年收入16萬，但感到生活壓力沉重的美國醫生該如何理財？

MD Lament

Most people who don't have "MD" or "DO" after their name would assume that $160,000 is a darn good annual income.

That's what a typical primary care doctor -- family physician or internist -- earns after expenses but before taxes, according to Medscape's first Physician Compensation Survey. Yet it's often not enough in a world where rising costs collide with stagnant reimbursements.

That's because in many ways, doctors are not your typical high-earners. On average, a newly minted physician in the United States graduates with $155,000 in medical school debt, according to the American Medical Association.

Many doctors trade more than twice that amount for a diploma. Add to that staggering figure a mortgage or rent, property taxes, insurance, utilities, and perhaps car payments and the cost of raising kids and that 6-figure income evaporates pretty quickly.

"With all the debt physicians have coming out of medical school, it's pretty hard for new primary care doctors to keep their head above water," says Cory White, a financial planner with Peak Financial Management in Waltham, Massachusetts.

Oh, Those Greedy Doctors!

Despite what the general public might think, many physicians who struggle to pay their bills are far from being spendthrifts. They don't drive a Mercedes, they don't belong to a country club, and their spouses don't shop at Neiman Marcus. Sure, they might donate a little too much to the arts or splurge on an expensive vacation or a flat-screen TV, but nothing too out of the ordinary.

A number of factors could contribute to making it legitimately difficult to feel flush on $160,000 a year, say financial experts. Even though a majority of American families live on less, it's still not outlandish for money to be tight.

Some of the factors include:

• Size of the student debt that you are repaying;
• Number of children, and definitely the number of children attending college;
• Size of your mortgage and/or the size of your mortgage in relation to your current income. For example, if you took on your mortgage when your income was higher -- perhaps before reimbursement cuts -- then too large a proportion of your income is now going to your mortgage. (And woe to those of you who took out a variable rate mortgage only to see the interest rate reset much higher);
• Other circumstances, such as supporting elderly or ill parents; and
• Losing much of your savings in a bad market or bad investments, with the result that you've got to save much more each week to stockpile for future income.
  
  Still, in many cases, feeling strapped on $160,000 a year comes from overspending: whether it's spending too much on certain items, such as a luxury car or a second home, or merely going out too often to very expensive restaurants. Then there are the less obvious yet sometimes questionable expenses. For instance, some primary care physicians send their young kids to private school or to a pricey summer camp because that’s what doctors are supposed to do. As a result, money that should be saved for the parents' retirement gets siphoned off to pay for current expenses.
  
  Some Questionable Expenses
  
  "Education is important, but ask yourself how much your kids are really going to benefit by going to private schools, especially private elementary schools," says Robert M. Doran, president of Infinity Wealth Management, in Wantage, New Jersey. "For some students, if discipline is a problem, a smaller school might hold them to a higher level of accountability. But for most kids, public schools are fine."
  
  The decision to send even one child to a public high school instead of a private high school can save as much as $10,000 a year, money that can be used to pay down debt or save for retirement. Parents can apply the same logic when it comes to community or state colleges vs private universities, at an even greater annual savings. One couple featured recently on CNNMoney.com saved $50,000 on their son's undergraduate degree in architecture by sending him to a community college for 3 semesters before he transferred to a more prestigious school.
  
  

  Put the same energies into all of your spending decisions, especially if you’re fresh out of residency: Do you need the 3000-square-foot house when something more modest will do? The BMW instead of the Honda? Will a week in the Adirondacks recharge your batteries as fully as a week in Rome?

  
  "A lot of doctors struggle to maintain a high-spending lifestyle that began when they finished medical school and decided to reward themselves for all the years they worked hard and sacrificed," says Matthew J. Kelley, president and CEO of Gold Medal Waters, a wealth management firm based in Colorado. "In my experience, they may overspend on the home and it often continues from there."

  
  
  How to Regroup -- Before It's too Late

  
  If you are a physician with a big mortgage and a slew of outstanding loans, you've got to get disciplined in a hurry and get smarter about how you spend your money. Otherwise, the debt can pile up fast and it is going to take even more effort to right the ship later on. "An annual income of $160,000 may sound like a lot," Bob Doran says, "but when you back out taxes and expenses, you're not going to be living high on the hog if you're trying to raise a family. So the sooner you can get disciplined about money and develop good habits, the better."
  
