How to give money to your family without going broke

Realize you can’t do it all

You’re a nice person. You want to help others. You love your family and friends. But let’s face it. You can’t do it all. You cannot put everyone else’s needs above your own. Although this is something we know, it can be hard to put into practice. You are successful. You’ve done well for yourself. And other people count on you. But you have to realize you can’t be everything to everyone. You cannot give all you have away leaving nothing for yourself. You cannot put the livelihood of yourself and your immediate family in jeopardy because of your generosity to more distant family members or friends. You cannot continue to give away endless amounts of money to others before paying off your own debts and obligations.  As the airplane stewards say “put your own oxygen mask on first before trying to help someone else”

Decide how much you can afford to GIVE away

There’s an old adage that says “Never loan money to family that you expect to get back.” In other words, when it comes to family, loaning money isn’t wise. Either give the money away with no strings attached or do nothing at all. Loaning money creates unnecessary tension that could destroy loving relationships and families. Give away what you can and make peace with the rest. While some people cannot fathom the thought of financing the livelihoods of their extended family, others consider it as natural as brushing their teeth. Whether you view it as an important tradition with tremendous value or a rare occurrence, decide what you are willing to give. Look at your monthly income and expenses. Decide a reasonable amount you can actually afford to give away each month. Is it $50 or $100 or perhaps $500?

Create a Family Savings Account

I find that having a set amount in your head may not be enough. When it comes to family many of us don’t stick to our boundaries or budgets as much. One way to avoid overspending is to create a family savings account. Deposit money into this account each month with the amount you can afford to give away. As family needs come up, you can pull money from this account to assist your family. This allows you to save for the financial needs of your family without having to assist with large purchases last minute. Make a rule that the money you give to your family will no longer come from your bank account directly. It will now come only from this family savings account. Each month you can make a deposit into this account to build up reserves for any financial requests/needs of your family may have in the future.

Set expectations and boundaries

Let your family know that this account cannot be over drafted. This means that once the money is out and the balance goes to zero, they must wait for the reserves to build up again before more money is given away. This allows you only give away what you can afford each month without being bombarded with last minute requests that you didn’t plan for. It creates boundaries and allows you to set expectations around what you can give away without jeopardizing your own financial goals and obligations. You get to be generous to your family and still take care of yourself. It’s a win-win.

What are I-bonds and are they worth the hype?

Every other month there seems to be a hot topic in the finance space. Some months the story is about cryptocurrency. Bitcoin mining is setting the world ablaze and Dogecoin has gone to the moon (and back). Other months it’s all about stocks. Tesla is undergoing stock splits. Amazon is crushing small competitors, and Walmart is taking over healthcare. Sometimes we can’t get enough of real estate as we hear stories of folks using cash to pay above-asking price for average homes or scroll down our newsfeeds of targeted marketing for overpriced real estate courses. The recent weeks are no different. Only the craze isn’t crypto or individual stocks or real estate, it’s bonds. Yep, you heard that right, bonds. More specifically I-bonds. Let me clarify some half-truths and dispel some myths.

What are I-bonds?

Generally speaking, bonds are a type of asset. You loan money to an organization, company, or in this case the federal government and they pay you back the money with interest. They promise to give you back the money with interest by issuing you a promissory note called a bond. There are different types of bonds and each one has a slightly different structure. I-bonds are “inflation-protected bonds", which is one of the many different types of bonds a person can purchase.

How do I-bonds work?

You pay for the bond (through the treasury website). Each person can buy a maximum of $10,000 worth of bonds each year. The interest rate that you make on the bonds is based on two factors: a fixed rate and a variable rate. The fixed rate is pre-set and based on market terms. Currently it’s 0%, which is about the norm. The variable rate is based on inflation and changes every 6 months. Currently, its around 9% per year. (A person would earn half of that amount for 6 months and then the rate would be changed once more if inflation changes during the next 6 months).

