Gratitude - Reflections of a disgruntled ER doctor

[cyanide12345678]

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And there it is.

Feel like most people here aren't in the situation.

My wife has only been out of training 4 years. Plus she has worked part time most of that.

Id probably be around 2.3M-2.4M in net worth even without her - probably more. In fact, without a wife and kids, i wouldn’t be spending 40k/year on childcare either and wouldn’t be living in 6000 sqft home. Would likely still be living in a small apartment.

Me as a single individual likely only needs 40k a year. Me as a family of 4 has spent 130-140k/year.

Reality is i learned options and beat sp500 by 2x in the first 4 years of trading. I had 1 year where i gained 70%. Last year was my only year where i under performed sp500.

It is not coincidence that my trader account is already up 3% compared to 0.6% spy for the year. It’s actually a skill developed over hundreds of thousands of trades. My most prolific trading year - i bought and sold 180,000 contracts. It’s a learned skill through practice.

Id actually have hit 3.5M net worth today at age 37 had i not invested 650k in real estate syndications (4 of which are likely worth $0 currently). So the 2.8M is actually after some poor timing with real estate.

You live and you learn. You’re not taking enough risk if you haven’t had Big losses.

So no, it wasn’t all because im married to a doctor. It’s because I’ve dedicated my life to learning personal finance and trading and is something I’m genuinely passionate about.

 

[cyanide12345678]

So now I do eyes.

But because of that, I didn’t start making reasonable EM money until like PGY-8.5, and 5.5 years of good pay and compound interest is hard to claw back. I see the discontent, but as in multiple examples above, it can be a pretty good financial move.

5.5 years of compounding is really hard to claw back because those also luckily happened to be the best investing years in the history of sp500.

Though you’ll have a 30 year career and will eventually claw it back and then some.

You made a better decision. 100%

 

[JacobMcCandles]

It is not coincidence that my trader account is already up 3% compared to 0.6% spy for the year. It’s actually a skill developed over hundreds of thousands of trades. My most prolific trading year - i bought and sold 180,000 contracts. It’s a learned skill through practice.

At first I thought you were joking about performance over 4 trading days…

 

[WhatJobDoIPick]

My wife has only been out of training 4 years. Plus she has worked part time most of that.

Id probably be around 2.3M-2.4M in net worth even without her - probably more. In fact, without a wife and kids, i wouldn’t be spending 40k/year on childcare either and wouldn’t be living in 6000 sqft home. Would likely still be living in a small apartment.

Me as a single individual likely only needs 40k a year. Me as a family of 4 has spent 130-140k/year.

Reality is i learned options and beat sp500 by 2x in the first 4 years of trading. I had 1 year where i gained 70%. Last year was my only year where i under performed sp500.

It is not coincidence that my trader account is already up 3% compared to 0.6% spy for the year. It’s actually a skill developed over hundreds of thousands of trades. My most prolific trading year - i bought and sold 180,000 contracts. It’s a learned skill through practice.

Id actually have hit 3.5M net worth today at age 37 had i not invested 650k in real estate syndications (4 of which are likely worth $0 currently). So the 2.8M is actually after some poor timing with real estate.

You live and you learn. You’re not taking enough risk if you haven’t had Big losses.

So no, it wasn’t all because im married to a doctor. It’s because I’ve dedicated my life to learning personal finance and trading and is something I’m genuinely passionate about.

This started as a thread about gratitude and has gotten sorta cringe. So your wife is a net financial negative? Weird thing to say. Seems like you/wife have a spending problem. Why do 4 people need a 6k sq ft house? You or your wife could easily quit right now and be a SAHD/M; there goes the child care cost.

Why do so many people have this fixation on "seeing the world?" I like travel too, but lots of beauty in the US and a lot less expensive to get to.

I don't need 10M NW. If I get to that magical 5M by 50 that @emergentmd references I'll be very very happy.

I dunno man. Me / wife / kids happy with 2,500 sq ft home, mostly domestic travel (some international sprinkled in), sub 30k car, without outsized risk taking or exploration of fringe / scammy alternative income streams like GLP1 slinging or nursing home stuff that I'm not qualified enough to do a good job at.

 

[emergentmd]

Many years ago I was considering EM during the height of its popularity. My school had a good department and we sent a ton of kids to residency every year. I asked for a shift to get a feel for things, and got paired with a really cool young doc who I thought had the best lifestyle ever. Only worked 10 overnight 8’s a month, no supervision, high volume but low acuity, no research requirement, still got 1.0 FTE and bonus for some EMS or tox or something when they wanted.

The shift was good. The doc asks me if I’m still interested and I say yes. They stopped charting, stared deep into my soul, and told me to never say that again and do anything else.

