Money & Mistakes Rounds – Building A Culture of Physician Financial Safety

“Primum non nocere”

“First do no harm” first appeared in medical texts in the 17th century. While not verbatim in the original Hippocratic Oath, the spirit was there and it is one of the ethical pillars that underpins medical practice. Of course, the practice of medicine in the real world is much more complicated. We sometimes cut people to heal them.

Despite the best of efforts and intentions, we also make errors and harm occurs. To pretend otherwise, doesn’t make the damage go away and only makes the likelihood of them recurring higher.

Errors occur in a cultural context, and in recent years, there has fortunately been a cultural shift towards improving patient safety.

Building a “culture of safety” for physician finance

There can be a plethora of administrative jargon around “safety culture”. However, from an actionable standpoint, there are some key concepts:

• Acknowledging that the nature of our practice means that there are risks and that mistakes will be made.
• Leveling the power hierarchy, so that anyone can bring forward a question or concern.
• Encouraging people to discuss their mistakes without fear of blame, punishment, or ridicule.
• Commitment of leadership and resources to support this.

These same principles apply to how physicians can better care for their financial health.

As professionals, our personal financial health and that of our practice are inextricably entwined. A solid financial base enables us to perform at our best, and for our practice to best serve our patients.

There are also many financial hazards that we face.

With our practice and personal finances, there can be increased complexity, limits to our time/expertise – and frankly, our interest. Most of us love practicing medicine, but dealing with the financial aspect – not so much. With the pressing issues that we face in the practice of our profession and living of our lives, coupled to the fact we make enough income to mask financial problems for a while – it is easy to neglect our financial health until we have a sentinel adverse event.

There are, of course, people who look to service the need of tending to our finances for us – for a price. Most, if not all of us, at different times need the financial expertise of professionals like accountants, lawyers, and financial advisors. However, their knowledge about medical life and their motivations may not be the same as ours.

Hence, physicians teaching physicians about finance is vital to our financial health and avoiding harm. Informed and engaged patients are part of a medical culture of safety. We need be informed and engaged clients financially.

We need to openly discuss money with each other.

Despite the hazards and the impact on us personally plus trickle down effects on our patients, there is a certain taboo around discussing money in medicine. Being highly educated professionals who have gone through years of academic competition may also contribute to our struggles. That conditioning can make many reluctant to reveal their ignorance. That is compounded by feeling overwhelmed when those of us who are discussing finance always do so at an advanced level. We need to overcome these barriers for our colleagues to comfortably bring forward financial questions and concerns.

To foster these changes does require leadership and resources to support it.

Fortunately, with the internet, the cost of this is low and the main commitment is time and effort. Some have been doing this with a forum, blog, book, and courses on a professional scale like the White Coat Investor in the United States. Canadian physicians are a smaller community with similar issues in a sometimes very different context.

The Physician Financial Independence Canada Facebook group is a closed group (for physicians & their spouses only) that has gone a long way towards building a physician financial safety culture in our context. That venue hits all four of the above bullet points. It is functionally the physician finance equivalent of the “medical staff lounge” of a hospital where much of the informal problem solving occurs.

There is a full range of expertise there. Some are trying to figure out how to open an account, whether to pay off a loan or invest, or even how find an accountant. There are also more hardcore discussions of the nuances of asset allocation or tax efficiency. It seems a helpful crowd. In my brief time following that group, I have seen some great discussions and some potentially bad financial “critical events” get deflected into “near misses”.

I hope to also contribute to these efforts here on Loonie Doctor with a periodic post, analogous to a Morbidity & Mortality round.

Introducing Money and Mistakes Rounds

In medicine, we use M ‘n’ M rounds to improve how we care for patients. These rounds don’t centre around eating little candies, although food is often used as a method to draw attendance. They focus on difficult cases. It is the medical confessional where someone openly presents about the morbidity or mortality caused when things go wrong.

Usually as you watch these rounds unfold, there are some archetypes that manifest in the audience.

Fortunately, the days of the audience being dominated by one or two narcissistic hecklers seem to have largely died off.

The vast majority of the audience at an M&M round, sits quietly with a mixture of horror and relief. Horror – as the clinical story unfolds and they realize that either they have made the same mistakes, or could see how they easily would under the circumstances. Relief – that it is not them at the confessional podium.

As a more level hierarchy and open environment develops, there is also a growing group of clinicians that responds to these rounds by sharing some of their experiences making mistakes. This leads a more fulsome conversation, and hopefully, helps the attendees better handle similar difficult clinical situations in the future.

In medicine, patients and their problems often don’t follow the textbook

There are usually multiple factors, many non-medical, that lead to our treatment decisions – and our mistakes. Similarly, personal finance takes place in the context of our lives and is influenced by our desires, emotions, and available resources.

We can read financial books and articles. However, we also need to see it in practice. Our lives and problems are varied. So, a similar diversity of experiences helps to fill out our financial educations. Like with M & M rounds, sharing our financial stories can help us all learn for when we may face similar situations ourselves. 

Let’s focus on “The Big Stuff”

Recently, on the blog, I have gotten into some pretty detailed and specific nuances of corporate taxation, income splitting, and some specialty investment products. I hope that has not scared too many people off.

The main reason that I have explored those areas is because they have become potentially important with the recent major tax changes affecting small business owners. I found it hard to find good information in those areas that wasn’t either superficial with a conclusion of “consult your advisor”, or so boring and heavy that I would gladly pay anyone else to just not have to think about it.

I have tried to fill that void, but my wife edits for me, and I am sure wishes that I had paid someone else to do so. She’ll develop cirrhosis of the liver or dry eyes if I don’t give her a break from flowcharts and accountant Klingon.

Slight efficiencies in returns or taxation here and there can make a difference over long periods. However, most of personal finance and investing is waaaayyyy less complicated than that:

• Personal finance is about getting the big parts right around earning, saving, and deliberately spending wisely.
• The keys to successful investing are to make a plan that is good enough that it will achieve your goals, simple enough that you will actually execute it, and honest enough about your emotional tolerance that you won’t sabotage it.

Most of what I plan to put out there for M & M Rounds will center on these themes.

Lowering the cost of your financial education.

While I am blogging about personal finance, investing, and financial planning for high income professionals – it does not mean that I am financially perfect nor that I know everything. I mostly certainly am not and do not. I am prone to the same financial mistakes as anybody, and I am primarily a physician in terms of knowledge base.

Much of what I have learned, and continue to learn, is through necessity when I encounter a problem or by making mistakes. Most have been minor, but some of those have been costly ones. I consider that to be the tuition for my financial education. I have paid some medical school level tuition. Despite that, overall I have come out ahead. However, I am sure that my continuing money education (CME) will continue to be an expense item.

Hopefully, by learning from my triumphs and mistakes, and those of our colleagues, will lower those tuition and CME costs for you. If you have any financial lessons that you learned the hard way and want to share, please feel free to post them in the comments section. Help to lower my financial education tuition. I’ll bet that many of them are complex and knowing the full context is helpful. So, you can also email me and perhaps we could do a more fulsome anonymous guest post.