Why do people want them?

Because they think they can make a lot of money. Because I bonds or inflation protected bonds are based on the inflation, the rate of return on these I bonds seems extremely attractive. As of early May of 2022, the stock market is down, the price of real estate has skyrocketed, cryptocurrency is volatile, and cash is losing value. Having an investment like I-bonds that provides you with a guaranteed interest rate over 9% (at least for the next 6 months) seems like a good deal and much better than other investment choices at the moment.

What’s the catch?

Although I-bonds protect against inflation and provide a guaranteed interest rate the real rate of return on your money is actually zero, or negative. Let me explain. Because the fixed rate of I-bonds is zero and the variable rate is set to inflation (currently around 9%) you haven’t made any true gains. If inflation has gone up by 9% and the value of your bond has gone up 9% then then your true gain is actually zero because your purchasing power is still the same. Stated differently, If you invested $1,000 in I-bonds, with a guaranteed inflation protected rate of 9%, the value of your money is now $1090. However, if the price of monthly groceries for your home also went up by 9% from $1000 to $1090 then you haven’t really gained anything. The price of goods and services went up at the exact rate your bond went up so your net gain was zero. You don't make money by just seeing an asset go up in value. You make money by increasing your purchasing power to outpace inflation. If all you do is simply break even with inflation each year then you haven’t really gained as much as you might have thought.

Are there any other downsides?

Yes. There are taxes and liquidity issues. Per the rules of governmental I-bonds, you must hold the bond for at least 1 year. This means if an emergency comes up, you cannot liquidate or sell your bond to get your money back. You have to keep the money there for at least 1 year. Secondly, if you take out your money in less than 5 years you forfeit 3 months of interest on your money. This means if you cash out the bonds in less than 5 years you lose some of the profit you made. Lastly, you must pay federal taxes on the interest gains (unless you use the money for college expenses or hold it for at least 30 years). So if your money was keeping up with inflation, but then you have to pay federal taxes on your profit, you’ve actually gained less than inflation, putting your real buying power in the negative.

Should you buy them?

It depends. It’s not like I-bonds are all bad. As we mentioned above, they keep up with inflation. So at a time where stocks are down, real estate is too high, and cash in a savings account is losing value, I-bonds can be beneficial. Although your real return is zero, your return is even more negative in other alternatives. For example if inflation is at 9% and your savings account is only giving you a return of 0.01% then the value of your money is losing value drastically day-by-day. I bonds can be a good way to protect some of your purchasing power or at least prevent you from losing so much of it in cash.

Some people think they could come out ahead by buying I-bonds during stock market dips then selling them and buying stocks when the market recovers. That strategy is flawed because it requires you to be able to predict the future and of course none of us have a crystal ball. Trying to predict the future by timing the market is a recipe for disaster. If you have large sums of money in cash or have transitioned from the wealth building stage of your life to the wealth preserving stage of your life, then I-bonds can be a great idea in today’s times. Just make sure you go into them with your eyes wide open and fully understand the value. If you are someone who is saving up for a large purchase like a home downpayment, a future car, or to buy into a practice or new business then I-bonds can be a great investment.

(Of note, I recorded a podcast episode on this topic at the Physician Philosopher with Dr. Jimmy Turner that you can find here)

8 Questions to Ask Before You Join a New Practice

The following article is tailored for medical doctors but certain aspects may be applicable for young professionals in other fields.

Starting a new job can be nerve-wrecking and exciting. Along with negotiating salary and benefits, you should also ask about a few other factors to make sure you know what you are getting into. Here are 8 questions to ask before you join a new medical practice.

1. Why are you hiring? Some practices are hiring because they are growing. Other practices are hiring because people are quitting. What is the case at this location? Are people getting promoted which creates new openings? Or, have multiple people decided to leave the practice for one reason or another? Don’t just take their word for it. Ask to speak to a couple of the physicians at that practice. Find out what they like about the place they work and also ask what they would like changed. Speaking to other physicians will help you get an idea of what working there would be like. You want to go into your new job with your eyes wide open.  