So now I do eyes.

But because of that, I didn’t start making reasonable EM money until like PGY-8.5, and 5.5 years of good pay and compound interest is hard to claw back. I see the discontent, but as in multiple examples above, it can be a pretty good financial move.

When picking a residency, I was down to anesthesiology vs radiology vs EM. 4 vs 5 vs 3 yrs. As they all seemed attractive, I went with the 3 yr. Time is valuable, money compounds, I was at least able to salvage some of my 20's. Delayed gratification sucks.

So I started 600K ahead of a radiologist and as I would have specialized in IR, prob closer to $1M. It is hard to overcome $1M and time.

My niece just finished a transplant residency and now an attending at about 32 or 33. She is exceptional and IQ greater than mine for sure, but holy crap, that is a lot of sacrifice and training. It would take the better part of her 30's/40's to ever catch up financially.

 

[cyanide12345678]

At first I thought you were joking about performance over 4 trading days…

Except I’m not

Ytd gain attached as of today 10:48 am.

13k through buy and hold
12k through trading

All trading gain reinvests into gpix - spins off another 6-8% yield through covered calls.

 

[Franzd'Epinay]

This started as a thread about gratitude and has gotten sorta cringe. So your wife is a net financial negative? Weird thing to say. Seems like you/wife have a spending problem. Why do 4 people need a 6k sq ft house? You or your wife could easily quit right now and be a SAHD/M; there goes the child care cost.

Why do so many people have this fixation on "seeing the world?" I like travel too, but lots of beauty in the US and a lot less expensive to get to.

I don't need 10M NW. If I get to that magical 5M by 50 that @emergentmd references I'll be very very happy.

I dunno man. Me / wife / kids happy with 2,500 sq ft home, mostly domestic travel (some international sprinkled in), sub 30k car, without outsized risk taking or exploration of fringe / scammy alternative income streams like GLP1 slinging or nursing home stuff that I'm not qualified enough to do a good job at.

These are really bad-faith criticisms.

He's clearly not complaining about his wife, just clarifying his financial set-up, which many people here are curious about.

He's also only spending $140k/yr for a family of 4 which apparently includes a 6k sqft house and 40k in childcare. All your criticisms about opulence/excess are moot.

 

[emergentmd]

I dunno man. Me / wife / kids happy with 2,500 sq ft home, mostly domestic travel (some international sprinkled in), sub 30k car, without outsized risk taking or exploration of fringe / scammy alternative income streams like GLP1 slinging or nursing home stuff that I'm not qualified enough to do a good job at.

I will hit $5M brokerage account/cash liquidity before the end of the year short of some market crash. I have been presented with many opportunities but b/c money is not a motivating factor anymore, I almost always say no. I will say I still enjoy of the game of building something. Was recently offered an opportunity from someone I know is hard worker and I invest in the jockey vs the horse. Told him, I will invest but will do very little work.

My joy now comes from doing a little clinical work, but most comes from being around my 3 teenagers who sadly will be out of the house in the next 5 yrs. Playing lots of golf. When they are all out to college, then my wife/I will be doing some serious travelling.

 

[cyanide12345678]

Why do 4 people need a 6k sq ft house? You or your wife could easily quit right now and be a SAHD/M; there goes the child care cost.

You’re likely white and have Different values.

But here’s how my Pakistani household functions.

wife’s parents immigrated to US. Now living under our roof indefinitely.

My parents when they visit and stay 6 months in the US - they will stay here.

My wife’s sister and her husband, they visit one or two weekends a month from 4 hours away and stay here.

Once a year my brother’s and my sister’s family of 4 will visit too - and most likely when my parents are here. We will officially be needing air mattresses at that time because we will run out of bedrooms but will make do.

One of my high school friends used to live 3 hrs away and spent at least 1 weekend per month here.

Our home is a revolving door with people coming and going. It’s the hub for our Pakistani family.

Similarly - if I’m going to Toronto (brother) or Boston (sister) or Nashville (sister in law) I’m not staying at a hotel. I’m staying with my family. That’s just normal Pakistani homes.

 

[cyanide12345678]

These are really bad-faith criticisms.

He's clearly not complaining about his wife, just clarifying his financial set-up, which many people here are curious about.

He's also only spending $140k/yr for a family of 4 which apparently includes a 6k sqft house and 40k in childcare. All your criticisms about opulence/excess are moot.

Yeah it’s 6000 sqft purchased for 620k back in 2021 at 2.75% interest rate in a cheap fly over part of the country. It wasn’t ‘beyond our means’ by any means.

 

[cyanide12345678]

These are really bad-faith criticisms.

