulate a lot of debt.  I reassured myself that "everyone was doing it" and that the debt was okay, because it would be easily repayed once I became a physician and started getting paid in bags full of money.  I rarely looked at the balance of my line of credit, and whenever I did it was just a quick glance, followed by a nervous chuckle at the ridiculousness of owing the bank such an enormous sum.

It wasn't until my last year of fellowship that I actually woke up to the reality of how much money I owed and started doing something about it.  I went on a budget, and I actually started spending less than I was earning for the first time in eight years.  I didn't save a lot of money in that year, as it was a major adjustment just to start living within my means, but at the very least I laid some groundwork for financial responsibility as an attending.

And then I finished training!  And got an adult job!  And suddenly there was a lot of extra money to put towards savings and debt repayment.  Every day that I worked, I got a little bit closer to the longed for balance of zero.  And yet, my anxiety about money actually got worse.  When my line of credit was ridiculously big, I comforted myself by saying that I could declare bankruptcy if I ever lost my job*, because there was no way I could pay it back on anything other than a physician's salary.  As it got smaller, and my investments bigger, I suddenly entered territory where I would be expected to pay back my loans, regardless of whether I could continue to work as a physician.  And the idea of earning a non-physicians salary but still being $50,000 or $60,000 in debt was terrifying.

Thankfully, I have kept my job, and after ten months of working and saving I got myself back into the black.  I expected that the anxiety about money would resolve instantaneously after achieving that milestone, but oddly enough I didn't take a lot of comfort in being a 39-year old with a net worth of zero.  I still felt vulnerable to the possibility of becoming disabled** or burning out of my career and not having enough money to have good options.  So I kept saving and repaying debt and watching my net worth get healthier and healthier.

In the past year, I've increased my net worth by enough that I could live at my current standard of living for about three years.  While I hesitate to share actual numbers here, I will say that my net work growth breaks down roughly as follows:  10% from growth on investments; 10% line of credit repayment; 30% cash savings (for a down payment on our first home); and 50% long-term savings (RRSPs and a TFSA to minimize taxes). 

My savings vary a lot from month to month, due to a fluctuating call schedule and taking time off work for vacations and conferences, but the overall trajectory of my net worth has been pleasantly positive.  And finally...FINALLY...I am starting to relax a little.  It is comforting to know that I could become disabled and live comfortably off my disability insurance payments.  Or I could burn out from medicine and pursue a different career, and I would be absolutely fine.  For the first time in a decade, I feel like I have some real security and real options.  I'm still a long way from financial independence, but at least I'm sleeping more peacefully at night.

*I only had private student loans, so I think they would have been cancelled out by a bankruptcy.  But don't quote me on that.  And don't be an idiot like me and think that bankruptcy is a good financial strategy!

**Yes, I have disability insurance.  As should every physician.

How To Be Less Stabby While On Call

As a resident, I couldn't wait for the day that I would be an attending and would get to do fewer call shifts.  In my last two years of residency, I did 130 days of call per year, while as an attending I do about 70 days per year.  I anticipated that my attending schedule would feel positively luxurious by comparison, but of course, as with many things in life, that hasn't been the case.  Somehow doing less call makes me less accustomed to it and even more resentful of it when I'm in the midst of it.

Generally, I spend my weeks on call in a self-indulgent funk.  I whine about how busy I am and how long the days are; I neglect anything that isn't work-related (thank all that is holy for housekeepers); and I live off of all the foods that I tell my patients to never eat.  I'm about as miserable and self-pitying as an adult can acceptably be.  Possibly more so.

This call period, however, things seem to have shifted, if only the slightest bit.  I hate my life a little less than normal.  My smiles for patients and co-workers are a little more sincere.  I spread a little less misery everywhere I go.

Being caught up on everything at the start of the call period has probably been the biggest contributor to my slightly less horrible than usual mood.  My state of being on top of things lasted for all of one day after I started call, but at the very least I've only had to scramble to keep up with the additional work of call*, rather than struggling not to drown under call work and leftover work from the weeks before.  There is comfort in knowing that, at the absolute worst, I'm no more than two weeks behind on things.

