STILL - A Review and Giveaway!!!!

When one of our own faithful Medical Monday participants writes a book she deserves a celebration, or in this case a post all about her.

Congratulations Eniola Prentice on the release of your first novel: STILL!

A few weeks ago she sent me a copy of her debut novel STILL to read and review. I was hopeful but skeptical. I had been a beta reader for another author once before. Thankfully, this turned out to be a  much more enjoyable.

Eniola does a wonderful job blending the story of medical school with the very compelling stories of each of her main characters. Although I didn't attend medical school myself, I was able to commiserate with the non-medical significant others and the complexities of maintaining relationships both romantic and familial.

What I love is that her book gave me the same "I have to know what happens" feeling that my favorite books do. I cared about her characters. I wanted to know what tragic event tied two of the characters together. I wanted to know how the characters would redeem themselves, if it was even possible. And like my favorite books she left me wanting to know more. Now I have to wait for the next release. Maybe I could convince her to tell me what happens in the next book if I promise to keep it a secret:-)

As an added bonus I learned a little about the Nigerian culture and wish I had some Nigerian friends to share some of the amazing food and drinks she writes about. Well done, and thank you for letting me be one of the first to read your debut novel! I wish you much success on your next installments.

The book STILL by Eniola Prentice is available now! You can get your own copy at Amazon today:-)

You can also follow Eniola through all the usual social media outlets: her blog, facebook, twitter (#still), and Google+.

Now for the Giveaway!!!

To celebrate the release of her debut novel Eniola is giving away a signed copy of her book and a $40 gift card. The winner will be announced on her blog on June 17th and notified by email. The giveaway is open to residents of the United States and Canada.

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The following is the back jacket summary of her book STILL and a little about the author herself.

When self-proclaimed atheist Fadesola, gets into medical school she believes that it’s a fresh start of sorts for her. Until she discovers  her class mate is charming and handsome Tayo Smith, a man she encountered in a violent moment years ago. This revelation shatters Fadesola’s already fragile emotional state but hope comes where she least expects it. A seemingly innocent friendship with Tayo’s friend, Ladi, slowly develops into a smoldering relationship with both afraid to acknowledge their mutual feelings. Things get even more complicated when Nikky, Fadesola’s classmate and friend, ignores her desperate warnings and decides that Tayo is the man she is meant to be with. However, within the complexities of this friendship these flawed individuals will experience God’s redemptive grace in a setting each believed his love would never find them. Still, the first book of a four part series is a coming of age story about navigating through medical school in the first year, complete with hilarious hook ups and breaks ups, legendary parties and incessant studying, and experiencing the triumph of success and disappointment of failure.

Eniola Prentice, in her extraordinary debut novel has written a gripping and thought provoking story that examines Christianity, mental illness, suicide and alcoholism.

Eniola Prentice was born in Lagos Nigeria where she began to pen her stories as early as nine years old, inspired by an eclectic group of writers. Her budding writing career was put in the back burner as she pursued her dream of becoming a medical doctor, completing her undergraduate degree in Chicago, Illinois and her medical degree in Washington, DC. However in the third year of medical school inspired by the holy spirit or the voices in her head (she would prefer to blame God for this one) and the unique and inspiring stories of friends that became her family in medical school she began to write her debut novel and series, Still. She hopes that her writing compels challenges, inspires people and draws people to the Christian God’s redeeming love.

Congratulations again Eniola on this amazing accomplishment and best of luck as you complete the series.

Can a Doctor and a Lawyer be Friends?

More specifically can a surgeon and a personal injury lawyer be friends?

I think I mentioned much earlier that we have recently moved back to the same city we lived during medical school. During that time we made friends with a couple who had just completed law school and were getting ready to start practice. They were great friends. I even hosted her baby shower - 8 years ago.

When I say great, they weren't the kind of friends we did much with. We never went out for dinner, never swapped recipes, or babysitting, never talked about the future or complain about what was happening in the moment. We saw them on Sunday's at church, or at other activities our congregation held. They were on our Christmas card list. But, we never called to chat and didn't really keep in touch much. They were solid, good people we knew we could depend on to do anything. We shared similar values and principles.

Fast forward and now we are living back in the same city, and they are still here! We were so happy to see them and had them over for dinner this weekend. It was nice to get caught up somewhat and to get our kids acquainted with theirs. And I think we have found a babysitter in one of their daughters. Bonus!

They hadn't change at all. And they said the same about us. It was like we had never left. In fact, we were all living in the same places we were then. The only thing that changed was the age and number of our children.

But as dinner concluded the guys were discussing work and the question of whether or not they could be good friends crossed my mind.

