OK, you’re in medical school or internship or residency, so you’re most likely deeply in debt or earning a small salary or both. Most financial books and advice would say that you have no business dining out… that it’s financially unwise. And that it is.
But let’s face it. Your work days are also long and the time you have to grab something to eat is short. And at times you want to go out with your friends and colleagues. Fine. We all do.
But then there’s that slightly awkward moment where you get the bill. No one at the table is really in a position to buy food for everybody (and if they are, they probably don’t want to).
You’ve been labeled. Even if you’re still a medical student, an intern or a resident… you are “one of them”, “one of those doctors who sleep on bags of money”. At least that’s what a lot of people think, anyway.
When you bring up your debt or how long your training is, it doesn’t matter. It’s irrelevant that everyone else enters the workforce 8-10 years before you. You’re still one of them. It says so right here, in such-and-such a magazine that your average salary is XYZ.
So guess what? You’re gonna pay more. Period.
Well, that’s how the Doctor Tax gets you. Now it’s time to change all of that. Check out this video. You’ll learn why you’re charged more and how to stop that from happening. I’m not saying you should be stingy… I’m just giving you the tools to have a little more control over your money. And the first step is to know the who, the why, and the how of the Doctor Tax.
Debt sucks. And if you’re like me, you probably chose to sort of ignore it at first. That’s what I did… early on anyway. At first, I bought into the fact that doctors were higher wage earners, in general, so I assumed that I would have no problem conquering my debt after residency training.
Well, in my third year of medical school, I began to overhear occasional conversations by attendings and upper level residents complaining about their debt. I saw some of my non-medical friends from college begin to buy houses and cars. And I thought… if the debt burden is already going to be huge, how is that new doctors are able to buy homes right after their training? Do they just add more on top of their already large mountain of debt?
What would happen if there were a life-changing event? A chronic disease? A severe accident? Or a delicate family issue that needed tending to? There’s no way they could leave their jobs, even for a short while, with all of that debt… right?
Well, I saw something horrible happen. A third year resident in internal medicine had begun to develop strange neurologic symptoms. After extensive testing, it was discovered that she had multiple sclerosis. I watched her deteriorate in typical step-wise fashion from a fully functioning resident… one of the best, in fact… to the point where she needed braces to walk. I hear that after I left that hospital that they allowed her to complete her residency even though she couldn’t really finish all of the rotations. Although she probably had several options after her training – consulting, writing, etc – I couldn’t help but think… what if that were me?
What would happen to my wife and kids if my debt came due and I couldn’t work? Anyway, I digress. Let’s get to the next video.
In this video, I show you how I rapidly… and I mean rapidly… got out of debt. This is Part 1 of a two-part video. Even though Part 2 is only available to members, this one gives you the exact step-by-step plan I followed. Click this video’s image to get started. (It might take a few extra seconds for the video to start. The file is a little large.)
For an introductory video this is a little long, but it is important. I don’t know how you feel about it… but if you’re like me, then you probably feel that your training thus far, was pretty skimpy on the financial and business side of things. That’s how I felt anyway.
Well, I’m going to try to change that. And here’s the road map. (My apologies, though… I wanted to get this video out, so I made it while I was pretty sick. It took a lot of editing for the coughs, sneezes, and random breaks in clear thought.) Click this video’s image to get started. (It might take a few extra seconds for the video to start. The file is a little large.)
In the next video, I’ll show you how I rapidly… and I mean rapidly… got out of debt. I’ll give you guys the exact step-by-step plan I followed. You can take it or leave it, but I bet you’ll find it quite useful.
After a great response from those of you on my “new release priority notification list”, the RookieDoc Membership program is being opened to anyone that is interested. Here’s a short intro video to show you some of the things that are part of membership. If it sounds interesting or useful, click the link below the video to find out more.
If you could sit down with me and ask me any question about being successful in your internship or residency, what would it be? I’ll answer some questions on upcoming RookieDoc FAQs – these are occasional phone conferences for RookieDoc fans and members where I discuss a hot topic or answer questions.
OK. I had a sad, humbling experience on a trip to Wal-Mart last night. My wife asked me to return something and my daughter was/is sick, so I had to get a prescription filled. Not a big deal, right?