The slight reduction in overwhelm at work has carried over into not feeling like I want to die when I get home, which in turn has led to me actually doing productive things in the evening.  Where normally I would binge watch Gilmore Girls with a peanut butter chocolate Drumstick** in my hand, I've actually gone for walks to enjoy the beautiful Spring weather.  I've done dishes.  I've paid bills.  I'm actually adulting!

Maybe forty will be the year that I actually grow up?

*Unsuccessfully, of course.

**Immediately after writing this I ate a peanut butter chocolate Drumstick.  Because I'm only human.  I would've turned on Gilmore Girls, but the girlfriend isn't home, and I think watching our show without her is probably grounds for divorce.

Parkinson's Law

Subtitle:  Work expands so as to fill the time available for its completion

Just over a year ago, I wrote smugly about how I had gotten caught up on all of my tasks at work and about how wonderful it felt.  At the time, I fully intended to keep up with everything, always and forever, so as to keep the wonderful feeling going.

I think I may have lasted a month.

Inevitably, I got behind during a busy time at work, and then I never seemed to have enough time or motivation to get caught up again.  So for most of the past year, I've left work every day knowing that there were piles of charts and long to-do lists waiting for me the next morning.

For me, the worst part about never being caught up isn't the overwhelming feeling of always having too much to do:  it's the terrible lethargy that comes from doing the same thing over and over again without seeing any progress.  There is nothing quite as demotivating as signing off on a letter, only to be greeted by 50 other letters that need signing off.  For the past year, work has felt like a neverending slog through the same neverending tasks.  Day after day after day.

A few weeks ago, I had a brief but welcome break from the teaching and presenting and administrative duties that fill my non-clinical time.  And I thought to myself "Now!  Now is the time to get caught up again."  So I took the extra time I had and phoned every last patient and dictated every letter and signed off on every chart.  For the first time in way too long, I was caught up.

And I've stayed that way for the past three weeks.  And once again, it has felt amazing.  I feel a little burst of joy every time I open my letter queue and see the words "You have no new letters to sign off".  Or when I look at my empty inbox.  Or when I look at the folders in my desk, and there's absolutely nothing in them.

The second best part of being caught up is that I've regained the efficiency that I had lost.  When I have just a few tasks to do, I can plow through them quickly, knowing that I'm going to get the satisfaction of being done, once again.  And it's much easier to let go of my relentless perfectionism when I know that it's standing between me and being caught up on everything.

The absolute best part?  I get a bonus day off today because I'm done everything!  I was finishing up my tasks yesterday, and I realized that there wasn't anything that needed to be done today, so I didn't have to come in for my usual catch up day in the office.  No dreaded Thursday paperwork day.  I've taken my car in to get the winter tires removed (just a wee bit late), gotten a haircut for the first time in eight months, and now written a blog post.  Next is lunch and then reading for fun.

Life, for this moment at least, is good.

(If you are hating me and my smugness right now, please note two things:  1)  I start two weeks of call on Monday, which is going to destroy everything I just wrote about; and 2) When I say I'm "done everything", I am ignoring the paper I need to write and the CV I need to update and a number of other longer-term tasks that will forever be on my to-do list.  No matter how efficiently I work or how late I stay, there will always be something left to do.)

What is Done, and What is Left to Do

It will probably come as no surprise to anyone who reads my blog that I am feeling pretty burnt out at the moment, as the few posts that I've had the mental energy to write over the past few months have been all about work stress and feeling exhausted and being too much of a grouch to even want to buy Christmas gifts.  I think I've done a decent job of hiding my dissatisfaction at work, but my poor partner, M, has had to put up with some pretty spectacular wallowing when I haven't been working.  It is frustrating, and frightening, to have put 16 years into training only to find myself feeling this level of unhappiness with my work.

So I've been thinking a lot (i.e. pretty much all the time) about what to do about it.  I've been reading blogs and journaling and talking M's ears off in an attempt to figure out some way of becoming happier.  (I haven't been exercising or meditating, of course, because those things might actually work.)  I even bought a book about physician burnout, despite absolutely hating the last physician burnout book I read.  And, much to my surprise, the book has been kind of helpful.