He's clearly not complaining about his wife, just clarifying his financial set-up, which many people here are curious about.

He's also only spending $140k/yr for a family of 4 which apparently includes a 6k sqft house and 40k in childcare. All your criticisms about opulence/excess are moot.

My response was only in reference to @VA Hopeful Dr implying that my secret sauce was having a 2 Doctor household. It’s definitely helped. But it’s been a combination of factors

 

[emergentmd]

5500 sq foot home here. Don't have a revolving door of relatives but big get togethers typically prefers our house. Like anything else, don't need but sure like the luxury. We have a 700sq foot master, 450sq feet game room, gym, movie theater, 23ft vaulted ceiling etc.... Once you have it, hard to go back.

 

[JacobMcCandles]

5500 sq foot home here. Don't have a revolving door of relatives but big get togethers typically prefers our house. Like anything else, don't need but sure like the luxury. We have a 700sq foot master, 450sq feet game room, gym, movie theater, 23ft vaulted ceiling etc.... Once you have it, hard to go back.

You spend a majority of your time at home so you might as well enjoy it. I wouldn’t encourage anyone to be house poor or to buy more than they can afford but your home needs to make you happy. I wouldn’t ever buy a primary home through an investment lens but as long as you aren’t moving every 5-7 years you’ll likely come out just fine on it in the end.

 

[cyanide12345678]

5500 sq foot home here. Don't have a revolving door of relatives but big get togethers typically prefers our house. Like anything else, don't need but sure like the luxury. We have a 700sq foot master, 450sq feet game room, gym, movie theater, 23ft vaulted ceiling etc.... Once you have it, hard to go back.

Agreed. Hard to go back. Have had get togethers with 50-60 people inside our home.

Home gym with smith machine, exercise bike, treadmill, free weights and sauna.

120 inch movie theater which i enjoy with my kids and watch movies with them.

It doesn’t cost an arm and leg to live in the mid west.

 

[EMdoc235]

5500 sq foot home here. Don't have a revolving door of relatives but big get togethers typically prefers our house. Like anything else, don't need but sure like the luxury. We have a 700sq foot master, 450sq feet game room, gym, movie theater, 23ft vaulted ceiling etc.... Once you have it, hard to go back.

Your master is equal to/larger than the average NYC apartment lol.. I think my first apartment was like 785 sq foot. I couldn't ever go back to living in such a small space. Now I have a 2800 sq foot house between me and my fiance, and it's perfect.

 

[emergentmd]

Your house is wayyyyyy to big. that is 1400sqft/pp 🙂 while mine is a scant $1100sqft/pp

 

[HemorrhagicShock]

Then compare yourself (well, I guess you can't since you're not EM anymore) to others in this thread who have put themselves in great financial shape all while maintaining their sanity and are pretty happy with their lives.

Exactly what I did when I decided to bail.

I am impressed that you all can continue to do this work for longer than a decade, and I'm glad there's people willing to put up with it for an entire career. Lord knows we need good ER docs who aren't burned out 24/7.

 

[HemorrhagicShock]

Family money.

Not having student loans.

Working 200 hrs / month.

Not having kids

Living in places where 75% of the year you don't go outside

Just build a portfolio c'mon it's simple.

Just marry rich duhhhh

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Your number is normal is is about where I am at the same age. This forum selects for people who like to see big numbers grow either by working an insane amount, or buying a crypto / options lottery ticket and getting lucky, and then making sure you know about it. If you compare yourself to people at your shop at the same age, you'll find you're likely 90th+ percentile. If I had 5M at 38 I would be on a ski mountain, not posting on SDN.

I do think you're correct about this, especially as somebody who did a combination of both the "live-like-aresident" for a few years as an attending + crypto lottery side of that equation.

There's a lot of emergentmd type thinking in this thread that absolutely downplays the importance of right place right time right industry. Of course the hard work and hustle had to be there too, nobody is denying that, but just like in the founder/entrepreneur world, we only hear about the massive wins and the subsequent founder's hand wavy advice about how "anybody can do it."

I'm no stranger to hard work, or smart work, but I also acknowledge there's a huge luck component too, and I don't think enough people in this thread acknowledge that either.

The truth lies somewhere in the middle.

There's a huge selection bias in this thread for sure.

I guarantee you the 90% of people still on this SDN subforum have far less than the average active poster in this thread. Divorce, bad financial decisions, lack of saving/investing discipline (or knowledge), illness/sickness/accidents ruining careers - there are far more of these than emergentmds.

 

[HemorrhagicShock]

The bigger my pile of gold has become, the more discontent I’ve gotten. Something to do with becoming increasingly unnecessary to deal with EM.