Before they were just "learning" their trade. So green and untainted, full of hope and dreams.  Now they are both practicing their craft and often they are disgruntled with members in each others profession. It's not like he is a strictly a malpractice attorney - that would be awkward. But my husband is being deposed this week and isn't very happy with attorneys. There were a few moments during the conversation where I could tell my husband was trying to change the subject. They agreed that there are bad lawyers and bad doctors.

The issue of health care, and the bureaucracy, and insurance companies are not good dinner conversations, especially when both of the participants are protecting their own interests. It didn't get out of hand, but it was interesting to see that my husbands views have been affected by his involvement on one side and our friends views have been affected by his on the other.

My husband has only been practicing for a couple of months and already his partner has been drilling into him the need to cover his tail. This profession may be one of a very few that requires absolute perfection 100% of the time. If you make a mistake and someone chooses to exploit it you can be ruined.

In the meantime, we really like this couple and hopefully we can maintain our friendship with the same degree of effort it has taken in the past: easy breezy. In the future I'll have to steer the conversations away from work and towards a subject that is less wrought with conflict.

I may have to pass a new rule in our home. Maybe even have it printed in large vinyl and posted for everyone to see:

We will gladly talk about sex and religion - just please don't talk about health care!

I wonder how that would go over?

It's Like the Lottery, Only Different

From the moment you our your spouse/boyfriend/sister/brother contemplated joining the medical profession family and friends gently urged them on with sentiments along the lines of "one day it will be worth it". What they mean by worth it is "one day you will have enough money and all your problems will be solved".  How naive they are. How naive we are.

I think this type of thinking (money is the answer to all of life's problems) is more common than we acknowledge. If you read my last post it is has been scientifically measured that the happy number for income is $75,000. So why would well-meaning friends and family want anyone to marry or obtain an income above that figure if it won't have any measurable effect on their happiness? Hmmm, maybe they are hoping that we will attempt to increase our happiness by spending money on them or buying experiences that we share with them. Or maybe they don't really like us as much as we thought.

I do not doubt their motives, really. I think they believe that having a higher income somehow means some of life's difficulties will pass us by. And there maybe some truth to it, but what if is was as equally untrue? What if it didn't matter how much money you had? What if the honest truth was that regardless of your income bracket you would be faced with challenges, hardships, heartaches and tragedies on par with others who have significantly less than you? Would you believe it? I have a feeling this might be closer to the truth than we are willing to admit.

Happiness has been on my mind lately because what I thought would make me happier (because I believed the lie) hasn't made a difference. I was happy before, don't get me wrong - but I think I was expecting elation, ecstasy and carefree to be a more permanent sensation. And now even I am laughing at myself. Go ahead, you can laugh with me. Instead it has just stirred up a whole new set of feelings I wasn't prepared for.

So what is the verdict? Will more money make you happier? It's a trick question and there is a lot of fine print and exclusions. You don't believe me. I can tell. Why? Because we all want the opportunity to try out the theory for ourselves. We will be the exceptions!

I won't attempt to deceive you. The first paycheck was like winning the lottery!  But, that feeling lasts for just a moment. Why so short lived? Because you quickly realize that having a high income doesn't mean you actually have money. Quite the opposite. Now that you have money everybody wants it.

Call it sticker shock, call it post-traumatic stress syndrome - the first time you see the income taxes portion of your payroll you may need to call 911. That is if you are able to get to the phone. Just like winning the lottery, most of your income is gone, never to be seen again and there isn't anything you can do about it! Taxes are now our single largest expense several times over. A cool 39.61% of our gross income. Sure we knew we were going to be in a different tax bracket, but I never considered that we would pay more in taxes in one month than we did in the last three years combined. It's the truth, I checked our filings because I am curious like that. I know what a great problem to have, but it's still a problem.

We need to lower our tax burden in a hurry! That would sure help pay down our debt in a big way. But what is there that we qualify for at this point? More kids? The ones we have now won't help anymore. Student loan interest? No.  Don't you find it ironic that once you are finally able to start paying your loans back you don't get to take a deduction for the interest you do pay because you make too much? This is going to be a topic of discussion for our financial planner. I am sure it won't be the first time they will have a new doctor in their office claiming that something must be wrong and asking to have some of those loopholes they have heard about in the news. Where can I get a loophole? Is there a dispenser somewhere?

I hear the naysayers now "why are you complaining about taxes, you have plenty of money"? You'd think, but....

