The Position Paper 9/4/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Personal Position

Featured Article: Modern Day “Needs,” Which Really Aren’t by Money Propeller

My Take

The recent tragedy with Hurricane Harvey has really gotten me thinking about what matters in life. Many folks lost all of their material possessions in the hurricane and subsequent flooding. I think it’s only natural to think about how I would react if that happened to me as I watch all the news coverage.

Today’s article from Money Propeller doesn’t quite have this kind of focus, but it does provide some perspective about modern day things that we, sometimes falsely, consider to be “essential.”

There are several items mentioned, but I was glad to see electronics like phones and computers put on there. I have been “unplugged” a few times in my life on purpose, and honestly, I really enjoyed it. This realization has greatly changed many of my daily habits for the better as I do not consider it essential to have many electronic notifications in my life.

I don’t need to receive every email that comes in exactly when it hits my inbox. I don’t even need to receive every text message or phone call exactly when it occurs. There are plenty of things happening my real life that require my full presence, free from outside distractions. So, I really can’t call a phone “essential” to my life.

In healthcare, I think we often overstate the importance of computers. I secretly love when our computer system goes down, and I am free to just see patients with no computer. I may pay the price when they come back up, and I have to chart everything. But, there is something truly sweet about seeing patients with nothing else around.

So think about the things you consider “essential.” Are they really that necessary for your life? I bet you’ll find that your list of truly essential things is really small. Our lives would probably be a lot better if we spent more of our time there than with computers or phones. Give it a try!

Have a great day!


Do you like The Position Paper format? Is this someone I should keep doing or trash it? Leave me a comment and let me know!

The Position Paper 8/28/17

Welcome to The Position Paper! The Position Paper is my series featuring my quick take on a particular topic to help you manage your position. I will often feature one outside article as well that will allow you to dig in deeper if you desire. Read this while you drink your coffee in the morning and start your day off right!

Today’s Position: Personal Position

Featured Article: Take Back Your Sanity By Switching From Push To Pull by Keep Thrifty

My Take

Chris over at Keep Thrifty wrote a home run with this article. He published it some time ago on his blog, but many people should probably save it to read periodically. If you’re anything like me, there’s an infinite number of “things” competing for your time. These things often distract me from what really matters in life, and I’m not OK with that.

Chris talks about switching, as much as you can, from a push to a pull method for incoming information. This method applies especially in the context of electronics but can be used in many realms of life. In short, others should not decide what you hear about first or what you react to first; you should.

Do you want your email to stop interrupting your day? Then turn off email alerts on your phone. How about social media? Phone calls? Text messages? Your mother in law? You decide if these things automatically interrupt you (the push method) or if you decide when you view these items (the pull method).

Chris makes a great case that our society often advocates for constantly being in push mode, however there is likely a better way to approach this. He references the great Dwight D. Eisenhower and his Eisenhower method for determining exactly how tasks should be reviewed and accomplished through the day.

By using this method to classify tasks based on urgency and importance, you can set up your day to focus more on tasks that really matter to you, and eliminate or delegate the rest. I especially like how Chris has applied this concept in his life to be more present with his family when he spends time with them. His phone no longer dings with each incoming email or Twitter post. That stuff can wait. Watching his kids grow up can’t.

I encourage you to check out the article over at Keep Thrifty and give this a shot in your daily life. I personally apply this concept a lot, and it has paid large dividends for me. Remember, I am out to help doctors control their lives before someone else does. We need more pull and less push to do that.

Have a great day!


Do you like The Position Paper format? Is this someone I should keep doing or trash it? Leave me a comment and let me know!

Boss For The Day: The Work Life Balance of Physicians

This guest post is the first of our Boss For The Day guest posts. In these posts, I aim to bring you the best content possible to help you manage your position, straight from the desktop of those that know best. If you’re interested in being the Boss For the Day, then shoot me an email. Today’s post comes from Tom, who runs a great site over at High Income Parents. Tom doles out great advice on parenting for high income earners and has dropped some knowledge for us here today. Thank you Tom, and enjoy!