2. What is the turnover rate of staff? Reliable support staff is key for a good work environment and quality of life. Find out what it is like at this practice. Have most doctors had their support staff for years or is there frequent turnover? How many medical assistants and nurses are there per doctor? Is there someone to assist with portal messages, medication refills, and patient forms? Many doctors get burned out due to lack of support and increasing administrative tasks so be sure that you understand the workload and have reliable support needed to get it done. The recruiter may not know this information offhand so reach out to the nurse manager or clinic manager, if needed.

3. Am I expected to supervise or work alongside mid-level providers? There has been an influx of physician assistants and nurse practitioners in the medical field. Are they hired at your hospital or clinic? If so, what is their role? Some practices have the mid-level discuss every patient with the physician. At other places, the mid-levels seem to practice independently. Find out how they are utilized where you are. Also find out if you are expected to supervise them. If you are, realize that you are now taking on more medical liability. Is the practice compensating you more for this risk? If you are expected to review their charts, are you given more admin time to accomplish this goal? Make sure you clarify this BEFORE you sign the contract.

4. What happens if I leave? No one goes into a marriage, expecting to get divorced. Nevertheless, break ups happen, especially when it comes to jobs. It is much easier to discuss terms ahead of time so make sure you ask. Inquire about the notification policy. Who do you need to tell and how far in advance must this be done? Also clarify if there is any money you will have to repay if you leave before a certain time frame? Are you expected to payback the full sign-on bonus or just a part of it? Also ask about malpractice and health insurance coverage. How does malpractice work if you leave? How long do you keep your health benefits? Lastly, clarify any rules or stipulations. Is there a non-compete or are you able to take a job nearby if you desire? Make sure you have all of these terms in writing in a place that is easily accessible.

5. Am I able to work part-time? Not every practice or healthcare system has kept up with the times or is structured in a way to handle part-time workers. Make sure you ask. Just because you plan to work full-time now, does not mean you won’t want to cut back to part time at some point in the future. Will this practice accommodate that? If so, what would be the pay difference? If you work part time are you still eligible for health insurance benefits? Will you have to repay part of your sign on bonus? Will you be given a different productivity threshold to reach? Understand the rules in place for part time workers and get a sense for how accommodating they will or won’t be with this schedule change if you were to desire it in the future.

6. What is the patient panel and insurance payer mix? Patient panel and insurance mix can drastically impact the revenue of the practice and your own personal satisfaction so be sure to ask about it. What are the patient demographics? Do you serve a diverse group of patients (in terms of gender, race/ethnicity, economic status, etc)? What percent of billing does the practice get paid for on average? Is this practice located in an underserved community with lots of Medicaid patients? Or, does the practice serve a more affluent population that tends to have private insurance? The type of insurance patients’ have will impact clinic reimbursements and your overall pay.

7. What are the clinic policies? Get a feel for the operations and interworking’s of your clinic. Is there a late policy for patients? Who handles forms like FMLA, prior authorizations, and work/school clearances? Also, understand how holidays work. Is your clinic open or closed for certain ones? Is there a chance you could be on-call? Make sure you understand how time-off works. Do you have to ask for it months in advance? Do you have to take it in 1-week chunks or can you request each day as needed? These are some of the intangible factors that can heavily influence your qualify of life.