From the moment you start medical school you begin digging the hole we call debt. You ignore it while it is happening because there is no alternative. In residency it slowly starts to remind you that it is alive and growing and waiting for you. You start cringing when the statements come in the mail. By the time you get your first paycheck, often decades later, it shows up on your doorstep with suitcases and a long term lease agreement that must be honored.  That little hole you starting digging years ago has become a tunnel to China.

You'd like to make your student loan situation a distant memory in a hurry, but you also need to start saving for retirement. NOW.  Remember that pitch from the HR department about contributing to a 401(k) and that if you started saving only $100 a month starting at age 20 by the time you retired you would have 1 Million dollars? That might not be the exact number, but the principle was that money invested over time grows exponentially. Guess what this doctor doesn't have? Time!  Instead of having a working career that spans 45 years - we will have 25, unless he wants to work into his seventies! And we might just have to do that. Time is not on our side and we are digging ourselves out of a hole. A house size hole. A house nicer than any house we have ever lived in hole with a matching mortgage payment.

But it's not just the student loans. It's the realization that being a doctor is a very expensive career decision. Because you have invested so much money that didn't belong to you pursuing an expensive career, you now have to take precautions to protect that career so you can afford to pay your debts. What a sick relationship. Outside of medical malpractice insurance, your family has to guard themselves from people that will never be patients! To say my husbands hands are insured isn't much of an exaggeration. We have insurance in case he can't work as a surgeon. Insurance in case he can only work in a limited capacity. We have insurance in case he expires prematurely. We have insurance to protect our home, cars, property, and assets we hope to accumulate. We have liability insurance should someone sue us from an accident in our car, home, driveway, sidewalk, tree, or from looking at them wrong, etc.

So when I look at our new income I see money that has already been spoken for and lots of hands coming to get what is theirs and not as much left as I would like. Not because I am ready for a shopping spree, but because I sincerely want to be done with debt as quickly as possible so we can move on to other things. The reality is that if want to pay off our debt aggressively, save for a meaningful retirement at a normal age, and buy a family house while our children are still living with us, we'd be smart to live like we always have. Right now it is the only way to mathematically make it work in the short time we have. Or we just throw caution to the wind and enjoy today and let tomorrow take care of itself. I am on the fence most days.

There are some things I have dreamed about and anticipated for years that would make everything worth it. (If you've been down this road, you know the "everything" I am talking about. If you haven't, I can't begin to describe it in one post and if I tried you wouldn't believe me anyway.) One was having a home in a safe neighborhood with a yard where our children could run and play outside. The other was taking family and couple vacations, something we never did during school or residency. I think both of these things are in keeping with the proven methods of increasing happiness: spending money on others and experiences. These are two things I am not willing to let go of now.

So for now, don't expect any debt-free announcements this decade.

Is This What It's Like For A Man?

By now every human in the world is aware of the research that exists on the number of times men think about sex in any given period of time. It is something like once a minute, and several times more than women do. There are many studies that have widely different reports. One suggests a man thinks about sex every 6 seconds, and another says they think about sex about the same number of times as they think about eating or sleeping. I suppose you could say the three most important things to a man are sex, food, and sleep. What else do they need to survive? For that matter, those are the basic things keep us all alive and prevent us from becoming extinct.

I still don't think about sex as often as my husband, but I have something that is consuming my thoughts at about the same rate: Houses. If men think about sex as often as I think about homes, it is amazing that they can hold down a job, let alone operate on a human!

It is seriously causing problems for me. Be prepared, because over the next several weeks I will probably be writing about it. It is a recurring theme in my brain, therefore I can't think about anything else until I get it out of my head.

It is causing problems with my sleep. I find myself falling asleep thinking about houses. Dreaming about houses, and constantly looking at houses, floor plans, magazines, pinterest, Houzz, etc. Talking myself in and out of them all day long.

I try to tell myself today is the day that I won't look at anything. And like the addict I am, I fall off the wagon. I tried to limit myself to just one day a week.... I can't do it. I have a problem.

And then I have a good laugh at myself.

Seven years ago a medical student and his starry-eyed wife were doing exactly the same thing. This is the season that everyone gets house-happy. We matched! We have to have a house of our own! Oh, if only I would have known then what I know now. My friends who are finishing residency this year are bustling around trying to finish home improvement projects to increase their chances of a quick sale. They are cleaning around the clock, and staying outside with the kids, storing their belongings in off-site storage, and stressing over finding a buyer at just the right time so they don't end up like us last year. That was fun.

I feel for them I do. But then I smile to myself and think of how nice it is going to be to write our 30-day notice letter and drop off the keys on our way out of town without having to worry about all that.