The work life balance of a physician or physician-in-training who is also a mother or father is a difficult thing to master. On one hand, you have a family you love. On the other, there’s never a lack of things to do to further your medical career.

I was once told the whole point of residency is to learn ten years worth of medicine in three or four years. There is some truth to the statement. That’s why we have the long hours and the endless amounts of material to cover. What we learn in that short time will contribute to the health and lives of our patients.

Before attending medical school, I sought a job in the local hospital for exposure to the medical field. The goal was to see if I really wanted to get myself into this business. It was a valuable experience but I met some doctors that were for lack of a better word, douchebags. As a naïve college student, I didn’t understand why a human being could treat another person like some of those doctors did every day.

It was a real eye-opener that a profession I thought embodied the ideals of caring for humanity and compassion would treat coworkers and subordinates with such malice and disrespect.

I vowed to never become like one of those doctors. I think I’ve upheld that vow, but after going through the process, I understand how the doctors for whom I worked reached that malignant attitude I saw then and still see today with some of my colleagues.

We’re taught to be aggressive and take charge. Often times a patient’s life is in our hands and we need to get things done precisely and accurately to save a life. You can’t be timid about those decisions. That training often spills over into our family lives and how we handle our spouse and kids.

The problem is often our spouse and children don’t respond very well when we tell them to jump. The nurse or technician at work may say, “How high?” and trust our decision making. That’s the chain of command, but when we tell our kids to jump, they say, “Why?”


Like most things in life, communication was and still is the key to a harmonious relationship with our families. There are several main things I discuss with my kids and spouse to help them realize what we as doctors go through on a routine basis. Even though they can’t experience our daily lives, we need to convey to them what we experience.

I’m pretty good at compartmentalizing when it comes to difficult patient situations but even for me, I think it is good to share what I see when I go through a difficult situation. Those patients that have bad outcomes can weigh on you. Even if you did everything you could and made the right decisions, we can’t control everything. Sharing that experience with my family has helped them understand what I did during training and even today with my regular day-to-day job. I think it helps them grow closer to me because they get a glimpse of the hard decisions that we as doctors make every day.


When you’re under pressure, it’s difficult to deal with these alone. Sometimes our natural tendency is to hold these in and not bother our loved ones with the troubles we face. This is a mistake.

Likely, the pressure we feel to learn the medical knowledge, practice good medicine that helps our patients and acing the never ending string of tests we take throughout our careers will boil over into misdirected frustration and anger. We should share this with our families.

I’ve been guilty of being short tempered with my kids for minimal things. It might be because of the weight of an upcoming presentation or dealing with a difficult patient. Our loved ones shouldn’t suffer the consequences.

Thankfully we frequently talk about the challenges doctors face and my family is forgiving. Being upfront about the pressures and not letting it get to the frustration level has always worked the best.


Leadership and a take charge attitude are a fundamental aspect of practicing as a medical doctor. When the stuff hits the fan, the hospital personnel look to us to lead them to the best decisions. This helps accomplish our common goal, helping the patient.

Leadership opportunities are a vital part of being a spouse and a parent, but it usually doesn’t manifest itself in the same way. If I started barking orders to my kids without guidance because I expect them to “know their job” it’s rarely effective. Getting down and working with them on their level is much more productive.

Like the BossMD says, we need to know our position.

I’ve also found it helpful to tell my kids and spouse the way things usually work in the medical setting. Since I’m in the OR and things get hairy from time to time, we expect everyone to know their job and perform.

With my older children, I’ve discussed how a code sequence played out or how taking life-saving measures quickly and decisively has rescued a patient from death.

They appreciate the honesty and getting to walk a mile in my shoes. They love that I can share my day with them as they also share how their guitar lesson went, or how the youngest learned to jump off the diving board.

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When we are tired and stressed, patience isn’t very abundant. Working long hours, taking care of stressful patient situations and dealing with administrators tries our patience.