This is EXACTLY how I felt once I reached a certain personal NW threshold.

The idea of doing another shift immediately became disgusting to me.

My ability to tolerate on shift BS plummeted.

Yet it still took a few years before I pulled the trigger. Letting the EM doc identity die has taken even longer, it's still not dead.

I don't think it ever will be.

 

[doctalaughs]

The only person i could consider switching jobs with is my ICU friend who made 1.1M last year working maybe 50 hours a week. Together with his ID doctor wife, they pulled 1.3M and paid 500k in taxes alone

The irony though, my family net worth is still almost double his family net worth - and we have a better lifestyle, less work, more travel, more time off. We’re both the same age too.

How do you make 1.3M/ yr and have less than 1.5M net worth (if I’m understanding what you say about his/your portfolios)? Or is this friend like 1-2 year out of training?

My perspective -after 10M it doesn’t make any sense to keep going unless you’d do it for free.

It’s not like lifestyle would change in retirement until you get to 100M+ (not like you can fly private or own mansions all over the world or start doing weird hobbies like expensive art and sports teams and private islands)

 

[cyanide12345678]

How do you make 1.3M/ yr and have less than 1.5M net worth (if I’m understanding what you say about his/your portfolios)? Or is this friend like 1-2 year out of training?

My perspective -after 10M it doesn’t make any sense to keep going unless you’d do it for free.

It’s not like lifestyle would change in retirement until you get to 100M+ (not like you can fly private or own mansions all over the world or start doing weird hobbies like expensive art and sports teams and private islands)

He’s 3 years out after fellowship. He’s also doing terrible investments - buying homes 100% on cash as an investment. Very very very safe, but eh….6% cash on cash return after taxes/hoa/maintenance etc. he’s also literally just sitting on 300k cash. Earning a whopping 0.01% on Chase. Just cash. No investments.

Also i think the real ramp in pay happened this year. First year he was making average icu doc income. This year was some sort of partnership status that happened.

Got him to fire his financial advisor two days ago who was charging 1.3% and had him in a fund with 0.99 expense ratio.

Basically spent 3 hours at his home to fix his financial life, built him a portfolio that he can self manage on m1finance that’s 50% voo, 30% vxus, 10% gpix, 5% vug, 5% ibit. His cash is now sitting in m1finance at 3.5% yield. Set up automated investments, and he will do PRN transfers on top as more cash becomes available.

Financial education matters, he had none. Now he’s learning.

The other big problem with all these Muslims i know, they invest in crap ‘halal funds’ - i asked him if he really really cared about ‘shariah compliant halal only investments’ - he said no. There’s no good shariah compliant halal etf with low expense ratio. Now he’s in sp500 because he actually didn’t care about that - his Pakistani Muslim financial advisor thought he did.

Edit: i told him he had to feed me chipotle to get me to do this. He didn’t even feed me chipotle 🤣 oh well…..

 

[Apollyon]

That's kinda a weird thing to reference IQ several times.

 

[doctalaughs]

He’s 3 years out after fellowship. He’s also doing terrible investments - buying homes 100% on cash as an investment. Very very very safe, but eh….6% cash on cash return after taxes/hoa/maintenance etc. he’s also literally just sitting on 300k cash. Earning a whopping 0.01% on Chase. Just cash. No investments.

Also i think the real ramp in pay happened this year. First year he was making average icu doc income. This year was some sort of partnership status that happened.

Got him to fire his financial advisor two days ago who was charging 1.3% and had him in a fund with 0.99 expense ratio.

Basically spent 3 hours at his home to fix his financial life, built him a portfolio that he can self manage on m1finance that’s 50% voo, 30% vxus, 10% gpix, 5% vug, 5% ibit. His cash is now sitting in m1finance at 3.5% yield. Set up automated investments, and he will do PRN transfers on top as more cash becomes available.

Financial education matters, he had none. Now he’s learning.

The other big problem with all these Muslims i know, they invest in crap ‘halal funds’ - i asked him if he really really cared about ‘shariah compliant halal only investments’ - he said no. There’s no good shariah compliant halal etf with low expense ratio. Now he’s in sp500 because he actually didn’t care about that - his Pakistani Muslim financial advisor thought he did.

Edit: i told him he had to feed me chipotle to get me to do this. He didn’t even feed me chipotle 🤣 oh well…..

You just saved that guy potentially millions of dollars. Definitely worth a chipotle - even with extra guacamole.

I don’t understand why they don’t require basic finance in high school. It’s not like it would take a lot of time and would probably do more for the masses than all this redistribution / tax ideas.

 

[cyanide12345678]

You just saved that guy potentially millions of dollars. Definitely worth a chipotle - even with extra guacamole.