The difference between us seven years ago, and today are rather amusing and stark. Seven years ago we didn't have two dimes to rub together and somehow thought buying a house was a good idea. Today we actually have more than two dimes but aren't going to buy a house.

So why am I looking at houses? It's a disease, and I've got it bad.

A Charming Recollection

Thanks Emma. Your post today reminded me of a something I almost forgot!

Once upon a time, when we were extremely poor medical students and preparing for our first adventure into residency, we took a trip. Our trip was all about finding a place for our growing family to live for the next 6 years. Six years seemed like an eternity at that moment.

Because we were traveling on the cheap, we made arrangements with the hospital to stay in their student house that was currently vacant. It had only been vacant for about 48 hours.

We stopped by the program office and picked up the keys and bedding in a bag and made our way to the house so pleased with our frugality and excitement bubbling in our veins. We were about to start a new chapter in our crazy medical life.

What cute little houses they had. They were located just behind the hospital and were used to house visiting medical students and professors. My husband had stayed in the neighboring house during his month rotation and said it was nice.

Nice.

I was so taken with the charm of these little houses. When you have lived in a place that has very different architecture it is easy to be fooled into thinking charming is charming, when in fact charming is old and falling apart.

In this case, charming was gross inside. Imagine ultimate bachelor pad circa 1962 - maybe earlier.

We walked around, carefully.

The visiting professor had only recently vacated and there were still dishes drying on the rack. I was holding my breath and trying to convince myself that things were going to be fine. This was a free room and since we were going to be there for 5 nights it represented a huge savings.

We made our way to the bedroom to make the bed with the clean bedding they provided for us, and as I looked at the mattress and bathroom I thought I might vomit. Very likely since I was also pregnant. I looked at my husband and told him that I wouldn't be able to sleep here, or shower here. Ever.

There were small bug carcasses on the mattress and in the corners of the rooms. It all felt so dirty, despite being clean. There was an old, musty, mildewy smell in the air. Something wasn't right and while I couldn't name the one thing that pushed it over the edge, I knew we had to make other arrangements.

Priceline to the rescue! A Best Western never looked so good and I didn't even care how much it cost. So unlike me.

Now when trying to decide where to stay I try to remember that a hotel/motel is only as good as the sleep you are able to get.

Match Day

Congratulations! This years residency match is over:-)

What a relief that I never have to relive that event again. Ever. My nerves can only handle so much excitement and drama.

I remember the absolute feelings of fear. Will he match? Will he match some where we want to live? Will it be close to our family? Will we know anyone? Will the people be nice? Will they have a Chipotle?

I had at least four different plans that had been previously worked out that were ready to be put into action the minute the news was received. I was probably a little over confident and had my heart set on one location in particular because it felt like home. Something about it seemed to call to me. Mind you I had never been in the state other than an airport layover years earlier. I had seen pictures that my husband had taken during his rotation and interview there. The location was far from home, and the climate was like nothing I had experienced before.

I knew before the match results were in that it was where we were going. We were supposed to be there. I could feel it in my bones.

Thankfully I wasn't disappointed, but I easily could have been. There are so many working parts to the match. Any one of them could have derailed our dreams. My husband assured me that he would match. But there is no guarantee than anyone will. We have good friends who didn't match the first time and had to scramble! Scrambling is about as much fun as the name implies.

We feel lucky that it worked out the way it did. The city we moved to was good for us in so many ways. We had been married for two years and had a small son. We grew up during residency, if that is possible for a pair of grown-ups to do. Rather we matured.

I am so excited for all the families who are starting this next adventure in the pursuit of medicine. Residency is about so much more than medical training. It is relationship and marriage refining. It is human development and social experimentation. It is strength AND endurance training.

I hope that you will look back on these years as some of the best of your life. I used to roll my eyes at the people who would say that about difficult years, but now that they are mostly behind me I can see what they mean. I wouldn't trade those 6 long years for anything:-)

P.S. They won't be the best because they are easy. Trust me, they won't be easy. They will be the best because you will discover who you are, what you are made of, and what you can do. Your husband will find that out for himself, too.

Congratulations!

Nostalgia

Maybe it is because we are coming to the end of a very long journey that I find myself longing for days gone by. This week in particular I have been thinking about some of the more interesting things we picked up or heard during medical school from different preceptors. Notice how freely I used the word "we" as if I were there? It certainly feels like I was, and yet I wasn't.

During your third and fourth year of medical school the classroom lectures are over and you are thrust into a clinical setting with various specialties. I suppose the exercise is meant to help you figure out what you want to be when you grow up and see examples of the good and bad. And in our case it provided for my entertainment after each rotation.