One of the ideas in the book is that, as physicians, we are always focused on what remains to be done: how many letters we need to dictate, how many patients we need to see, how many bloody multi-page forms we need to fill out.  By constantly thinking about what still needs to be done, however, we inevitably feel like we aren't accomplishing anything, and we get discouraged by the seemingly neverending to-do list.  Instead, we'd be much better off putting our focus on what we've already done, so that we are positively celebrating our accomplishments instead of always negatively dreading the work to come.

It's a pretty simple idea, and it requires pretty minimal energy and absolutely zero time, so I decided to try it out this week.  No longer was I going to count the patient files on my desk that needed to be dictated (about 20 at current count); instead, I was going to count the ones in my outbox that were already done.  Instead of focusing on the number of patients remaining to be seen, I was going to focus on the ones that had already been dealt with.  Pay attention to the positive, not the negative.

It sounds cheesy to even write this...but it kind of helped.  It made me realize that my list of things that I have already accomplished is pretty enormous, and it dwarfs the few hours of paperwork that I left undone at work on Friday.  It felt surprisingly good to be a bit of a cheerleader for myself, instead of the evil taskmaster who is always yelling at myself to work harder! and faster! and better!

It worked so well that I decided to apply this mindset to an area of my life that causes my unnecessary anxiety:  my finances.  I'm in pretty good financial shape for being 17 months into practice, yet I waste a lot of energy thinking about how far away I am from being able to retire.  This week, instead of constantly thinking about the minimum of 10 years of work that I will have to do to save up a decent retirement fund, I took a few minutes to list the major financial accomplishments I've made over the past 17 months:

• Saved up enough money in my investments that I could pay off my line of credit if I wanted to;
• Saved up enough money that, between M and me, we can make a 20% downpayment on a nice house in our chosen neighbourhood; and
• Saved up enough money in my investments that I could live at my current level of spending for approximately one year (or for a very long time if I stopped eating out so frequently).

That list makes me feel vastly better than saying to myself "I have to work at this miserable job* for another 10 years before I will feel happy again" all the time.

I know that there are still a lot of things that I need to do to feel happier with my work, but I think that changing my mindset has been an important first step.  Despite being on call again this week**, I've been in a much better mood than I have been since my really stressful department meeting.  I now have six weeks of no call, which includes a one-week trip to Cuba, so hopefully there are even better things ahead.

*My job isn't actually all that miserable.  I'm just feeling so exhausted by it that I am having a hard time seeing the good things.  Which I'm working on.

**I sat down this week and figured out just how much call I've been doing lately, and I realized that I've been on call 1/3 of the time for the past 3.5 months.  That's the amount of call that I should be doing in a 6-month period, and it's equal to the maximum amount of call that a resident is allowed to do.  Suddenly I don't feel so guilty for feeling tired!  As a result of this realization, I've reviewed my call schedule for the upcoming year and identified a few similar problem periods that can hopefully be improved by a bit of swapping with my colleagues.

Surviving Call

When I wrote my most recent blog post, I was feeling a little bit smug about how well my life was going.  I was exercising, I was feeling calm, and my relationship was in pretty much the best state it has ever been.  I was happy.  I was about to start an 11-day stretch of 24-hour-a-day call, but I felt ready for it.

I've got this, I thought.

Except I didn't.  It took less than one day of teaching residents, and rounding on inpatients, and answering outside calls (all while still running my normal outpatient clinics) for me to return to my usually high stress level.  I went to a movie with M and a friend the evening of my first day of call, and I spent the entire time stressing about work and feeling annoyed that the two of them were calm and actually enjoying themselves.  (How dare they?)  After weeks of respite, my mind was back to ramped-up panic mode.

And that's where it remained for most of my 11 days on call.  I worried and obsessed over the decisions I was making.  I felt stressed by the increasing pile of undictated charts piling up on my desk.  I lay awake at night rehashing everything I had done and questioning whether I was, in fact, good enough.  As it often is, it was awful.

