Dear Younger Self: Female Physicians Share Financial Advice

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MEDICAL ECONOMICS

Research data have shown that female physicians earn $2 million less than their male colleagues over a 40-year medical career.¹ Although societal and system changes are necessary to address the gender pay gap, individual female physicians should prioritize smart money management. For example, the quickest way to lose half your assets is to not have a prenuptial agreement in place when you get married, a financial lesson I learned the hard way. I asked other female physicians to share their financial mistakes and what advice they would give their younger selves.

Overcome Negative Money Beliefs

According to findings of a recent report, women often experience discomfort and embarrassment when it comes to talking about finances, with just 55% saying they feel confident about money management and only 28% feeling empowered to take action to better their finances.² Julie K. Gunther, MD, a family physician and owner of a direct primary care practice in Boise, Idaho, struggled with this notion early in her career. “A huge problem for me has been understanding that how we make money and value ourselves is based on our belief system—what has been passed down from our parents or our family,” she said.

In particular, Gunther felt uncomfortable with the idea of profiting from her work as a physician. “I wish I could go back and tell myself that my ability, talent, and good works and contribution do not need to be free or even affordable for everyone. I don’t have to justify how I make money, how much I make, how much I spend, or who I give it to,” she added.

Gunther recommended all physicians read about money management or take a course on the subject. “I don’t mean just how or where to invest, but to understand what money means to us,” she said. “It is a resource just like time, and we need to protect it, care for it, and [not] just give it away.”

Negotiate Your First Salary

The idea of negotiating salary never occurred to me when I received my first job offer. With such an increase over residency wages, I recall just saying, “Thank you.” It was only when my potential employer immediately volunteered another 20% that I realized my mistake…and in retrospect, I probably could have asked for much more.

“Never accept the first salary you are offered,” agreed Tiffany Leonard, MD, a family physician in Hatboro, Pennsylvania. Failing to negotiate your salary is a mistake that can lead to $1 million or more in lost income over a career, and it is a mistake that women make 4 times as often as men.

Greater pay transparency and sharing salary information with peers and colleagues may be helpful for negotiations. I am seeing this more often with graduating residents: New physicians are increasingly discussing salaries with each other. This is an area in which women can engage male colleagues as allies, too. In turn, this can help women close the pay gap by negotiating higher wages.

Spend Less and Save More

Many midcareer female physicians would tell their younger selves to live on a lower income and start saving for retirement as early as possible. “Get a professional financial planner early,” said Leonard, who owns her own practice. Leonard advised contributing the maximum to retirement accounts first and foremost, and then living on the remaining funds. “I do this now, but I didn’t in college,” she added.

Investing early for retirement is essential for physicians because extended training time translates into less time for retirement contributions to grow. Once we start earning full wages, income caps may limit our ability to invest in tax-favorable retirement funds, such as a Roth IRA. Although investing in retirement may feel uncomfortable during lower-earning residency years, most physicians wish that they had made the sacrifice.

Another benefit to living frugally is the freedom to walk away from a job you do not love. Shenary Cotter, MD, said she would advise herself to “keep your lifestyle the same as [you did in] residency until you have enough money in the bank to leave any job that makes you sad.” Andrea Otto, MD, a family physician in Kirkwood, Missouri, agreed. “Don’t let the idea of having money or your first paycheck allow you to get comfortable living at or just below your means. Plan to live well below your means by keeping in mind what really matters to you,” she said.

Pay Off Debt Quickly

An important step to financial independence is paying off debt, especially student loans. “Be aggressive about making sacrifices to pay off your loans early,” advised Katie P. Edson, MD, a family physician in Christiansburg, Virginia. Edson says that debt and lifestyle can trap physicians in jobs they dislike, while paying off debt allowed her to open her own clinic. Sarah J. Martin, MD, a family physician in Sauk Centre, Minnesota, agreed, and suggested using a budget to help quickly pay school loans. “Don’t take out the maximum in loans if you can help it,” she added.

However, Janice C. Brown, MD, a physiatrist in Ocala, Florida, said fears about student loans should not deter doctors from practicing medicine on their own terms. “Medical school debt is an investment in you and not a burden; pay it off based on your emotional comfort level,” she explained. Brown would advise her younger self: “Save money and invest it. Making money while you sleep trumps any debt.”

Take Care of Your Health and Wellness

Female doctors emphasized that they would urge their younger selves to be more mindful of their health. “Don’t eat from a vending machine in undergraduate because you are worried about money,” said Esther Khatibi, MD, a family physician in Corpus Christi, Texas. “Your health is a bank that you deposit into.”

Cotter said that she would tell her younger self to prioritize self-care and family over work and to use her vacation and sick days. “Yes, all of them,” she said. “Every single year.” Cotter added that she would also advise herself to work part-time when her children were small.

Otto agreed. “Don’t let your job or career run your life. It’s too easy to get caught up and lose sight of your priorities and who you really are,” she said.

Meanwhile, Langley would also urge her younger self to devote time to hobbies. “They can support you through difficult times,” she noted.

Many female physicians pointed out the importance of having adequate insurance, especially disability insurance, and recommended obtaining an own-occupation policy during residency training. “Given that I had breast cancer at 40, 2 years into an entrepreneurial venture, I encourage everyone—absolutely everyone—to have a long-term disability policy,” Gunther said.

Be Your Own Boss

Many physicians said they would encourage their younger selves to take a chance on self-ownership. Family physician Candice Cavicchia Miller, MD, owns her own practice in Lancaster, Pennsylvania. Miller said she would remind herself that doctors are always replaceable to corporations. “It sounds scary, but it’s actually very reassuring,” she explained. “You can leave the job you hate—it will go on without you. So take care of yourself.”

The best financial advice for female physicians, according to Brown, is to take control. “Don’t be afraid to practice medicine the way you want,” she said.

Dr Bernard is a family physician in Fort Myers, Florida, and the coauthor of Physician Wellness: The Rock Star Doctor’s Guide.

References

1. Whaley CM, Koo T, Arora VM, et al. Female physicians earn an estimated $2 million less than male physicians over a simulated 40-year career. Health Affairs (Millwood). 2021;40(12):1856-1864.

2. Women, money, confidence: a lifelong relationship. Bank of America. Accessed June 11, 2023. https://business.bofa.com/content/dam/flagship/article/Women-money-confidence/WomensResearchReport.pdf

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