8. How are bonuses structured? You deserve to be paid well for the work you do and rewarded for the efficiency you provide. Be sure to understand how bonuses work and clarify which milestones are required. For example, if you get a sign-on bonus find out if you get all the money up front when you sign the contract or if you have to wait until you start working. Also clarify if it is given in a lump sum or dispersed evenly over time? Along with the sign-on bonus, ask about productivity bonuses. Usually this is extra money you get for hitting a certain RVU target. Figure out what that RVU target is and whether or not it is feasible for you to reach. Healthcare systems may even have additional bonuses based on the practice revenue or patient satisfaction scores so ask about those as well. Lastly, inquire about a longevity bonus or a reward for staying with the same organization for a certain length of time. Is there some sort of reward for your loyalty in terms of an increased retirement match, a higher bonus, tuition reimbursement for your kids, a partnership promotion, or a cost of living adjustment? Their answer may be “no,” but it certainly doesn’t hurt to ask or negotiate something like that into your contract.

What should you do about housing?

It’s that time of year again. Med students are getting ready to graduate and young physicians are about to start their first doctor jobs or move up in the current ones. Some folks will have to move across the country and others may only be moving a few hours away. Regardless of which camp you are in, one question inevitably ensues: What should you do about housing?”

As most of us know, inflation has skyrocketed this year. Rent prices are higher than they’ve ever been. Homes are selling for more than they are worth. It’s a catch 22. Either you struggle to buy a home in this crazy market, or you resort to paying ever-increasing rent amounts on an apartment. Here are some things to consider before you make your decision:


1. How much can you afford to spend on housing?

This is the first question you should honestly ask yourself. As someone who has contemplated the rent vs buy question almost yearly, I’ve come to learn there is a difference between what you’d like to spend on housing and what you can comfortably afford. Don’t confuse the two. The general rule of thumb is to spend no more than 1/3 of your gross income on housing. This may be a bit more challenging in these current times of rapid inflation and rising housing costs. It may also be challenging for those of us living or planning to move to high-cost-of-living areas. Keep in mind that if you end up spending more than a third of your income on housing then you may have to cut back in other areas. It may even prevent you from meeting some of your savings goals, being able to take the vacations you desire, or buy the type of food you’d like. Take some time to write down all of your sources of income and use that number to determine what you can reasonably afford to spend on housing each month.

2. What is the average rent price in your area?

Once you figure out what you can afford to spend on housing each year, try to determine what you’d reasonably spend on different types of housing—the first being rent. Go to apartments.com or Zillow and get an idea for how much rent is in your area or the city you will be moving to. Does a one-bedroom cost $1,000/month, $2,000/month, or $3,000+? Look at newer places and at older styles. Consider different areas of the city. Although prices are subject to change, doing this type of research will help you determine what you can expect to spend for an apartment monthly. (It may also help you decide if you should consider getting a roommate or not).

3. What would it cost to buy a home in your area?

Once you get an idea for rent prices in the area, take a look at home prices as well. Many folks see the rising rent prices and automatically assume it is better to buy a home. That assumption is not true. Rent may be high, but home prices and estimated mortgage payments may be even higher. Even if the mortgage is affordable, there are other home buying costs to consider. You may need a down payment which can often be at least 3 to 5% of the total home cost. You also have to account for the transaction costs of buying a home (attorney fees, inspections, appraisals, etc), yearly property taxes (which can be up to 1% of the home value), homeowners insurance, homeowner’s association fees, and maintenance costs. These costs can add hundreds if not thousands of dollars to your monthly housing costs each month. Be sure you have a good idea for what your total housing costs would be if you were to purchase a home.

4. What are your future plans?

Another decision that could alter your decision to rent or buy is your future plans. Although no one has a crystal ball (or at least not a working one), take a few moments to contemplate what your life may look like in the next few years. Do you plan to stay in your current city or is there a good chance you could move? Renting gives you more flexibility and the transaction fees of buying a home may be hard to recoup if you live in it for less than 5 years. Do you foresee a change in your family size? Oftentimes, the type of house you may like or the area you may choose to live in as a single person is vastly different from what you would choose if you were married with had children. Lastly, is there a good chance you could have a change in your income? Are you fairly confident that you’ll get an income boost which will make things more affordable? Or, maybe you or your spouse will cut back on work to focus more on family which will result in an income drop or increased expenses? Although it is hard to predict what will happen, taking a few moments to contemplate your future plans could drastically change your decision to rent or buy in this market.