Then we come home and have another set of challenges to overcome. Maybe teaching your 15-year-old to drive or sitting down with your four-year-old to practice phonics are your next duties at home. Discussing how you would teach a nurse to assist with a procedure isn’t going to prepare you for dealing with your kids. Take a step back and remember the way to success.

If I don’t have the capacity to be patient right at that moment because of an especially difficult day at work, I ask the kids or my spouse for a 15 or 30-minute break. I gather my thoughts and tell them I’ll be back to tackle any challenges.

They care about me and understand. Often they even ask if they can help me. We both exercise patience for each other.

Double Lives

Sometimes I think of doctors as superheroes. At work, we are doing things that would be considered assault if we didn’t have permission. We commit these actions because we know they should lead to good.

At home, we are usually mild mannered and don’t always take the leadership role. Our kids and spouses have expertise that we don’t and we should let them demonstrate that knowledge.

It’s kinda nice in a way to not always need to lead the way. It gives us the opportunity to think about the way we treat those who we lead and how we would react to the leadership styles of our coworkers.

Finding the balance between work and family takes requires thought and intentionality. It’s not easy but like all good relationships, it takes both sides working their hardest to help and serve the other. This is especially true with our families. If we want a good balance we should commit to both and give both career and family our all.

How do you cope with the two lives of being a doctor? Do you find it hard to separate them? Is it hard to transition into family life? How do you share your work with your loved ones?

Tom is the creator of Tom is a doctor, husband and father of five with a passion for parenting and finance. When he isn’t skateboarding, riding BMX, or jumping on the trampoline with his kids, he is reading and writing about personal finance. He helps high income parents educate and mentor their kids to become financially, emotionally, and intellectually self sufficient.

Its OK To Be A Doctor With A Real Life

physician lifeCan I tell you a secret? I enjoy when my patients call me “Doc.” I know some of my colleagues may not like this, but where I come from, this is a pretty significant term of endearment. When I get called this, I know I have progressed from being just a doctor to a significant part of their life.
I didn’t always feel this way. In my first job out of residency, I worked hard to separate my professional and personal life. I shared no details of my family with my patients. I would do everything possible to avoid talking about anything outside of medicine.
One significant episode of burnout later, I realized that I have to be me when I go to work. I cannot be this soul-less robot that I had set out to be. My patients are real people. Its OK for me to be one too.
This revelation led me to the vastly different approach I take today. My new outlook is a significant part of the reason I enjoy my work much more.
My patients know me. They know where I live. They know about my family. They know that my wife is much more responsible for my personal fashion than I am (yep, I’m incompetent in this area). The benefits are numerous but let me expound on a few.

My Patients Talk To Me

Because I am open with my patients, they are open with me. I learn all sorts of things in our conversations that allow me to take better care of them.
I learn that Aunt Jean has moved in and cooks fried foods every day. I learn that their nephew totaled their car, which is why they didn’t show up for their last appointment.
On an even more personal level, I learn about their relationships. They tell me they don’t get along with their kids, which makes them depressed. Then, they fix three cocktails every night, and I see their blood work start to look bad.
This openness and honesty allows me to be frank about needed changes (like not drinking three cocktails every night). I tell my patients that I cannot guarantee that I will know everything, but I can guarantee that I’ll be honest with them. That includes being honest about my own struggles when I have them.

I Can Take Time Off

Have you ever had your patients encourage you to take some time off? I experience it all the time, and it’s awesome! I am convinced doctors do not take enough time off, and this leads to burn out amongst our ranks.
When your patients know you as “Doc” and not “the doctor,” then they will want you to have a satisfying life. Not only will they accept you taking vacation, but they will even encourage it! A wonderful example for me is the birth of my second son.
I decided to take two weeks off with the birth of my second son, which I admit I was nervous about. I didn’t want my patients to see a doctor who knew nothing about them.
Not only did my patients accept my time off, they facilitated it! Upon my return, I wasn’t met with the usual “back from vacation” barrage of messages. Many told me later that they delayed scheduling appointments because they knew I would be tired with a newborn. You better believe I hugged every one of them!