And of course, my life outside of work suffered.  My relationship that had, until that point, been ticking along nicely, suddenly struggled.  I was short-tempered.  Everything she did seemed wrong and irritating.  I had moments of panic that I was making the wrong decision about staying with M, even though a few short days earlier everything had been going really well.  Also awful.

In the past, my approach when I've felt this way on call has simply been to count the days until it's over and to feel thankful that I'm only on call for 10 weeks a year.  Now, having been through some counseling, I realize that there are things that I can do to make the tough parts of my life better, and I'm no longer happy with the grin-and-bear-it approach to call.  I want my life on call to still feel okay.

So I've been thinking a lot about the things that I can do to make call less awful.  This is what I've come up with so far:

Undercommit:  I am about as introverted as introverts get, and as a result, I need a lot of time to rest and recover from activities.  Evenings on my couch with a book and my cats are as essential to me as vitamins.  This is particularly true when I'm on call and I'm dealing with a lot more people, decisions, and uncertainty than I do in my ordinary life.  Unfortunately, I have a bad habit of making just as many plans when I'm on call as when I'm not, even though I know that my work life will use up most of my capacity to function in the world.

The other downside to making plans when I'm on call is that I hate disappointing anyone.  Somehow the pager always goes off when I'm getting ready to go out with M, and I hate making her wait for me or (worse) do things without me.  It makes me feel like a terrible partner, even though she is incredibly patient and supportive and never says anything that even implies that she's disappointed that I got paged and our plans had to change.

I'm not saying that I won't ever make plans when I'm on call, but I do need to be very cognizant of my limitations.  I need to plan much less than I often do, and I need to leave enough couch time to recover from my days.

Keep moving:  It always comes back to this.  Exercise is good.  I need to do it.  Regularly.  End of story.

Talk to M:  I have a really good partner who is loving and supportive and a good listener.  I always feel better after talking with her, and I need to get better at being open with her about how tough my work life can be.

Let things go:  The low point of this week was on Tuesday night, when I really needed to just relax and recharge, but I had a slow cooker of pork that was waiting to be turned into pozole.  I normally love cooking, but I resented every minute I spent chopping and frying and pulling pork instead of reading a book.  And the resentment was completely unnecessary, as there are clearly foods that are much easier to make than homemade soup!

I need to let go of the idea of myself as someone who always cooks elaborate whole foods from scratch.  I can eat a fried egg with toast or a frozen fish fillet and the world will not end.  Pozole can wait for a week when I'm not on call.  As can many other things.  Call weeks should be about doing what is necessary, not what is perfect.

Recognize my irrationality:  I am an anxious person, and I am only now starting to realize just how detrimental a role anxiety plays in my life.  When I'm in the extremes of my anxiety, it can lead me to think really irrational things.  Like that my relationship may not be a good one.  Or I'm not cut out to be a doctor.  Or I'm going to end up on the street if I don't hoard every penny I earn.  Thankfully, I'm learning to distinguish between true facts and crazy anxious talk, and I'm learning not to listen to the latter.

Keep going to counseling:  I am somewhat amazed at the difference that six counseling sessions made in my life.  It probably saved my relationship with M.  It certainly made work better.  It was worth vastly more than the $480 it cost, particularly because the cost was covered by our provincial medical association.

Unfortunately, the medical association only pays for six sessions, so I stopped going after the sixth.  Which is UTTERLY AND COMPLETELY STUPID OF ME, because I can still afford to go.  I spend $80 in restaurants without batting an eye, so I can spend $80 on a counseling session.

UTTERLY AND COMPLETELY STUPID.  (I'm looking at you when I say that, Solitary.)

For now, call is done, and I am recovering on my couch with my computer/books and Callie.  It is taking all of my self restraint to not add 85 other activities into my day (dishes! groceries! laundry! coffee with friends!), but I know that I depleted all of my reserves over the past 11 days, and I need to replenish them.

Hopefully my next time on call will be better.

The End of Budgeting?

My budget is currently sitting at $294.13 in the red.  A year ago, when I was just starting to work and I was trying to dig myself out of nine years of medical school debt, this would've caused me to panic.  Or more realistically, I never would've gone $294.13 into the red.  I would've eaten rice and beans and said no to get togethers with friends to keep myself from ever going over budget.