There was this really old family medicine gentleman who worked in a retirement community. When I say old, I mean he was certainly of retirement age, but situations were such that his accountant had stolen money from him and while he should be enjoying his golden years he was required to work well past his planned retirement date. (Note to self: get a good accountant and have the books audited annually by a third party.)

You can imagine that his attitude toward patients and medical students was somewhat tainted by his financial predicaments. He is what you might call a grumpy old man. In his practice he did just about everything, except prescribe certain medications. He told patients straight up "NO", and they didn't like it. He had no problems telling a patient exactly what their problem was, even when those problems were not medically related.

He also liked to give the most disgusting jobs to the medical students. Like clipping toenails that were nasty. Or digging things (more nasty) out of some one's belly button. This community had lots of men in need of prostate exams, too. Fun times.

And then there was another man whose office was in a downtown strip mall, next to a strip club. Classy place. His clientele seemed to be heavy on the drug seeking variety. The doctor was part social worker, part doctors, part pastor. He did it all.

To this day I really wonder if he even when to medical school or if he acquired his MD from an online university. It wouldn't have surprised me. Now that I think of it maybe his office was a front for a drug operation - that would make more sense!

My husband always came home with the best stories and words of wisdom from these preceptor. After all these years, these are the two gentleman that I remember out of the 15 or so different preceptors he had.

I had always thought that family medicine was kind of boring and mundane, but after hearing stories from these two family practice docs my tune has changed. It may be possible that family medicine is where all the action is and the regular hours.

I still get to hear stories every once in a while, but it seems the people he works with now are more normal and less fringe. Fringe makes for good stories, normal is not nearly as much fun.

People are fascinating, and their doctors are too!

Dress Code - Unwritten Rules

Before you go thinking this is going to be a post on what to wear to the hospital Christmas party you should know that I don't have that problem.... because we didn't get invited to any parties this year which makes the dilemma of what to wear no dilemma at all. I will wear my pajamas thank you very much. It's time to get back to talking about medicine!

This weekend I was watching a cheesy movie that had a character who played a specialist in a big fancy hospital (aren't they all). I didn't pay any attention to the white coat the doctor was wearing, but my husband did! He rolled his eyes and said the "specialist" is wearing a medical student coat. Obviously the stylist on the movie didn't know the unwritten rules for hospital attire and should be fired!

I wasn't even fully aware of the rules until I started noticing that some people wore their scrubs tucked in and others untucked. Some people wore printed scrubs and others didn't. My husband explained to me that only doctors tuck in their scrubs, everyone else wears them untucked. A doctor would never wear printed scrub tops unless maybe they were in Pediatrics. Kind of convenient for judging people harshly when I am out and about the town. You are a doctor. You are possibly a vet tech.

What an interesting dress code. I wonder where it all started? Like who said only doctors get to tuck their scrubs in. What if I like to wear all my shirts tucked in but I am not a doctor? Or what if I am a doctor and want to leave my shirt untucked? Is there really a need to be able to tell who is who when everyone is wearing the same color scrubs? I guess there is, especially if your ego hasn't enlarged the size of your noggin by now. Couldn't they have come up with something else to identify the players?

I remember watching Gray's Anatomy, one of the two times I did, and my husband pointing out that white coats aren't that tailored! Sure they are boxy, but if I were a doctor with the appropriate white coat and scrubs tucked in, I could see having them tailored to fit. I like things to fit. You wear a big unshapely thing and you look big and unshapely. No thank you. I am vain like that!

Good thing I am not the doctor around here. Have you seen the awful shoes they have to wear! Clogs, no thanks. Crocs, wouldn't be caught dead. Tennis shoes.... maybe.

Are there any other dress code rules you know of?

How Not To Make Friends

Today I talked with a young woman from my church who has children the same age as mine. We were talking about play groups and how we should start one.  She indicated that there is a group that meets together for a weekly play group but she didn't go anymore.  They were mostly attended by the medical wives and, according to her experience, all they did was talk about their husbands, how much money they were going to make, what kind of state benefits they could get while in school, and their latest purchases.

I wanted to die. I hope she wasn't putting me in that group by virtue of my husbands profession. I could tell this woman wasn't impressed with what she saw. And no wonder that no one other than the medical wives went to play group.  Who would want to sit around and hear that every week? I sure wouldn't!

So a word to my medical friends. It is rude to talk about such things in public. It is one thing to have a discussion with your friends who are in the same boat, but when you do it with others who aren't in the same boat, or even floating on the same ocean, it comes off as exclusive and aloof. Certainly not a way to make friends.

