✅ Keeps investing instead of paying off the mortgage.
Mortgage = 3.75%
Market returns = historically ~7-9%
More cash invested = bigger nest egg later
But… you’re stuck with that monthly mortgage bill.
And possibly more shifts than you’d like.
Jun 11 • 13 tweets • 2 min read
Academic docs who actually want to do research are getting squeezed HARD.
The system says it values discovery.
The paychecks say: “More RVUs, less thinking.”
Let’s talk about the quiet collapse of the research track in medicine.
In theory:
Academic medicine = ⅓ research, ⅓ teaching, ⅓ clinical care.
In practice?
Try 100% patient care, 0% protected time, and a “bonus” if your patient’s parking experience was pleasant.
Jun 2 • 11 tweets • 2 min read
Most physicians go from broke to a significant salary overnight.
It feels like a win.
But for many, it’s overwhelming.
Let’s talk about why doctors struggle with money.
Even the smart ones.
Step 1:
Spend your 20s buried in books and maybe burnout.
Step 2:
Spend your late 20s and early 30s making $60K working 80 hours a week.
Step 3:
Suddenly make $300K+ and think you deserve to “live a little”
This is the trap.
May 29 • 9 tweets • 2 min read
You’re a doctor making $250K a year.
You’ve got a 2-year-old.
Your mortgage is $5,500/month because, of course, you live where everything costs a kidney.
You want to save for retirement and your kid’s college.
Let’s get real for a sec.
First, taxes. Let’s call it 27%.
And then after your pre-tax retirement plan contributions (more on that later) leaves you with around $146K/year to work with.
You’re not broke, but you’re not balling either - especially not with that mortgage.
May 29 • 15 tweets • 3 min read
Congrats, you’re a brand-new attending.
You just finished residency, and now someone hands you a contract that says:
“$39 per RVU”
Cool, cool…
What the heck is an RVU? And how much money is that?
👇
Caveats:
A lot of physician comp structures are not pure RVU-based.
But they are the foundation of production that all employers (of physicians doing clinical work) care about.
Also, mind you, the per RVU rates and average RVU production per specialty below are estimates.
May 25 • 16 tweets • 3 min read
Private practice is under siege.
Hospital consolidation, CMS cuts, and insurance lobbyists are squeezing independent physicians harder than ever.
But if you run your practice like a business, not a legacy, you can survive and potentially thrive!
Here’s how👇
The threat is real.
CMS cuts reimbursement every year.
2025 could bring another 2 to 3 percent reduction in Medicare rates.
Commercial insurers often try to follow CMS.
The higher your revenue is insurance-based the more impactful these hits are.
Apr 20 • 23 tweets • 5 min read
Medical school tuition has skyrocketed.
It’s outpacing inflation and leaving many physicians wondering:
“Is it financially worth it?”
The short answer: Yes—but only if you use your degree like an investment.
Here’s how to turn that massive cost into massive freedom:
Let’s get real:
Physicians often graduate with $200K–$500K+ of student debt.
That’s intimidating and ridiculous.
But the value of your medical education doesn’t depend on what you paid, but rather it depends on how you use it.
Mar 23 • 11 tweets • 6 min read
It’s pretty common to hear, physicians say that since they only have W-2 income, filing their taxes themselves is pretty easy and that most people in their situation can DIY.
I’m going to explain why this thinking can be potentially wrong, particularly if you are married and have student loans to manage.
First, let’s review the latest student loan news and potential action items relevant to physicians:
Oct 26, 2024 • 18 tweets • 5 min read
A physician who earns $250,000 is going to face a steep hill if they want to buy a home that costs $800,000.
The mortgage ➕ taxes/insurance is about 44% of their take-home pay!
Why am I even bringing this up?
Because of the good people of NYC/LA/SF.
This thread is for you.✊🏻
2 important points -
1) there’s no wrong answer, even if “the math doesn’t lie.”
We are not products being evaluated by calculations. We are humans. We value/need different things to make life our version of success.
Nevertheless the math is helpful for us to sift our options.
Sep 14, 2024 • 8 tweets • 2 min read
Calculating what dollar amount one needs to save for retirement is pretty simple.
Say you’re 35 years old, got out of training in 2023.
Not counting your retirement (and potentially college) savings contributions, you spend $10,000 per month.
How much you need to save for retirement depends on two calculations:
1️⃣ Inflation projection
2️⃣ Sustainable retirement income withdrawal rate
Aug 13, 2024 • 18 tweets • 4 min read
HALF of all disability insurance applicants either are only allowed limited coverage or flat out denied. 😱
Nothing short of millions in a trust fund can assist a physician in overcoming an income-halting disability.
I have two pieces of advice for you.
Physicians really need to pay attention to this.
It is THE earliest critical financial decision of your career.
Your attending income must be protected at all costs.
So take the following 2 steps:
Aug 31, 2023 • 23 tweets • 4 min read
📚 New Attending
Financial Checklist📚
The inclination to hire a financial planner to take care of all of this once you complete your training isn’t a bad idea.
But even then, you need to protect yourself by knowing the important financial steps to take.
Let’s learn!👇🏻
1️⃣ Debt Management
This step can have quite the variation.
Credit card debt needs to be eliminated as soon as possible from your new higher paychecks. Private student loans and other personal loans also deserve such elimination.
Now federal loans…
2/22
Jan 29, 2023 • 25 tweets • 1 min read
Get own occupation disability insurance.
A 🧵
Get own occupation disability insurance.
Jan 29, 2023 • 20 tweets • 3 min read
The Three-Fund Portfolio: A Simple Way to Invest
A three-fund portfolio is an investment portfolio that’s made up of three investment funds. Commonly, this includes:
- A U.S. stock index fund
- An international stock index fund
- A bond index fund
These can be mutual funds or exchange-traded funds (ETFs). Index funds are commonly used for a three-fund portfolio because they can offer diversification with moderate risk and low cost. By tracking an entire market index, you gain exposure to all of the stocks in that index.
Nov 21, 2022 • 6 tweets • 2 min read
The REPAYE income-driven repayment plan loan interest subsidies:
➡️ Subsidized loans
First 3 years - 100% of unpaid interest is forgiven
After that - 50% of unpaid interest is forgiven
➡️ Unsubsidized loans
50% of unpaid interest is forgiven
So let’s look at an example
👇🏻
You have $400,000 in student debt. Your average interest rate is 6.54%.
$50,000 is subsidized and $350,000 is unsubsidized.
You are single and your income is $60,000.
The IDR payment will be about $4,000/year.
The total annual interest accrued is $26,160.
👇🏻
Nov 19, 2022 • 5 tweets • 2 min read
📚 Resident Financial Plan 📚
Debt Management
- consolidate high interest debt
- pick an IDR for student loans
- keep good record’s especially if you’re going for PSLF
I can’t get this ball jar lid out of the drain. I’ve been at it for 20 minutes. 😳
I drilled a hole!!
Oct 23, 2022 • 12 tweets • 2 min read
📚 Tax Advantages of Home Ownership 📚
The decision to buy a home should not be driven by purported tax advantages. They do exist and I am going to explain them below.
But any tax advantages will be a bonus and not the reason we bought a home.
⬇️
Side note: You can’t deduct any of these unless you itemize your deductions. Itemizing deductions is something people do if their sum total of individual deductions exceeds what's called the "standard deduction." The standard deduction is currently $25,900 for joint filers,