I don’t understand why they don’t require basic finance in high school. It’s not like it would take a lot of time and would probably do more for the masses than all this redistribution / tax ideas.

7 million actually over 30 years.

Showed him a compound interest calculator and the difference between a 7% and 5% return if he invests 240k/year over the next 30 years). With his income, he should definitely be investing that bare minimum.

 

[doctalaughs]

7 million actually over 30 years.

Showed him a compound interest calculator and the difference between a 7% and 5% return if he invests 240k/year over the next 30 years). With his income, he should definitely be investing that bare minimum.

1.1M/yr in icu seems an extreme outlier without working extreme hours and may not be sustainable over 30 years- but yeah. He could easily invest that much a year with much less (hell I get close some years and don’t make nearly that much).

 

[HemorrhagicShock]

He’s 3 years out after fellowship. He’s also doing terrible investments - buying homes 100% on cash as an investment. Very very very safe, but eh….6% cash on cash return after taxes/hoa/maintenance etc. he’s also literally just sitting on 300k cash. Earning a whopping 0.01% on Chase. Just cash. No investments.

Also i think the real ramp in pay happened this year. First year he was making average icu doc income. This year was some sort of partnership status that happened.

Got him to fire his financial advisor two days ago who was charging 1.3% and had him in a fund with 0.99 expense ratio.

Basically spent 3 hours at his home to fix his financial life, built him a portfolio that he can self manage on m1finance that’s 50% voo, 30% vxus, 10% gpix, 5% vug, 5% ibit. His cash is now sitting in m1finance at 3.5% yield. Set up automated investments, and he will do PRN transfers on top as more cash becomes available.

Financial education matters, he had none. Now he’s learning.

The other big problem with all these Muslims i know, they invest in crap ‘halal funds’ - i asked him if he really really cared about ‘shariah compliant halal only investments’ - he said no. There’s no good shariah compliant halal etf with low expense ratio. Now he’s in sp500 because he actually didn’t care about that - his Pakistani Muslim financial advisor thought he did.

Edit: i told him he had to feed me chipotle to get me to do this. He didn’t even feed me chipotle 🤣 oh well…..

I was surprised to learn how many Muslim colleagues (well, previous colleagues) of mine refused to invest in anything that wasn't a Halal fund.

It was a vast vast majority of them too. Didn't realize there was a whole market for culture- and religious- specific investments, but just like the ESG bs from a few cycles ago I suppose it makes sense.

 

[HemorrhagicShock]

1.1M/yr in icu seems an extreme outlier without working extreme hours and may not be sustainable over 30 years- but yeah. He could easily invest that much a year with much less (hell I get close some years and don’t make nearly that much).

It's not a sustainable number if you talk to anybody who is in the ICU game right now. Their market is quickly drying up as eICU and crit care midlevels become the preferred way to cover rando ICUs.

The FB "Physician Community" is full of posts from CCM docs who are disgruntled about how the opportunities are disappearing fast.

It's also possible this guy is eICU too.

I suspect he is either VERY midwest, VERY rural, or VERY last-minute locums in high-need areas/institutions.

 

[cyanide12345678]

1.1M/yr in icu seems an extreme outlier without working extreme hours and may not be sustainable over 30 years- but yeah. He could easily invest that much a year with much less (hell I get close some years and don’t make nearly that much).

Honestly…. He makes it sound like a very cushy gig where the NP does a lot of the work and even a lot of the procedures like central lines. In fact, he’s left the ICU when he’s at work to come watch India vs Pakistan cricket matches while leaving the NP in charge.

What he does a lot of are bronchs and a lot of biopsies with bronchs. I’m hazy on details because this was a while ago, but he said something like he can knock out a bronch in. 5-10 minutes and that it’s 8 rvus and he’s getting $72/rvu (i could be wrong on the exact numbers - but it was something very high).

He does a lot of bronchs.

 

[cyanide12345678]

I suspect he is either VERY midwest, VERY rural, or VERY last-minute locums in high-need areas/institutions.

Mid west yes. He’s not locums. It’s his full time job. Technically far enough to qualify for j1 waiver, but also just 25 minutes away from a metro of 2 million residents.

It’s the bronchs. Yeah he’s an icu doc, but he’s established himself as a proceduralist. Whose doing bronchs and biopsies all the time. There’s days where he would do 6-7 bronchs.

Plus that hospital system does pay very well. The private group of ER doctors there make 400/hr - but they see 3 pph.

 

[Franzd'Epinay]

I don’t understand why they don’t require basic finance in high school. It’s not like it would take a lot of time and would probably do more for the masses than all this redistribution / tax ideas.