To summarize, the decision to rent or buy may not be as easy as you think. As stated above there are several things you should consider before making your decision. Being honest with yourself about what you can reasonably afford is key. Choose wisely.

How to Get Money for Moving Expenses

It’s late spring. This means lots of med students and physicians are preparing to start new jobs or hoping to advance forward in their current one. This is an exciting time, but it can be stressful as well, especially when it comes to finances. Gathering money for moving expenses, housing costs, as well as basic living expenses can be quite daunting. As someone who is moving across the country to start a fellowship myself, I completely understand the sentiment. When people ask me about ways to get money for all these expenses here are the 4 things I tell them:

1.     Moonlighting. As a physician one of the things we know how to do is work. Moonlighting is when we as doctors work extra shifts for added pay. Some people work in the hospital, others work in the urgent care, some even take call from home. Each employer has their own set of rules or stipulations regarding moonlighting but if your program allows it, working a little extra to cover the cost of moving expenses can be a great way to earn extra cash. 

2.     Uber/Lyft/Doordash/Amazon. Some folks, especially med students may not have the credentials to moonlight or work extra shifts. If that’s the case for you, there are other options to consider. You can try driving for Uber or Lyft or even sign up for food and package delivery services like Amazon and Doordash. While these jobs may not be the highest paying, the flexible hours may be a great fit for your busy schedule. 

3.     Monetize your talents. I’m a huge fan of having multiple income streams and encourage all young professionals to do so as well. Perhaps there’s a skill you have that other people would pay you to learn? For example, some of my friends are good at tennis and charge others for tennis lessons. I also have friends who are great at cooking and charge their friends for meal preps or who are great at photography and charge others for headshots. Can you think of a skill you have that you can monetize? If so, let your med school classmates or co-residents know and get started!

4.     Get a side hustle. Side hustles can be great. They are jobs that we do for others or passion projects that we make money from. For example, some people have started a blog or podcast and charged companies for ads. Other people do some consulting on the side. Some folks make money from social media or act as ambassadors for other companies. Think of ways to leverage what you know or who you know in order to bring in some extra cash.

5.     Personal Loans. When all else fails and you need some money quickly, you can always consider a loan. I’m not a huge fan of taking out debt you don’t need, but even I had to borrow money at some point, especially when I was waiting on my first residency paycheck. Moving can be expensive and trying to get money for housing and living expenses can require cash that you may not have on hand. As long as you don’t take out more than you need, getting a personal loan at a low interest rate can be quite beneficial. While there are several companies that may offer relocation loans, Doc2Doc is a company for physicians by physicians that offers loans at low interest rates to graduating med students and physicians. If you have a pressing need for cash, these types of personal loans can be a great option as well.

7 Tax Tips to Keep in Mind

One of our largest expenses each year is the amount we pay in taxes. Although we should all contribute to various government programs and priorities, it behooves us not to pay more than we need to. Here are some tax tips to keep in mind:

1. Contributions to retirement accounts lower your taxes. As a young professional, you have many uses for your money. Perhaps you want to go on vacation, drive a nice car, or maybe just need to keep up with rising housing costs. Regardless of the expense, it is important that you not lose sight of the bigger picture. Many of you would like to build wealth or at least become more financially stable. One way to do that is to invest money on a consistent basis. Ironically enough, investing money through retirement accounts not only helps build your net worth, but it also helps lower your taxes. When it comes to tax lowering strategies, investing through retirement accounts is a no-brainer.