Well, three things… One. I am not a Wal-Mart guy. No offense to Wal-Mart Inc, but in my area the “customer service” there is quite pathetic. It is the type of place where those hilarious guys at Despair.com get inspiration. I have to consciously prepare myself to keep my mouth shut… suck it up… and move on.
Two. I am not a go-to-the-store-and-return something guy either. It’s just not me. I don’t like doing it. If I can get out of it, I will. (But if I’m wronged, I’m going full tilt – Better Business Bureau, letters to the home office, etc… just don’t make me return anything.)
Three. It’s the week after Christmas and the place is packed.
Anyway, I went.
There were no less than 40 people in line at the “customer service” desk (so naturally, I didn’t return anything :). I briskly bobbed and weaved to get to the pharmacy pick-up line. I was number 16 in line. Ahead of me stood 15 uncomfortable-looking, elderly patients. Since 11 of the 15 folks did not have a smooth pick-up, I had plenty of time to stand there… to just watch and listen.
Here is some of what I saw and heard:
The patients in line were elderly and uncomfortable standing so long.
Most of the patients had even sicker-looking (in a chronic sense) family members sitting aisles away on empty shelves or in wheelchairs.
While in line, these patients were cordial and patient, but as time went on, frustration and fatigue began to show.
While they were waiting and becoming increasingly tired, several employees were walking out from the back talking about their break and why they need to take it now, “even though it’s busy”.
Several patients were discussing “coming back out of retirement” just to be able to afford things for daily living.
Several quoted the $4 prescriptions as the reason they were willing to withstand the “customer service” and the lines.
Despite their interest in the $4 bargain, most (8) of them were unable to actually get the $4 drug… mostly because the way it was written.
11 out of 15 had issues with their scripts being filled at all – and not one of the 11 was given a solution that they could control… The staff blamed each issue on the doctor or the government – 8 on the doctor, 2 on the government (specifically Medicare Part D), and one on both.
The second person in line (appearing to be in her late 70s) ended up being shouted at by the pharmacist, “Didn’t you read Medicare Part D?! Your doctor has to put the indication on your prescription! It’s not my fault! Go ask your doctor. We called, but your doctor is not getting back to us.”
There was one employee who was visibly working her tail off to get the patients their meds before they even reached the counter. She walked out and asked each person in line their names and began trying to get their stuff 3, 4, and 5 people deep in line. No one thanked her. No one said, “Job well done”, at least in the 45 minutes I stood in line.
Here are some tips and pearls for interns and residents to take away from this experience:
Small things on your part can make a humongous difference for your patients.
Write the indication on your elderly patients’ scripts.
Advise your patients to bring their discharge instructions with them to the pharmacy when they leave the hospital for the first time.
If you are writing a narcotic, put your DEA number and spell out the number of pills to dispense.
Try to avoid writing “Use as directed”… that doesn’t fly with some co-pays, Medicare D, and some discount programs.
Choose the medications wisely… with cost being a huge piece to factor in.
Ask your patients if they’ve ever had problems filling scripts before and what the nature of the problem was… too many to dispense, not covered by insurance, etc.
Consider titrating doses before adding new classes, if possible.
Keep an updated list of the discount meds available. And familiarize yourself with other discount programs (Target, Wal-Mart, Giant, etc).
Get in the habit of writing the generic name anyway.
If you get paged from a pharmacy outside of your hospital, it is probably regarding a patient you just discharged… Answer it promptly. That person who was just hospitalized is probably standing in Wal-Mart, or sitting off to the side waiting for a family member to fill their scripts.
If there’s a discrepancy when looking at their meds and the meds you thought they were taking at home, ask the patient. Reconcile your scripts with their current meds.
Be careful what you talk about in front of others. Sure, there’s nothing wrong with discussing where everyone wants to order from for lunch. But if you do that while a patient or their family is in earshot, you might really rub them the wrong way.
Social workers and case managers know about these patients’ frustrations and potential problems… learn from them. Ask them for feedback. And appreciate what they do. (The insurance industry is like Wal-Mart on steroids.)
When someone does something well, or goes a little further than they have to, tell them about it… thank them… let them know that it was appreciated.
