After borrowing extensively to complete my education, I finally get the opportunity to begin repaying these debts. As I watch the health care debate play out, I hope for the best from both a patient and physician perspective.

The healthcare debate has made me all to aware of the power of the rule makers to affect my livelihood. Dependent upon the outcome, it will be very interesting to see how smart of a decision I have made in my choice of a career.

Regardless of the outcome, I am confident in my ability to become successful.

• Forbes ran an article last month addressing the major concerns facing most physicians right now.

• There is a large divide between the generations of physicians currently in practice and those such as myself entering the work force.

As a resident who has yet to enter the work force I am very conscious about physicians and our attitudes towards our work environment.

I personally believe that myself and many of my colleagues made an “investment Mistake” when we entered medicine.

We thought the past performance of physician salaries would guarantee future results.

From a pure investment point of view my choice to go to medical school will likely be a poor decision compared to the career choice of others.

The current trends in medicine are creating a type of job security that no-one wants: Being relatively underpaid and overworked.

If not for the satisfaction that a physician gains from developing a skill and learning to perform this skill well for the benefit of others, the future of our health care system would be bleak.

The good news for me is that I still enjoy what I have chosen to do and realize that I have the freedom to pursue better opportunities should they arise.

I was surprised to see this in one of their articles:

even a $100,000 debt is a reasonable trade-off for a medical degree

This is the foundation of this blog. As I approach 30y/o our family’s net worth remains negative, mostly due to my educational costs and some poor finacial decisions in residency.

I have a hunch that I should be able to play catch up over the next decade but the long term picture of my career choice is hazy. I sense some discomfort among some of my collegues about the brewing health care crisis and the push for socialized medicine.

We shall see. There are no guarantee’s for tomorrow but I’ll keep you up to date.

Those who could wait the fifteen or twenty minutes for the experimenter to return would be demonstrating the ability to delay gratification and control impulse. About one-third of of the children grabbed the single marshmallow right away while about another one-third were able to wait 15 or 20 minutes for the researcher to return.

Years later when the children graduated from high school, the differences between the two groups were dramatic: the resisters were more positive, self-motivating, persistent in the face of difficulties, and able to delay gratification in pursuit of their goals. Those having grabbed the marshmallow were more troubled, stubborn and indecisive, mistrustful, less self-confident, and still could not put off gratification. They had trouble subordinating immediate impulses to achieve long-range goals.

Every July I get a quick reminder of a different form of delayed gratification……SLEEP. Anyone who has had to take overnight call and function at a high level for 30-40 hours strait can truly appreciate just how great a full night’s sleep can be. I might not be any richer but waking up refreshed after a brutal call is just a wonderful feeling. Just another crazy way of practicing your skills of delayed gratification.

See you all in the morning.

Here are some of the key points:

“About 150 years ago, Americans were dying from old-fashioned infectious-disease epidemics. Between 1813 and 1850 in Boston, Philadelphia, New York, and New Orleans, death rates increased by 42 percent thanks to such burdens of newly industrializing cities as crowding, dirty water, and open sewers. Cholera epidemics killed people by the tens of thousands.

The age’s medical experts didn’t actually know much about the causes of such diseases or how to fight epidemics. But noticing that poor immigrants in the filthy slums of port cities like Boston and New York were particularly likely to get sick and die, they concluded that their eating and drinking habits were “intemperate”; that, as public health historian John Duffy writes, “the basic problem with the poor lay in their lack of moral fiber.” The poor had no one but themselves to blame for their diseases. They needed to be taught a combination of personal hygiene and resistance to sin.”

Then Edwin Chadwick published The Sanitary Conditions of the Labouring Population, which argued that miserable working and living conditions made the poor sick and argued for ensuring clean water, building sanitary sewers, removing animal carcasses, and providing decent housing.   The result was a virtual elimination of the infectious disease epidemics and between 1850 and 1915, death rates fell by 55 percent.

The solution was public health reform which was undertaken for people, rather than by people.  As a society it may clear our conscience to say that obese people can control their habits in eating and exercise, but it will not touch the epidemic

If we are to “cure”  obesity it will take another great public health reform but there’s our cherished individual freedom. Some of our fierce individualism spills over into a vague feeling among eminently reasonable Americans that the government shouldn’t be telling its people where they can or can’t put a vending machine, and also translates into the sense that health is an individual responsibility. 

If we keep this attitude it will not be long before obesity is killing far more than 325,000 Americans a year.

Last week was one of those weeks that I thank those who came before me and the ideas they instituted, which include the ACGME 80 hour work week and the invention of online bill pay. These two developements coupled with direct deposit enabled me to:

1. automatically deposit my paycheck without ever being off during banking hours
2. Pay my Rent, credit card bills and electricity without ever having to check my mail

I would have never been able to accomplish those tasks during normal banking hours which were not intended for anyone working  their way up the career ladder.

My second thought last week was that I don’t think the point of making saving/investing automatic and effortless can be emphasized enough. As humans for whatever reason we tend to gravitate to the path of least resistance. Every respected financial writer makes automating your savings a point of emphasis, yet I still have managed to rationalize not doing yet.

My current reason is that I am using my excess income to pay down my credit card debt and develop an emergency fund before I automate my investments. Is this a rational reason, for me at this time, yes but it does not follow the principle of “pay yourself first”

Once again I have this funny feeling that my life is an example of why markets are not completly efficient and most American’s are not prepared for retirement.

Hope you are having more luck with this than I am.

I want to be clear, I do earn an income as a Resident and I definitely work enough hours for it to classify as a job, but because residency is a formal continuation of the education process(an apprenticeship basically) I don’t want to call it my “real job” just yet.

One of the quirks about a career in medicine is that, by the time most of your friends have switched jobs a couple of times , been laid off once or twice or decide to go back to school, you will be getting ready to start your career.

I realize that by the time I finish my training I will have spent half over half of my working life just getting ready for the show.

This prolonged education has some obvious effects on your finances. The one that always gets the headlines is the six-figure debt a large number of us accumulate in the process of completing our degree.

It is easy to focus on this negative number and the relatively late start to a career and blow it out of proportion while ignoring the positives of pursuing a satisfying career.

The parallel question in the business sector seems to be whether it is financially worth it to go back to school for an MBA. Other bloggers have mulled over this question before.

• Franky is leaning on not going back for his MBA here
• On workthing 5 people share their perspective retrospectively and all seem to think it is worth it

As one of my attending physicians once told me: “its rare that you will look back and regret being as educated as you are.” With that perspective, it probably is worth it, IF you can afford the time.
Nothing earth shattering here, just a thought as I approach 30 and eventually my first real Job.