2. Remember that every dollar is not taxed the same. I’m constantly reminded of this whenever I’m contemplating a new side hustle or business partnership. The tax code is progressive. This means that lower amounts of money are taxed at lower rates than higher amounts of money. As soon as you reach certain thresholds you could jump from one tax bracket to another resulting in a higher tax bill. This is important to keep in mind as you continue to progress in your career. Chances are that you will make increasing amounts of money as you continue to work, so understanding the tax implications is vital. If someone is in the 24% tax bracket, then they will only get to keep about 76cents of each dollar they earn (and this doesn’t account for state and FICA taxes). I’m not saying earn less, but don’t forget that the more you earn, the more you will owe in taxes, so plan accordingly

3. Don’t forget to account for FICA taxes. For some reason, when I think of taxes, I think of my federal tax rate. Oftentimes I forget about another high tax: FICA taxes. FICA is the Federal Insurance Contributions Act that mandates workers contribute to Social Security and Medicare. If you are employed, then your employer deducts these taxes from your paycheck. However, if you’re self-employed or own a small business like I do, then this tax becomes a lot more noticeable. Those who own a small business or who turned their side hustle into an LLC are now responsible for paying taxes on the money they earn. In addition to paying federal and perhaps state taxes on the profits, they must also pay these FICA taxes. As a self-employed person, you have to pay the employee half of FICA taxes and the employer half of these taxes. This amounts to an extra 15% in taxes you must pay, on top of your normal federal and state taxes. You may want to consult with a tax attorney or accountant for the best strategy when your business becomes profitable.

4. If you’re single and childless, you’ll likely pay more in taxes. I’m reminded of this fact every year around tax time. Many of my friends from high school who have kids are usually excited to be getting money back from their taxes. Meanwhile, I file my taxes and just hope I don’t owe anything. Why is it that my friends are getting money back and I’m not? Could be due to a variety of reasons, but there are a couple things to note: 1) single people have higher tax rates than people who are married and file their taxes jointly and 2) people who have children get more tax credits and tax deductions than people who don’t have kids. I’m not saying get married and have kids to lower taxes. This is just some insight as to why some folks may owe more or less in taxes than others.

5. You must pay taxes on business profits. Many people are entrepreneurial and have dreams of building a business they can call their own. While there is nothing wrong with this aspiration, don’t forget about one of the responsibilities of owning a business: added taxes. As a business owner, you must pay taxes on profits you make. This means you have to keep good records of business revenue and business expenses so you can determine the business profit amount to pay taxes on. Since you don’t have to pay taxes on business expenses, be sure to keep receipts of business purchases you make. Failing to do so could result in higher taxes.

6. You may be able to write off some educational expenses. This was a pleasant surprise to me the year I graduated medical school. I was able to get a noticeable sum back on my taxes that year by accounting for my time in school. The IRS has a tax credit called the “lifetime learning credit” worth up to $2000. If you’re someone who paid for some sort of schooling in 2021, you can take advantage of this credit. Those who were still in undergrad may be eligible for a different credit that results in even more money. Simply ask your school for “From 1040” so that you can enter the necessary information to get the credit.

7. You can deduct some of your charitable donations. Many people give a portion of their earned income away. Some people do it at their church and give 10% of their income as tithes. Other people give to certain non-profits or noteworthy causes throughout the year. If you do something like this as well, keep in mind that you may be able to deduct this expense. Everyone can deduct at least $300 of charitable donations. Depending on your tax bracket and the way you file your taxes, you may be able to deduct even more.

I am not a tax lawyer or accountant. However, each year I continue working in my career and building my side business, I learn even more about ways to be more efficient with my money. This includes profitable tax strategies.

What tax strategies have you learned this year?

What you need to know about non-compete clauses in your work contract:

The following post is part of a series on physician contracts

Non-competes are restrictive clauses that are found within many physician contracts. Unfortunately, they can drastically impact where a doctor is able to work and how they practice medicine. Before you sign any contract, look to see if it contains a non-compete clause and make sure you understand all the nuances around it.