I'm pretty sure most/all kids learn the basics of interest and compounding in high school math. I'd venture to guess the overwhelming majority of those lessons make the explicit connection to wealth growth. I can't speak to all states, but mine also had a semester of economics as a graduation requirement that touched on personal finance. A tons of schools also have Junior Achievement programs that go further into the stock market itself.

The problem, as often is the case, is not the school, but the students. Even if you mandated more personal-finance classes, the average student will just not care. This was the case when I was in high school, but I hear it's even worse now.

 

[emergentmd]

You just saved that guy potentially millions of dollars. Definitely worth a chipotle - even with extra guacamole.

I don’t understand why they don’t require basic finance in high school. It’s not like it would take a lot of time and would probably do more for the masses than all this redistribution / tax ideas.

This is a huge failing in the house of medicine. Teach them useless stuff like biochemistry but then put them out in the world and say.... here is 500K/yr, live it up.

 

[bravotwozero]

The other big problem with all these Muslims i know, they invest in crap ‘halal funds’ - i asked him if he really really cared about ‘shariah compliant halal only investments’ - he said no. There’s no good shariah compliant halal etf with low expense ratio. Now he’s in sp500 because he actually didn’t care about that - his Pakistani Muslim financial advisor thought he did.

So, I actually do care about this. There may have been/are terrible funds like that, but there are others performing well. Wahed investments being one (among others), fairly low cost, performance pretty close to S&P 500.

 

[cyanide12345678]

So, I actually do care about this. There may have been/are terrible funds like that, but there are others performing well. Wahed investments being one (among others), fairly low cost, performance pretty close to S&P 500.

Is it low cost like Voo - 0.03 expense ratio?

No.

The biggest difference in returns is from 2 things:

1) fees
2) asset allocation

That’s it.

 

[cyanide12345678]

So, I actually do care about this. There may have been/are terrible funds like that, but there are others performing well. Wahed investments being one (among others), fairly low cost, performance pretty close to S&P 500.

Also cool fun trick.

You can go through the holdings of your portfolio at wahed, create a pie at m1finance that mimics it. And boom - 0% fee, complete automation.

Keep 5000 at wahed so you can look at their portfolio of what they’re doing so occasionally you can change things around to continue mimicking them.

if/once you have a big portfolio, the 0.5% they charge will really be millions over a lifetime. Think about it…it’s very easy to set up a pie on m1 finance with hundreds of companies.

 

[Pinner Doc]

I'm pretty sure most/all kids learn the basics of interest and compounding in high school math. I'd venture to guess the overwhelming majority of those lessons make the explicit connection to wealth growth. I can't speak to all states, but mine also had a semester of economics as a graduation requirement that touched on personal finance. A tons of schools also have Junior Achievement programs that go further into the stock market itself.

The problem, as often is the case, is not the school, but the students. Even if you mandated more personal-finance classes, the average student will just not care. This was the case when I was in high school, but I hear it's even worse now.

I digress, but I’ve thought about this. We had senior year required courses: Econ and Participation in Government (fondly known as PIG). But if you took AP US History, you could place out of both. So I’ve never actually taken an economics class, which I regret.

 

[cyanide12345678]

I digress, but I’ve thought about this. We had senior year required courses: Econ and Participation in Government (fondly known as PIG). But if you took AP US History, you could place out of both. So I’ve never actually taken an economics class, which I regret.

I’ve taken an economics class in college.

It didn’t teach me any personal finance - so no compound interest, investing early, value of time in market, tax loop holes, Roth vs traditional iras, back door roths, 4% rule, how to invest in broad diversified etfs/mutual funds.

Yup……i honestly didn’t even understand a Roth account until i was a pgy3.

 

[Janders]

I think there is a huge difference between "learning" some math, interest, economics, etc VERSUS being taught pragmatic functional personal / life finance.

Even the VERY basics for an EM Doc coming out of training-- Here is how to max your retirement savings with your basic work accounts, here is a checking account to keep 20k in, here is a fidelity account to sweep other stuff you are saving in and put it in 80% SP500 and 20% International, here is a goal of per-year savings to work towards if you want to be able to cut back at 45 and walk at 55... it is SHOCKING the amount of people who just know zero of this. Much less anything slightly more advanced.

 

[Janders]

Going back to the gratitude theme.

I do think goals are important for a lot of personalities that go into medicine (and the type that come onto SDN). We can all maximize work for maximal income for maximal high score when we are 60...

But I think most of us see the value of winning stages of the game, and thus having freedom.