  

  There are a number of ways that you can pay down debt or increase the amount you save. First, if you have an older mortgage that you have not refinanced, you're leaving money on the table. Interest rates are at historic lows, and a reduction of even 1% can shave hundreds off your monthly bill. If you have multiple student loans, reexamine those as well. You may be able to bundle them and refinance them at a lower rate. That is something that a lot of doctors don't take advantage of but should, White says, even it means stretching out the term of the loan to free up more cash.

  
  "The main focus should be on paying down the school loans first," Doran says. "Once the balance shrinks and hopefully your income rises, you can redirect some of those dollars to your retirement funds."

  Be Determined About Saving

  It's easy to let your savings slide when money is tight. But doing so is a penny wise, pound foolish strategy. If you contribute to a SEP IRA (as a medical practice owner) or a 401(k) plan (as an employee), you will reduce your taxable income, which will in turn reduce the amount you owe Uncle Sam. Doctors in debt can find all sorts of excuses notto save, but financial planners agree that laying the groundwork now for retirement is one of the most important things you can do.

  
  "I have people tell me all the time, 'I can't afford to invest,'" Doran says. "I tell them, 'You can't afford not to. Yes, if you invest 10% to 15% right off the bat, you're going to feel it. So start with 3%, then increase the percentage gradually as your debt shrinks and your income increases.' Eventually, you get used to living on what you bring home."

  
  Matthew Kelley agrees: "If you pay yourself first and save before you spend, it's a lot easier. You don't notice it as much." He advises you to set aside a percentage of your income to invest in your retirement and rainy day funds, and have these amounts automatically deducted from your paycheck or checking account.
  
  

  This brings us to the topic of budgets. Should you have one if you don't already? When it comes to high-earners like doctors, financial pros are divided on the topic. Some say if you take care of the big areas -- mortgage and school loan interest, education costs, insurance, etc. -- you won't have to pinch pennies in other areas, like cable TV or groceries. Cory White, for one, recommends a Website called Mint.com, which pulls all of your accounts together (credit cards, debit cards, private loans, etc.), tracks each transaction, and divvies the monies up into separate categories, so you can see with a few clicks where your money is going. The site is free and it takes about an hour to register, plus roughly 15 to 30 minutes a week to monitor it.

  
  
  Set Clear Goals and Stick to Them

  
  Like someone who resolves to eat less and exercise more, it is easy to fall off the wagon after an initial push toward a goal. The excitement of making a big change wears off, and all that's left is the hard work.

  
  If you are a primary care physician, lamenting that specialists make more than you while you endure the headaches of being on the front lines of medicine isn't going to make your bottom line any fatter. You are going to have to work with the paycheck you've got, even if what you've got is half or less of what the orthopaedic surgeon or radiologist in the next office suite is making.
  
  

  Still, there is a way to potentially boost your income when everyone else is staying flat or reading water: buy into your practice. Although becoming an owner has its own headaches, the financial rewards can be great.

  
  "There's a lot of work involved, but from what we've seen, the doctors who do better financially are the ones who own the practice vs being an employee," says Matthew Kelley. If you're already an owner, hiring an associate -- or perhaps a physician assistant or nurse practitioner -- can also increase your income. So can offering new services, like cosmetic procedures or nutrition counseling.

  
  In short, anything you can do now to improve your financial standing will have serious ramifications on the road to retirement. "Doctors have the ability to save more than they do," Kelley says. "We all probably spend more when we're younger and getting established, but if you don't change that pattern, eventually you might have to adjust your goals downward: work longer or have less to spend in retirement."

  
  No matter where you're currently at financially, it is never too late to get your house in order. If you are at a loss for where to begin, schedule a meeting with a professional. Most financial planners offer a complementary evaluation and can help you set or adjust your goals. The first step will have to be yours, of course, and it may be the most important step you make.

  
  
  (Author by Dennis G. Murray, MA)