What are non-compete clauses? Non competes are stipulations in contracts that prevent you from “competing” with your current employer by working for one of their competitors if you were to leave your job. They prevent you from working for a competing organization or health system within a certain radius for a particular time frame to prevent you from taking away any business form your current employer. For example, if you are a psychiatrist who decides to work for a large health system, the non-compete clause in your contract may state that if you leave your current job then you cannot practice psychiatry within a 20-mile radius of that employer for the first 2 years after you leave.

Why do they exist? Non-competes exist because employers have discovered that many patients like their doctors. In fact, patients tend to be more attached to their doctor than to the health center or clinic that they go to. Because of this, if patients find out that their doctor is leaving the current practice or hospital to work at another location nearby, the patient may follow the doctor to his or her new location. Health centers and hospitals don’t want to lose patients, so many of them put terms in place, like a non-compete clause, to prevent doctors from leaving the practice, taking patients with them, and becoming their direct competitors.

Why don’t doctors like them? It is rare for a doctor to work at one place for the entirety of their career. They may want to switch jobs for an increase in pay, more work/life balance, a change in family priorities, a job promotion, etc. Non-compete clauses restrict this. If a physician is already settled in a city that they love, non-competes clauses may require them to move to an entirely different location in order to continue to practice their specialty. If a non-compete states they can’t work within a certain radius for a certain length of a time, then a physician may not be able to take a better job in the same city and may be forced to move away or have a long work commute in order to avoid being sued for violating this clause. Many doctors feel as though non-compete clauses keep them stuck in jobs they may not like, getting paid less than they are worth.

What can doctors do to change it? Many doctors have encouraged others to refuse to sign contracts that contain non-compete clauses. They argue that no other profession tends to have this sort of restrictive language in its contracts and believe if physicians collectively refused to sign contracts with these clauses then the clauses would be removed entirely. Other doctors disagree. They feel as though trying to eliminate noncompete clauses altogether is a lost cause and instead encourage doctors to negotiate better terms. They suggest shortening the length of time in the non-competes, lessening the radius, or having the clause eliminated altogether for doctors who have not yet built up their patient practice or who have worked for their employer for a certain length of time.

My point? Be aware that non-competes clauses exist and try to eliminate them out of your future contract. If you cannot remove the non-compete clause, then be sure to negotiate more favorable terms.

8 Things to Negotiate Besides Salary

The following article is focuses mainly on physician contract negotiation

Whether we are considering a new job or up for review at our current place of employment, there are several things we should negotiate. Many of us focus solely on salary, but there are other things we should be sure to negotiate as well:

1. Benefits and Insurance: One of the first things to consider besides salary is benefits. For physicians and other young professionals with college degrees, student loan forgiveness may be one of the top things to look at. Some jobs offer direct loan forgiveness. Other jobs qualify for federal loan forgiveness through the public service loan forgiveness program. Be sure to see if either is offered at your job. Along with loan forgiveness, also look at retirement matching. Retirement matching is when your employer gives you extra “free” money to invest in your work retirement accounts. They may “match” the amount of money you invest up to a certain amount, which can add up to tens of thousands of dollars per year. I’ve seen some jobs in which the salary was $10-$15K less than another place but the retirement matching was so good that it more than made up for it. Another benefit to look at is malpractice insurance. Ensure that your job covers you if a patient or client tries to sue and that the insurance in place will cover you for claims made while you work for the organization AND even after you leave.

2. Sign-on bonus: One of the initial bonuses doctors get when they sign their first attending physician contract is a sign-on bonus. There are many nuances involved with a sign on bonus that doctors should be aware of but in general, a sign-on bonus is a 4 to 6 figure amount of money that many businesses provide to newly hired doctors. It can be given in one lump sum or in smaller installments. It is usually structured as a loan that gets “forgiven” after you work at the company for a certain period of time. This free money can be great, but the first amount they mention is unlikely to be their best offer. Ask for more.