Now, I barely notice.  When I hit a positive net worth, my stress level about money dropped, and I have gradually gotten less and less worried about money as my savings have climbed.  Slowly, I've reintroduced things into my life that I've forgone over the past two years:  fancy drinks in restaurants, expensive cheeses, clothing of any sort.  And it feels really nice.

I'm not entirely sure what to do about budgeting at this stage.  Even with being over budget, I'm saving over 2/3 of my earnings, so I am more than meeting my financial goals.  I don't really have to budget anymore; and yet, there is part of me that doesn't want to abandon budgeting altogether.  Part of it is for the reasons I outlined in a long ago post about why I continue to be relatively frugal.  But it's more than that.

I think a huge part of me worries that I'll go back to my terribly consumeristic ways if I stop budgeting.  Before I started budgeting two years ago, I had developed an almost instinctual habit of buying whatever I wanted.  Whether I was shopping for clothes or eating in a nice restaurant or ordering books online, I would simply buy whatever appealed to me in the moment with the knowledge that it was going on my line of credit and I wouldn't have to pay for it until I was an attending*.  I would take whatever boredom or loneliness or exhaustion I was feeling and try to spend it away.  Always unsuccessfully.

Starting to budget made me much more mindful of my spending.  It made me realize that I often wasn't looking for a new thing when I went shopping, but rather for some feeling that I was missing.  A lot of the time, the best thing I could do when I felt like buying something at random was to just go have a nap, as I've been chronically tired since my first day of medical school in 2006.  It also made me focus on non material ways of being happier, rather than on buying a new pair of happy socks.  (Although I really love happy socks.  And am now searching their website thinking about placing an order.  Well done, me.  You've clearly learned your lesson.)

I guess what I'm looking for is some way to be intentional with my spending while not feeling constantly constrained by my budget.  I want to take advantage of the fact that I'm earning ridiculous amounts of money for a single woman with no dependents, without thinking that I can somehow buy happiness.  Balance.  The endless search for balance.

Any ideas?

*Thank you very much, past me.  You are an asshole.

---

To update you on my habits from a few weeks ago, I've been doing surprisingly well with them.  I have completely resisted the cans of Coke in my fridge, and I've passed on pop multiple times in restaurants.  I am allowing myself to have pop in mixed drinks (something I decided to do in the beginning but didn't mention in my previous post because I was lazy), but in total it's been about one can of pop since I started.  I almost always put my things where they belong when I get home, which has made leaving in the morning much more efficient and peaceful.  I've also started putting my keys/wallet/phone in specific spots in my bag (my bag has about 8 different spots, so searching for something can be frustrating), and that has also been a huge improvement.  Finally, I have planned out my weekly schedule every Sunday night, and it has given me a bit more awareness of the week and a big more structure.  It also saved me from missing dinner with a good friend this week (I thought it was on Thursday, but it's actually on Tuesday), so that is also a win.

Well done, me. 

Happiness Over Money

Years ago, soon after I had started medical school, a friend of mine who is a physician came in from out of town for a visit.  During his stay, I inundated him with questions about medicine and work life balance and time off for physicians.  When the subject of vacation came up, I was quite surprised to hear that he could take almost as much time off as he wanted to, but he didn't.  It was, he said, too hard to give up the money.

At the time, I didn't understand.  I viewed vacation as a wonderful time of happiness and freedom, and I couldn't imagine passing it up for more money when doctors already make lots of money.

Fast forward eight or nine years, and I understand completely.  When the amount you earn is directly proportional to the amount you work, and especially when you still have 5-10 years of debt repayment ahead of you, it's really hard to justify time off from work.  Every day off is a calculation: 

One half day of clinic x X patients/half day x $Y/patient = I think I'll go to work.  

It's so easy to look at that calculation and think that I don't need a vacation and that it's okay for me to miss out on the things that make me happy.  Except that I do.  And it isn't.

So I'm learning to value my time more than my income.  It started today, with cancelling a half day clinic so that I can go to a really interesting conference on work life balance.  And then, emboldened by that decision, I decided to take an entire week off during our local theatre festival.  A week!  It took me hours to commit to the decision, but now that I've made it, it feels right.  It feels entirely right for me to make time for something that I love that gives me joy.