Now, it is important to realize that when you actually do these things, you will not be praised. No one will thank you. No one will really notice. And that’s okay. It’s not about you. It’s about them, the patients.
And if you don’t think it’s about your patients, then quit health care right now… and go work at Wal-Mart. You’ll fit right in… probably best-suited for “customer service”.
And here are some tips for Wal-Mart and pharmacies, in general:
Put some seats or benches for your elderly patrons. Be generous and be strategic. Put them in such a way that people can remain in line and remain seated if need be.
Consider having a health professional (MD, DO, NP, PA, Pharm D, etc) that can write scripts for the edits and tweaks that someone else simply forgot… things like indication, quantity, etc.
Consider having a looping video that explains procedures, policies, what’s needed, etc. so that people don’t have to wait in line to find out that they’re missing something.
Keep track of all of the issues that prevent people from getting their scripts on the first trip up to the counter… use that list to get to the root causes… or at least publish it. If it is truly the doctors, then send the list to me, I’ll get it out there.
Try to hire people that “own” problems, not the Me-Myself-and-I types that consistently shunt blame.
Remind your workers that it might be viewed as a little inconsiderate to discuss their breaks while frustrated customers look on. Remind them to consider how they would feel.
Tell your pharmacists that it is a very, very rare patient that ever “reads Medicare Part D”… In fact, I’ve never met one.
There’s my rant, but there are lessons in there, though. I learned a lot standing in line at Wal-Mart.
I posted a blog post a couple of weeks ago, just after the American Board of Internal Medicine (ABIM) issued a press release warning about scam certification boards. In that post, I mentioned that I was working on an identity theft report for Rookie Docs – medical students, interns, residents, fellows, and new attendings.
Well, the report is done… all 40-some pages of it. And you can get it free. “Free” meaning no money, but not entirely free. It will “cost” you three short questions.
Now, I can sit back and write random post after random post, not having a clue if you find them interesting and helpful… OR, I can ask you what you want me to write about. So, that’s what I’m doing. That’s the catch…
You anonymously answer three short questions about your financial fears and concerns, and I give you a free 40-page ebook on protecting yourself and your patients from identity theft. Sound fair? Here’s what I want you to do:
Keep in mind, I am not a lawyer (thank God), I am not a financial planner, I do not know your particular circumstances, and my advice does not substitute for a qualified professional in these areas. You can take my tips or leave them. In general, it is solid advice, but it may or may not apply to you.
And, as always, I want your feedback. (And a quick thanks for all of you who gave such good reviews of the CXR Mistakes report in the Members Area… keep it coming)
Doctors and nurses often have an “alphabet soup” after their names, representing certifications, memberships, and/or degrees. While many physicians are well-acquainted with the organizations in their particular discipline, patients usually are not. Patients, then, are at significant risk for being treated by frauds claiming to be “board certified” simply because they have a certificate from one of these “organizations”.
Already targets for identity theft by virtue of their high-paying jobs, doctors and nurses are at significant risk by these fraudulent organizations too. If they are so unethical as to pose as legitimate organizations and companies, what makes you think they would treat your sensitive personal and professional information as private and confidential?
The ABIM is asking that anyone who is contacted for joining such a group to notify them immediately. You can email them at firstname.lastname@example.org. Certainly, if you know of someone using fraudulent credentials, you should report them to the appropriate authorities. In your residency program, you would probably report it to Risk Management and the hospital’s credentialing officers.
Identity theft and fraud are huge. And unfortunately, our residency programs do not teach us enough about them- how they happen or how to recognize them. As such, within the next few weeks, RookieDoctor.com will be releasing information on identity theft and what you can do o protect yourself.
Most residency programs offer an education stipend or allowance. If you’ve purchased anything related to your training lately, make sure you submit your receipts. I posted Reimbursement Request Templates in the RookieDoc Members Area. Just plug in your information, print, and hand it in to your program.
By the way, for those of you in the RookieDoc Mastery Orientation Program, make sure you submit your receipts for reimbursement. RookieDoctor.com services should count under your education stipend. If your program does not reimburse you, send me the program address and a contact person and I’ll see what I can do. So far, every program that receipts have been submitted to have accepted them.