It is in poor taste, regardless of what your husband is studying or what his income potential may be, to discuss salaries. Or maybe I am just old-fashioned, it could be that.

I am well aware that my family income potential is xyz and our friends and family know what he is doing and can take guesses at what that might be. They don't need me or my husband to tell them. And we don't plan to. Likewise, anyone who knows that your spouse is studying to be a doctor can make a guess about what kind of income future he has without hearing it from you. The Internet can tell anyone just about anything who is interested in knowing.

My point is, not everyone has the same income trajectory. Most of the people we will meet during training are at or near their maximum income potential for their particular career. They aren't going to have the same day/night experience that you and I will have.  It is true. But just because it is true, doesn't change the fact they no one wants to hear how much money you expect to make in five years and how that amount is going to be several times more than you make today. And just because you might temper it with a confession of your student loan debt doesn't make it sound any better.

Don't do it.

Many people live on the salary that you and I do through residency for most of their life and make it work. I have complained here about how difficult it is, but it will end. Maybe it is only difficult because I know what is coming. For many, it will never end, or it will only change in small increments. I can't imagine how difficult it would be to make this our life AND know that it wouldn't be changing. I can also imagine how insulting it would be to hear a resident wife complain out loud about her misfortune but that in a few years it will all be a distant memory.

It's A Tie!

Funny things happen to my husband when he is getting ready for something important, he gets spendy. All of a sudden the things that were good enough yesterday are no longer good enough for today.

Let me start at the beginning. Somewhere along the line, long before I came into the picture, my husband was introduced to fine twilled linens, specifically those made by Armani. He bought a new suit for his medical school interviews and wore that suit for probably 10 years. It had a good life.

When it was time to interview for residency, he would have liked a new suit - but at the end of 4 years of medical school with a wife and new baby is hardly the time to buy a new Armani suit, so we settled on looking at a new tie. Not just any tie would do. We went into Nordstrom. A Burberry tie. We didn't buy it then, because reason finally grabbed hold of him (being married with children has a way of doing that). But being the good wife I was, I memorized that tie and bought it for him the next day. It was his birthday after all, and this was a moment that should be marked by a new tie - and I hadn't gotten him a gift yet. That tie landed us a residency spot in a city we loved.

Fast forward 5 years and it is now time to start interviewing for fellowship programs. It is an important interview, at an important program, with important people. He is afraid that old suit won't make the right impression so the suit hunt begins. I am a wet towel and tell him that an Armani suit will not make magic happen. I balance the books around here and there is no money for an Armani suit. He tries them on, they look great, he really wants one. No can do. So the poor man settles for a Brooks Brother Suit in a fabric that won't wrinkle, on sale at the outlet store. (Incidentally, he loves that suit). New suit lands us our prime fellowship in a city we love.

Now we are on the cusp of THE interview of all interviews. This is the interview that has been in the making for the last two decades (almost). This is the interview in the city that is THE ONE. So what does he do? Time to buy a new tie! The man has dozens of ties. I get the whole psychological reasoning for wanting a new tie, I do. If it makes him feel more confident, then it is what it is.

Let me remind you that we have just spent our entire savings moving to this new state and getting set up/licensed/etc and we will have gone a month without a paycheck. We head to the Macy's near our neighborhood to look at the ties, and he selects a Tommy Hilfiger tie on sale $39. It was a nice tie, but what do I know - they all look alike to me. Not to him.

Later that night I catch him online looking at Armani ties. Before I know it he has located the nearest Neiman Marcus and we are planning a trip. I say a trip because we don't live in the part of town that has a Neiman Marcus, we have a Macy's.

My husband is giddy. On the freeway we see a Lamborghini. As we pull into the parking garage we see another Lamborghini. I can't remember the last time we saw two in the same day. Remember my husband is the car guy, without a car. He has one, he just doesn't like it. Where are we?

By divine providence we park on the same level, on the same side as the men's department so we don't have to look lost for too long. We are not Neiman Marcus material, and I don't ever think we will be. No offense to anyone who shops there, I am sure it is lovely. Going there with children in tow really livens the day up. I picked up what looked to be an over-sized bowling ball bag from the clearance table. I thought it looked like a nice overnight bag. But for $2,500 I think I can make do with what I already own. Kids, don't touch anything! He asks me if I want to look around? NO, thank you very much I just want to leave as soon as possible.

In the end he left happy with his $165 Armani tie. How can something so small cost so much? It is a tie!  If this tie gets us THE job, I won't bring it up ever again and will forever revere the name Armani.