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I Feel Human When I Drive Home

Ok, this point has no “data” that I can point to, but every physician reading this knows what I’m talking about. How many days do you drive home after hearing about quality metrics, patient experience, or clinic revenue and don’t feel human?
I admit there are days where I feel this way, especially days where I may be doing administrative tasks most of the day. It’s amazing, though, how one authentic interaction with a patient can change that.
The numbers may say that the quality improvement work I do has the largest impact on the health of my patients, and many times it does. But as a person, I still need to see my efforts at work in my patients’ lives. That data point needs to translate from my computer screen to a real person for me to feel really good about it.
On those days where I have real and authentic interactions with my patients, I am the kid that signed up to change the world. On days where I don’t have that, I feel like a bean counter. I didn’t sign up for that.
I wish I could say that I’m perfect in this area now, but I’m not. There’s a lot of forces in medicine working against the doctor-patient relationship. I can say, though, that I enjoy medicine much more when I am authentic with my patients. I also happen to provide better care too.
Don’t be afraid to be yourself with your patients. Your patients want to see you, not some robotic person going through the motions. Give the people what they want!
Are you scared to open up to your patients about your life? Do you fear the consequences? Leave a comment and let’s talk about it.

My Burnout Story

It’s no secret that medicine has an epidemic of burnout plaguing it. I’ve read a number of articles both in journals and blogs outlining the sometimes stunning statistics regarding physician burnout, including this article from White Coat Investor.

Today, however, it is not my intention to discuss burnout in a dry, statistical sense. Today, I want to discuss a burnout story near and dear to my heart, my own.

The Beginning

I determined that I was going to be a physician roughly around the age of four. OK, a bit of an exaggeration, but I was pretty young. I don’t remember dreaming of being anything else. After studying hard in high school and college, I entered medical school with my intellectual and professional flame burning brightly.

Four years of medical school and three years of residency later, that flame was burning a bit, shall we say, dimmer. I was tired, just like everyone else that has gone through residency. I started studying personal finance pretty intently near the end of my intern year. This had two effects on me. One, I began to get my personal financial house in order, which was helpful. Unfortunately, it also allowed my massive student loan debt to weigh on my mind 24/7.

This can be problematic for someone entering the primary care field, where my paycheck will never touch those of some of my specialty colleagues. With that set up, I then proceeded to make a very large mistake.

Forgetting the Mission

I got into medicine because I loved it, pure and simple. I loved the intellectual curiosity and the personal connection with my patients. There was no money involved. I would still be a physician even if my paycheck was much lower than it is now.

As residency ended and I searched for my first job, I promptly forgot everything that made me choose medicine. With my financial position squarely at the forefront of my mind, I signed up to work for the place where I thought I could grow my practice, and consequently my paycheck, the fastest.

In short, it was a disaster. Sure, my practice grew. I enjoyed treating my patients, and they seemed to enjoy having me as their doctor. Every day though, I would drive home and wonder what my life had become. That kid that dreamed about being a doctor and helping people had turned into a money hungry young professional who would count the number of patients on his schedule and get frustrated if it was less than twenty-five.

I forgot everything about my personal position and what my mission was in my career and life, and that is the fastest route to burnout that I know.

The Change

It didn’t take long before I hit rock bottom and informed my employer that I was done. It was one of the lowest points of my professional life. I was a young physician with large debt, no real career path, and a rapidly diminishing sense of who I was.

There are many situations where this could end much worse than it did, but with the help of friends and family, I gradually found my way. I found a new job with a healthcare system that fits my ideals. The pay was lower, but the job satisfaction was much higher.

And sure enough, you tend to do well when you work in situation where you know exactly why you show up to work every day and enjoy that purpose. Eventually, I was given an administrative role in addition to my clinical duties, and TheBossMD was born.

So please don’t take it as fluff when I say that the personal element of your position is the most important part of who you are. I know firsthand the effect that losing yourself can have on your life.

I will be speaking on the blog more about how managing your finances responsibly can be instrumental to you accomplishing your goals. Don’t worry, however, my focus will always be on how to make your finances work for you, not the other way around. Trust me, you don’t want go there.