$1mil is a great goal and looks nice, and now you can weather any storm that hits you. This is a great achievement. You should get yourself and your family a treat.
$3mil seems like an amount where technically you have won. You could stop, not work, and survive comfortably for the rest of your life on 3-4% spun off this. Yes yes, maybe no mansion or private jet.. but you can live off this forever without going hungry and enjoy yourself. You have won. You have the freedom to consider all further work technically optional and beholden to YOUR desires. Shift your mindset. Don't GRIND unless the grind is working for you. Consider your age, your family, your timeline. Plan the next 10 years.
$5mil is the amount where now you really need to ask if you SHOULD purposefully take your foot off the gas and do LESS work and enjoy the one life you get, however YOU personally want to do that. Every moment is precious, how are you spending them?
$8-10mil What are you doing bro? YOU BETTER BE HAVING FUN. You better be helping your village. You better NOT be bitching about grinding out 60hr weeks because WHAT ARE YOU DOING.

I think people who work SO hard through schooling and residency and young attendinghood, working 150%, maximizing saving, churning for that nest egg, the safety of ready reserves... to shift mindsets as they start to achieve the success they wanted. It helps so much to push yourself immensely in the early half of your career, live-like-a-resident, etc... but there are downsides. It is very easy to lose human connection. Lose the gratitude. Lose what deeply matters to you.


[also the stock market for the past 15 years has been pretty nice to all of us; image a world where it was largely stagnant over the same period]

 

[GassYous]

How do you make 1.3M/ yr and have less than 1.5M net worth (if I’m understanding what you say about his/your portfolios)? Or is this friend like 1-2 year out of training?

My perspective -after 10M it doesn’t make any sense to keep going unless you’d do it for free.

It’s not like lifestyle would change in retirement until you get to 100M+ (not like you can fly private or own mansions all over the world or start doing weird hobbies like expensive art and sports teams and private islands)

my friend made 1.3 m a year and had less than 1.5m net worth by 40

Spends all his money on name brand jewelry, first class trips to expensive places and the best hotels. Also divorced. If he just kept his first wife and expenses reasonable he could be at 10 mil by now and basically working for fun but his spending habits are just too extravagant.

 

[Porfirio]

my friend made 1.3 m a year and had less than 1.5m net worth by 40

Spends all his money on name brand jewelry, first class trips to expensive places and the best hotels. Also divorced. If he just kept his first wife and expenses reasonable he could be at 10 mil by now and basically working for fun but his spending habits are just too extravagant.

Sounds like a wild ride.

 

[EMdoc235]

my friend made 1.3 m a year and had less than 1.5m net worth by 40

Spends all his money on name brand jewelry, first class trips to expensive places and the best hotels. Also divorced. If he just kept his first wife and expenses reasonable he could be at 10 mil by now and basically working for fun but his spending habits are just too extravagant.

Sounds like he’s having fun. Even if he lays off the party now he could be solid in 5-10 years.

Did the first wife take a lot?

 

[Pinner Doc]

Sounds like he’s having fun. Even if he lays off the party now he could be solid in 5-10 years.

Did the first wife take a lot?

Maybe she was the breadwinner…

 

[SeekerOfTheTree]

I'm glad you're working on getting out.

Yep, the three year residency and ability to stack hard early on is what got me to escape velocity. I'm still chasing that $10M though, but I'm in no rush.

I've been out now for a long time, long enough to realize that I am now a happier, more present, and hopeful/optimistic person than I ever was or could dream of being as an ER doc.

I will say I'm immensely proud of the work I did as an ER doc, and I've posted before about how when you tell people you were an ER doc it's immediate respect and street cred.

Many specialties don't get that. Tell somebody you were a retired neurologist and they'll fall asleep instantly.

It's even better in my early retirement because I still get the EM street cred and valor, but without having to do any of the day-to-day work any more.

I agree with this. I am proud to practice EM and part of the reason I keep doing 5 shifts a month. I enjoy what I do and like knowing a bit about everything. We are pretty damn good at what we do.

 

[SeekerOfTheTree]

The shifting pressures on EM over my 10ish or so year attending career have been interesting.

I feel like my first few years all we heard about was the CMG threat. Now that they've essentially pillaged everything and have gone broke, I don't seem to hear much about CMG takeovers, at least in my neck of the woods.

Now it's more CMS/insurance ****ing us over, hospital system consolidation, and increasing medmal suits.

I think CMS and INS F us (ER Specifically) over less and supposedly get the hospitals more. What we generate through the ER versus what one ortho procedure does is ridiculous. I have had the chance to look at the financials for all of our non-profit hospitals around here (did the whole PA thing for a while and did redid alot of contracts) and everyone seems to be making alot of money. CEOs pay has gone up, the c-suite has grown, investments have ballooned! They are really good at reducing their profits down to a 1-3% margin by going ahead and writing off a ton of stuff.