After all, why else am I here?

Why I Continue to Live the Frugal(ish) Life

One of the best people I met during my fellowship training was our Educational Coordinator, S*.  S is slightly older than I am** and married later in life, so she could empathize with me during both the single-career-woman-looking-for-love and the single-career-woman-falling-in-love stages of my training.  She was also a huge advocate for me and the other fellow, which was invaluable in dealing with a system that was often indifferent and occasionally blatantly hostile to its trainees.  When I finally finished my training, one of the few things that made me sad was no longer working with her on an almost daily basis.  (Everything else was bliss.)

While I liked S from the very beginning, I really bonded with her after I abandoned my spendy ways and started living more frugally.  She would stop at my desk to chat fairly regularly, and one day we got talking about money after she caught me binge reading the great Mr. Money Mustache.  It turned out that she had learned to be frugal while living as a single person, and she'd carried that approach into married life, such that she and her husband currently live off a single income and bank the second one for retirement.  Over the remaining months of my fellowship, we talked regularly about the freedom that comes from living well below your means and about all the sources of happiness that don't require money.  In a financial sense, she and I clicked.

Which is why I was surprised the other day when I ran into her in the hallway, and she asked me "Are you getting used to living like an attending now?"  Her assumption, like everyone else's, was that I had abandoned frugal living as soon as my first fee-for-service patient entered my clinic.  In reality, for anyone who is curious, I'm living on almost exactly the same budget as I did during fellowship***, and every additional dollar I earn is either getting saved or applied to my debt.  Which makes many people (my accountant, my financial advisor, my spendthrift physician friends) ask me "Why?"  They point out, quite legitimately, that I could afford to be more liberal with my spending and to buy a house and a car that doesn't have a giant chunk out of its rear end.  They simply don't get why I keep living like a fellow despite my attending's salary.

For me, the answer is easy:  choice.  As long as I am in debt, as long as I am spending most or all of the money that I earn, then I have to keep working long hours as a physician.  If I buy the big house and the fancy car, then I'm always compelled to earn a high income to pay for them.  Which isn't so bad now, when I'm fresh from training and still somewhat keen, but who knows how I'll feel in 10 or 20 years.  Maybe I'll want to stop working full time and take three-day weekends every week.  Maybe I'll be sick of my subspecialty and want to retrain in another field.  Maybe I'll burn out altogether and want to move to the West Coast to smoke pot.  Who knows?  All that I know is that saving money now, and living on less, means that I can practice medicine because I choose to, not because I have to. 

Even in the short-term, frugality makes life better.  I can work at an inner city clinic, where I earn slightly less ridiculous amounts of money than I would at a tertiary care centre, because I don't have to maximize my salary at the expense of my happiness.  I can say no to extra weekends of call, even though I usually don't****.  I can sleep better at night knowing that I'm within a few months (maybe as little as two?) of having a legitimately positive net worth, even without counting my car.  All of this is way better than a $30 bottle of wine or a $200 dinner out. 

And let's be honest:  I'm really just pretending to be frugal.  I'm not living a Frugalwoods life of 10-cent rice and bean lunches over here.  I'm living off of more than the average family in my city.  I'm traveling to the Middle East in May, and I'm going out for Korean food tonight, and I'm buying weekend passes to our local music festival instead of volunteering.  As my accountant said recently, I'm living a "relatively modest" life.  It's only in comparison to the crazy excesses of many doctors that my life is in any way frugal.  And for that, I'm very lucky. 

*I'm so creative with the names.  You're welcome.

**5 years?  10?  15?  I'm terrible at guessing ages.

***I added $200 per month to my travel budget, because we love to travel and have some big trips planned this year, and I threw a bit of money at my budget to make up for the Great November Debacle so that I wouldn't have to spend a year recovering.