Taxes and Net Income: The Real Numbers Story

I left off yesterday with the encouragement to approach residency like medical school. Depending on whether you took out Student Loans to the maximum, minimum, or some where in the middle, will determine how you view your first paycheck.

Your first check will be much smaller than you anticipated depending on when in the payroll cycle you actually start working. Even though we started our first day on July 1st, our first check wasn't issued until July 13 and it was only for the time period July 1 - July 8. Small. Because it was so small, it didn't have federal income taxes on it. And because it was the first, it didn't have our health care premiums withheld.

The next paycheck was on July 27, but it still wasn't the "real paycheck" because it was still too small to have any federal income taxes withheld, but this check they took out the current health care premiums for that pay period, plus the pro-rated amount from the previous check. Obviously we weren't completely enrolled until then.

Our first real paycheck with all the appropriate with holdings wasn't until August 10th. This would be the paycheck we needed to use to base our budgets on going forward. Take away message: just because you start working on July 1st, doesn't mean you actually start getting paid on that day.

The example I provide here is our actual paycheck from intern year (2006). Don't discount the date saying that salaries have increased so much. I'll explain why in tomorrows post. Also note that this isn't our actual first check.  This was our third payroll check as an intern that included all of our health insurance premiums, taxes, etc.

Your check is obviously going to look different, and the numbers are going to be different. The point is to demonstrate the often dramatic difference between gross and net pay. 

Gross pay = $1,654 per pay period      $43,000 per year

Net pay = $1,349 per pay period          $35,086 per year  

A difference of $7,936 is a big deal. When you hear the gross salary that you are being offered as an intern/resident it is tempting to think you will actually have all that money to use - you don't. You'll have about 20-30% less. 

The reason I say that your actual numbers may be different is because each intern completes a tax withholding form (W4) during their orientation. This document tells the payroll department how much of your check to withhold and send to the federal and state income tax authorities. 

There is a worksheet attached to the W4 form that will assist you in calculating your exemptions which in turns determines your % of withholding. They even have a box that allows you to select an additional amount to include.

Based on our calculations, and our estimated taxes for that year, we selected 9 federal exemptions and 3 state exemptions. We have kept our federal exemptions the same for the last 6 years. Why did we select 9? We knew based on our tax estimates for the year that we would be getting a refund. Why wait until April 15th to get your money when you could have it every month when you could use it. 

This strategy worked for our family (married with children). It may not for yours. The end result is that our federal tax returns were smaller, but during the year we had more money in our paycheck. Your calculations and amounts may be different. They may be smaller, they may be larger. 

Don't be surprised when your payroll checks don't look as large as you thought they would.

Next: The First Year is the Roughest... Not always.

An Intern Must Make More Than A Student, Right?

In my last post I wrote about the differences between those who graduate form medical school and those who graduate with other advanced degrees. Think law and business school grads. That is where we get these rules, because everyone who graduates and lands a job feels as though they have arrived. But alas, the medical profession is the exception to the rule.

In the real world you graduate, get a job, and your career starts. In our world, we keep training and our income shifts from student loans to paid training, but the numbers don't change that much.

I went to our medical school website to see what the current tuition/personal allowances were for the academic year 2011-2012. These numbers are probably fairly close to your personal allowances too, regardless of where you trained.

This budget information is provided to assist you in estimating your monthly budget and managing your available financial resources (e.g., employment earnings, financial aid, and assistance from your family members) for the 2011-2012 academic year. You should refer to the base expense budget given below when estimating your expenses. The average monthly living allowances listed below were derived from the 2011-2012 Cost of Attendance figures developed by the Office of Student Financial Services. Your expenses may vary from the "average" cost of attendance for your class. Consequently, you should calculate your monthly expenses based upon your anticipated expenses for the 10-month academic year. These monthly estimates should be derived to ensure you have enough funds to complete the year.


Student Service Fee                                      512
Health Insurance                                           2,700
Disability Insurance                                     50
Books & Supplies                                         3,398
Room & Board (rent, utilities, food)
     On Campus                                              13,090
     Off Campus                                              16,490
     With Parents                                             2,100
Transportation
     On Campus                                              1,104
     Off Campus/With Parents                        3,092
Auto Insurance/Registration                        1,650
Personal Expenses                                      3,650
Loan Fees                                                     1,177
Total
     On Campus                                             27,331
     Off Campus                                             32,719
     With Parents                                           18,329


These numbers need to be broken down into manageable numbers for purposes of comparison. The information from the school says that these figures are intended to cover a 10-month academic year, not the entire 12 months of the calendar. Easy math: divide the total by 10 to get the monthly amount you have to work with.