 

[SeekerOfTheTree]

Your wife and I may differ in that it’s not the patients who make the job insufferable. It’s the admin. And that’s a harder pill to swallow when they cut your resources, staffing, and pay.

For me I am lucky. I know admin and don't mind them. My patients (yea meth is a problem) for the most part are nice and appreciative.

 

[SeekerOfTheTree]

There was definitely some coping involved but also an attempt at healing myself.

The last 2 months have been rough for me. I got assaulted at work by a psych patient. The week after, another psych patient was threatening to kill everyone in my ER. And then just 2 weeks after that, the guy that assaulted me, was back again for psych and took a swing at our police officer.

I’m emotionally done with emergency medicine.

My unhappiness with emergency medicine was at its absolute peak in the last 2 months. In fact, there’s a reason there’s another thread from me regarding the VA (i started job hunting because of the unhappiness). And another thread from me regarding post acute care because i started looking of ways to get out.

I literally was having discussions with my wife about ‘hey…. We have enough. Let’s just leave the US and go to a safer and cheaper country’.

My dissatisfaction and unhappiness with EM was at its peak especially in the last 3-4 weeks.

So yeah…. There is a degree of coping.

And guess what? My post felt cathartic. For several weeks, i just felt lingering unhappiness. And the day after posting this, i actually felt somewhat happy and grateful.

emergency medicine definitely has taken a lot from me. Which is why I’m actively looking for a way out, i literally have 2 interviews tomorrow. But you know…. I’m 37, about to hit 3M in net worth, have numerous passive income streams, and have had time to develop skills that i just wouldn’t have had, had i been in a specialty where i was working 20 days a month. But if i was a cardiologist as an example, id barely have 1M in net worth right now due to only being 3 years out instead of 6.

EM was the highest paying specialty for the shortest residency and had the lowest number of hours. This fact allowed me to Invest early and create income streams.

My family income in 2024 was 750k. In 2023 was 900k. In 2025 i gained 550k in net worth post taxes and expenses. In 2026 im up 50k already In net worth in 6 days. Why??? Because i have assets and a portfolio that is doing a lot of heavy lifting. This is the point I’m making, EM got me to this point so damn early that other specialties might never catch up.

EM is at the end of the day the highest paid 3 year specialty with the lowest number of hours.

I hate EM. But it did something for me. It made me rich earlier than most other specialties and now has given me the option to drop income, work less, get out of EM, while my portfolio makes up for that lost income.

That is what EM did for me. And you know…. It gave me extra time in the market. That’s a big plus.

And seriously…. This was cathartic. I’m proud of my journey and I’m genuinely feeling significantly better as I’m trying to realize the blessings that i have.

Leaving the US and starting somewhere all over with a youtube channel could make you even more of a millionaire. You are at the age you could do it to try for a year. ER doc in Thailand!

 

[SeekerOfTheTree]

I have several close friends in the O&G industry. They’d trade places with me in an instant. While EM is a stressful job, I think they have way more stress than I do.

Also, nothing is stopping you from going back to school and trying to get that engineering job you speak of. It’s all going to take you time, and of course, luck. Those jobs are the exception and not the norm.

Was an engineer. Can confirm you are correct.

 

[finalpsychyear]

my friend made 1.3 m a year and had less than 1.5m net worth by 40

Spends all his money on name brand jewelry, first class trips to expensive places and the best hotels. Also divorced. If he just kept his first wife and expenses reasonable he could be at 10 mil by now and basically working for fun but his spending habits are just too extravagant.

Unlikely. Making money. Saving Money. Investing Money. Each one feeds the next pillar. Maxmimizing the 3 giant pillars to financial wizardry requires being in the 1% in each category. Its a rare find for someone to be in three 1% groups back to back to back. The golden trifecta but i agree they would likely be near the 10m sub 50.

 

[dozitgetchahi]

not every chemical engineer makes 300k. Only a small percentage of them do that after making it to big tech.

Those in oil and gas are usually around 150-200k. Oil and gas goes through its phases too whenever oil prices drop.

In comparison, Almost all ER doctors make 300k, if they don’t, it’s their choice to make less.

Tech is brutal for culling, they hire to fire. Sister in law got laid off from apple 2 years ago and has been on edge the last 6-7 months because she’s with amazon. I think amazon is laying off another 14k workers soon.

I was gonna say…I know a number of chemical, mechanical, biotech engineers from college. None of these people are making $300k a year. Some aren’t even making six figures.

 

[WhatJobDoIPick]

I was gonna say…I know a number of chemical, mechanical, biotech engineers from college. None of these people are making $300k a year. Some aren’t even making six figures.

Must not be very good.