For the most part, it's very difficult to get rich simply by being a doctor. Unless money is thrown at you (derm @ 500K/yr), it usually takes sound financial planning. For a long time, I've been extremely interested in business, and have read many books regarding the subject. I plan on combining the two (business and medicine) when I get out of residency. That being said, every authority on getting rich boils down to a few basic concepts:
1) Own your own business/work for yourself. People who earn paychecks don't get rich for 2 reasons. 1- the only financial reason to have you as an employee is if you bring in more money to the company than your salary. If you work for yourself, you reap the full benefits of your hard work. 2- Equity. Equity is the single most important source of wealth for anyone who's rich. The 10 mil + you're talking about ALL own their own business. Look at the Forbes 400: they're all CEO's/owners of corporations. They do it in different areas (law, oil, airlines, entertainment, the list goes on...) but they ALL own a business. Equity is simply the amount of the business you own. It's yours, just like your car, house, etc. It can be sold. The more profitable it is, the more it can be sold for.
2) Invest in tax-sheltered ways. Let's look at two examples. You and I both work, make $1000, and want to invest it all. I take the money out of my paycheck, and taxes take roughly 40% +/- out of it. I now have $600 to invest. I get 10% over 1 year and end up with $660.
Now you take the same $1000 and invest it in a tax-sheltered way. Your financial adviser will be better able to advise you, but this includes company retirement funds if you work for someone, investing directly in your business if you work for yourself, investing in IRA's (granted there are restrictions), real estate roll-overs, etc. The point is that if you do this, and you make the same 10%, you've got $1100. Now if I were to take this money out at 40% tax rate, I'd have the same $660 as you. However if we were to both leave our investments alone for 5 years, then take it out at the same 40% tax rate, I'd end up with $819.79, and you'd end up with $1244.20.
Taxes are, from what I've conferred from various sources, the single reason the average person doesn't become rich. The rich invest before taxes. Middle class invests after taxes.
3) Own a home. Real Estate investors, when they do well, do better than everyone else. Why? Well let's say you buy a home and I rent. My rent and your total costs (insurance, mortgage, upkeep), work out that I'm paying $100 less a month than you. Over 30 years, I've payed $36000 less than you. I'm $36,000 ahead, looks good for me, right? Well you've payed off a mortgage on a $150,000 house. You own it. If I move out, I've got nothing. If you move out, you sell a house that's probably appreciated to well over it's initial worth (over $600K if we're assuming an 5% appreciation, and you've paid $359,262 assuming a 7% mortgage and no down payment... granted you took it to term which rarely happens). So you pocket that money. It's the same principle as owning a business. Equity. (also there's the roll over. when you sell your house, you can take the profit that you made, and use it to buy a house tax free. So if you've make 100K on your house, instead of paying 40K in taxes and THEN buying a house, you just buy a house with all 100K. Talk to your accountant).
Now let's say you invest in real estate. Now you've got renters that pay your expenses for you. If you invest right, you'll make money every month. So you're making anywhere between 0 and a couple hundred a month. And after 30 years, your renters have paid your mortgage for you. Talk about a way to make money!
4) Have the goal of financial freedom. This idea means that you can choose to work or not work, and still pay the bills. Let's say you have monthly expenses of $1000. That means you're spending $12,000 a year. If you have $150,000 in investments earning 8% a year, you've just covered your monthly expenses. You can work or not, whatever you want.
There are two tricks to this: 1- making money and investing (playing offense). This is inherently easier for dermatologists. 2- keeping expenses low (playing defense). This means buying the smaller house, the used car, etc.
These are the ways that everyone who is rich got there. You talk about $10 million plus? Look at Bill Gates. Look at Warren Buffett, Steve Jobs, Mark Cuban. They all owned a company that did very well, went public, and had a huge payoff. Now there's a lot of risk, but they handled the risk and made it work for them. Is it easy? Hell no. A lot harder than being a Dr. and a hell of a lot more risky. But that's how rich people got rich. Even Tiger Woods makes more money from marketing his business (himself) than he makes from actually swinging a club.
I'm convinced that business should either be a pre-med requirement or a course in the med school curriculum.