3. Productivity Increases: Along with a sign-on bonus, it is also important to inquire about productivity bonuses. Most places want you to be as efficient as possible since increased efficiency leads to increased profits. If you’re actively increasing the business’s revenue because of your efficiency, then you should get a share of the profits. Be sure to negotiate this ahead of time and be aware that the amount they offer may differ for people in certain specialties. Some places will pay you a flat salary until you hit a certain work productivity threshold. Other places will pay you based on productivity from the onset. There are even businesses that offer a set monthly pay but provide annual or semiannual bonuses to employees based on the total company revenue. The exact structure of the productivity bonus can differ. Make sure you understand what other folks in your profession are getting so you can ensure you are being compensated adequately for the efficiency you provide.

4. Vacation and Personal Leave: Whether you love your job or not, everyone needs periodic breaks to step away and recharge. Do not forget to negotiate paid vacation time. While 3 weeks may be standard at most places, who says you have to settle for average? Why not ask for more? Aim for 4 weeks or negotiate additional vacation time after you have been with the organization for a certain length of time. Many jobs like to lump vacation time and sick time together as “personal time off” but try to keep this separate if you can. If you or a loved one gets sick or diagnosed with an illness, you shouldn’t have to use all of your vacation time dealing with medical issues. See if you can get at least 5 days of sick time in addition to your vacation time. If you’re a parent or plan to be, be sure to ask about parental leave for the birth or adoption of a child. Although FMLA holds your job while you are out, you may not get paid during that time. Negotiating paid family leave is vital.

5. Work Schedule Flexibility and Expectations: Along with personal time off, it’s also important that you negotiate a healthy work schedule that allows you to be productive without causing you to burn out. Perhaps you decrease the frequency you are on call? Maybe you negotiate a 4-day work week. Or perhaps you consider starting and/or ending work a little earlier or later some days to accommodate your family needs. You have the power to create the work schedule you desire. Figure out what type of work schedule you want and negotiate for it. If you can articulate how you will maintain productivity with your desired schedule, employers will be more likely to consider your requests.

6. Automatic increases: I am amazed by the number of physicians and other young professionals who don’t get automatic raises each year at their job. Because of inflation, things get more expensive each year. If you don’t get a cost-of-living adjustment to account for inflation, then you may actually be losing money year after year. Cost-of-living adjustments may not be standard at many places, so be sure to negotiate that in the contract if you don’t see it. It may also be wise to negotiate general productivity targets or a longevity increase. The goal is to get an automatic increase in pay after working for the organization for a certain length of time, like 3 years, as well as an automatic increase for bringing in “X” amount of revenue for the company. These types of automatic increases help you continue to be paid your worth over time and ensure that people hired after you don’t start off making more than you.

7. Licensing and Continual Education: As physicians, this is an important expense to inquire about. State medical licenses (to practice medicine), DEA licenses (to prescribe medicine), and board certifications (to maintain your medical credentials) can cost thousands of dollars in fees. It’s standard that the business pays for these expenses so if you don’t see it in the contract, ask for it to be added. Along with getting these fees covered, most medical societies require you to stay up to date on new medical treatments by doing a certain amount of continual medical education (CME) each year. Ensure that your job provides you with an adequate amount of CME funds to attend conferences and programming that provide these CME credits.

8. Autonomy (Intellectual property and non-compete clause): A surprising number of physicians do not have autonomy over their work. Don’t let that be you. Ensure that your intellectual property (ideas, products, or services that you create) are yours and not the job you work for. Be sure that you have the freedom to do other projects and work at other places outside of your job should you choose to do so. Lastly, watch out for non-compete clauses. These phrases in contracts prevent you from doing similar work at a nearby organization if you were to leave your current job. As you can imagine, they can cause a huge problem because they may require you to uproot your entire family or drastically increase your work commute if you were to quit your job since these non-compete clauses prevent you from getting another job at a different location in the same city. Try to avoid non-competes if you can.

Was this helpful? Do you plan to negotiate these things in your physician contract? Are there other things you plan to add?