****That will happen once I hit a positive net worth.

Montreal

I'm sitting in a hotel room in Montreal, awaiting dinner with a friend (in 1 hour) and the start of a conference (tomorrow morning), and I am struggling to write one of the blog posts that has been floating around in my brain for the past few weeks.  I want to write about how it feels to be six months into my work as an attending, about my struggles to start up a research program, or about my recent two-year anniversary, but all my brain and body want to do is rest.  In the past two weeks, I've taken on three extra clinics and an extra weekend of call, and while my net worth is very happy about the additional work, the rest of me is not.  I'm exhausted.

This past weekend, my girlfriend and I had a long discussion about careers and life goals and what is important to us.  Both of us want to do work that is meaningful and that hopefully makes the world a slightly less miserable place, but we also want to have full lives outside of our work.  We want to sleep in on weekends and cook good homemade food and read books and knit*.  And maybe even do productive things like exercise and clean our messy apartment.  If we run out of fun things to do, that is.

At the moment, it feels like what I want to do is always in conflict with what I need to do (work).  I wish at times (always) that I could go back a decade and live more frugally so that I would have actual money now, instead of debt, and would feel like I could take more time to myself.  I keep hoping that hitting the zero net worth mark will bring about a major change in how I feel and how I approach work.  I'm hoping that it will make me feel okay with saying no to the extra clinic time and the extra weekends of call.  Because while I like my job, I love my life outside of it more.

*Well, I want to knit.  Specifically this, in a gorgeous grey yarn that is ridiculously expensive but will be worth it because it will undoubtedly take me at least six months to knit the scarf, thus keeping the cost per hour of knitting very, very low.

Book Review - Doctored

"Among my colleagues I see an emotional emptiness created by the relentless consideration of money.  Most of us went into medicine for intellectual stimulation or the desire to develop relationships with patients, not to maximize income.  There is a palpable sense of grieving.  The job for many has become just that - a job."

 

At the end of my recent pseudo-holiday (home call but no clinics), I picked up the book Doctored:  The Disillusionment of an American Physician by Sandeep Jauhar.  I can't recall now how I discovered this book, but it was in my list of books to read at my local library, and it had been a while since I'd read anything at all medical, so I decided to order it.  The book is the autobiography of a junior physician who is starting his practice as a Cardiologist in New York City.  In the beginning, he is idealistic and has big plans for improving the care of patients with congestive heart failure at his hospital.  As time goes on, however, he quickly realizes that the salary of an academic physician isn't enough to support a wife and a growing family in Manhattan, so he starts taking on more and more work to try to cover his bills.  First it's paid lectures for pharmaceutical companies, then it's moonlighting with a private practice physician reading stress tests and echocardiograms.  Very quickly, he finds himself becoming burnt out and depressed as he spends too much time doing work that he doesn't love.

I loved this book.  Part of it was the perfect timing of discovering a book by a junior physician (especially a nerdy internal medicine sub-specialist) at precisely the time when I'm starting my own career as a junior physician (and nerdy internal medicine sub-specialist).  I could relate to the sense of uncertainty about how to structure one's career and to the testing out of different things (like paid lectures for pharmaceutical companies, which is an entirely different post) .  I understood his desire to finally start seeing the financial payoff for all of the years of training and his cognitive dissonance at suddenly viewing the patients he cared about as sources of income.  In reading the book, I started to forget that I was reading and to feel like I was sitting in a coffee shop commiserating with a friend about how medicine hadn't turned out the way we had hoped it would.

What I liked best about the book, though, was the solution that the author arrived at.  Without giving too much away, I will say that the book isn't just a rant against modern medicine and the failings of the American medical system.  Instead, it's an exploration of what it means to be a physician and of how physicians can find happiness and purpose in an imperfect system.  It's realistic yet hopeful in exactly the way I needed it to be.  I may actually go against my plan to avoid buying books and get myself my own copy so that I can read it again.

At the very least, I'm adding Sandeep Jauhar to the list of people that I'd invite to dinner if I could invite anyone.  I think he, Gandhi, and my Dad would make for some interesting dinner conversation. 

"How to prevent the burnout that is so widespread in the profession?  There are many measures of success in medicine:  income, of course, but also creating attachments with patients, making a difference in their lives, providing good care while responsibly managing limited resources.  It is whether you find that meaning in your work that determines whether you feel successful or not."