It may seem silly to compare a medical student budget to a real doctors budget (ha, ha, ha), but I am telling you now you may have had it good in medical school! And that is no joke.

Depending on whether you lived on campus, off campus, or with your parents makes a difference - until you move out and are living on your own. And really, how many people did you know who lived with their parents? That is assuming your got into medical school in the same town that your parents lived, and they would LET you live there. Not very likely. So from this point forward I am going to make comparisons based on the living off campus total, since that is what you will be doing. Welcome to the real world.

$3,272 dollars a month sounds great... even now that sounds like a nice sum to work with. I know you didn't actually get all this money to divide out because the school took everything that was theirs first. This is GROSS dollars. (For the record we didn't receive anything close to this. Six years ago, our figures were closer to the living with parents numbers). 

So what are the interns at our program making this year gross? $45,990 annually or  $3,832.50 monthly. But here is the catch. Not only is that gross (pre-tax & withholding), it is also misleading due to one BIG factor. Our program doesn't pay semi-monthly, they pay every two weeks.

Why should that matter? Well because if you are paid, say on the 1st and 15th of every month, you will have exactly the same amount of money to budget each month. If you are paid every two weeks, there are two months of the year (which we celebrate around here) approximately 6 months apart in which you will get paid 3 times. Yippee!

Before you get too excited, it isn't really good news. What it means is that the other 10 months of the year (and I would argue they matter most) you get paid less. It works like this. You take your gross divided by the number of pay periods. If you get paid every two weeks, there are 26 pay periods. If you get paid twice a month there are 24. The same amount divided by 24 will always be larger than if it is divided by 26. It is math, there is nothing I can do about it.

The reality is the gross paycheck of an intern at our program is $1,768 per pay period. Because 10 months only have two pay periods the real amount of gross dollars you will be working from would be $3,537/month.

It still seems like a nice sum to work with, but because you have gone from borrower status to earner status you are also expected to pay taxes. I am sorry to be the bearer of such bad news. When it is all said and done you may even have less money to budget as an intern than you did as a student.


Next: Taxes and Net Income, the Real Numbers Story

We are Done!

Yes, you have a degree. Yes, you have a family or maybe one on the way. Yes, you worked hard. Yes, you have sacrificed much. And for all those things I say Congratulations! You did it!

Finishing medical school is a big deal, but don't let your exuberance blind you to the reality of what is coming up next.

The primary thing that you need to establish in your mind is that medical school isn't like other degree programs, or advanced degrees for that matter. Law school graduates, MBA's, etc start working at competitive wages right after graduation. Seemingly overnight, they go from being mired in student debt and Ramen noodles, to having an income that is significantly larger than the one they previously had. That is not us. Yes, we went to school longer. Yes, they will hand out a diploma that says "Doctor". But what no one told you is that you aren't really done. You are almost done. Undergraduate degree was just the beginning. Medical school is the middle. Residency is the end (or at least when you finish it will be, unless your DrH wants to do a fellowship - then fellowship is the end).

For all intents and purposes internship/residency is more schooling without tuition payments and no access to student loans. When you actually graduate from that program in 3-7 years, depending on your desired specialty, THEN you will be done. That is the graduation certificate that officially says it is now over, welcome to your career.

I remember the first few conversations I had with people we meet in our new city now that DrH was officially a "doctor". They were awkward. I am sure they couldn't figure out why I was driving an old beat up car and my kids were wearing clothes from the thrift store, and my purse wasn't a brand they recognized. I had fears of people looking up my address and taking a Sunday drive hoping to get a glimpse of the "doctors" house only to be disappointed when they found a 35 year old bi-level ranch with a sinking driveway and peeling paint.

They would ask innocently what kind of doctor my husband was. Maybe he was the kind of doctor that doesn't make any money like my science teacher in high school who had a PhD. I would tell them that DrH was a intern and that we would be here for six years while he finishes his training in neurosurgery. Out of curiosity they would ask what that was, and I would explain it was a surgical speciality of the spine, nervous system, and brain. That would always get them. I married a brain surgeon. Yes, I did and here I am.

They would find clever ways to ask about how much money he made: "So does he get paid during his internship"? Without actually giving them the exact amount of money our family now earned instead of borrowed, I would tell them that he makes about the same as a school teacher in our particular state but works much longer. Everyone knows that teachers are underpaid, but compared to an intern/resident - we have them beat, hands down.

The funny thing is the women I had these initial conversations with are now real friends. They get it! Or maybe I just did a really good job explaining it.

Residency is still school/training and if you can approach it with that mindset you won't be disappointed.


Up Next: An Intern Must Make More Than A Medical Student, Right?