Diagnosing the Doctor

Strategy | Financial Solutions for Physicians
Winter 2008

Dr. Mamta Gautam opens up about doctors, money, and the love/hate relationship between the two.

Help is one of the hardest words for many people to say, but particularly hard for physicians. "Doctors see getting psychiatric or other professional help for themselves as a failure; they feel they haven't made the mark," explains Dr. Mamta Gautam.

Dr. Gautam connects with the physician patients she sees at her private psychiatric practice because she can relate on a collegial level. who better to listen to and understand the stresses of being a doctor than someone who has been down that road? From the pressures of medical school, to the delicate balancing act of work and home, Dr. Gautam has "been there and done that." And while she helps her patients deal with a variety of issues over the course of her day, one that comes up time and again is how to effectively manage stress.

Trained for so long to be care providers, doctors can find asking for help a difficult change to accept: "We are care-givers, not care-receivers." An unfortunate result of this mindset is that by the time Dr. Gautam's patients come to see her, she often finds "they are in a much more serious situation than the average person seeking help that one might see in general psychiatry."

Dr. Gautam explains that stress can stem from a number of areas (be it work, family, friends, general community, personal issues or financial concerns), but whatever the source, the one commonality her patients seem to share is a sense of loss of control, or lack of choice, in a given situation.

Regardless of the cause of stress, one way to combat it is to learn about its causes and outcomes, and develop coping strategies: these steps can help relieve stress and regain control.

while there can be many causes for stress in a physician's life, financial stress is among the more common concerns that Dr. Gautam sees. There are three common themes related to money that tend to affect physicians: money as a measure of success, money as an entitlement and money as a mystery.

Success Measure:Keeping up with the Dr. Joneses

"When I was growing up, the average doctor made about seven times what the average person earned. But that gap has closed dramatically," Dr. Gautam recalls. Unfortunately, what hasn't changed over time are the societal and personal expectations related to money.

Dr. Gautam continues, "Money is a way for us to show our level of achievement. It inherently makes our lives easier, but many people don't use it that way. It allows you to buy all the symbols that visibly show success to the world; however, you inevitably reach a point where it literally becomes seductive."

Unlike professionals working in a salaried environment, physicians know that by working more, they earn more money. This can become a never-ending cycle. "We then have to rely on our inner resources to think about how much is enough," she explains. It's too easy to take on "one more case, two more patients," she says. "That's easy to justify, but can quickly build to something much bigger."

Entitlement:"But I've earned it!"

After the long years of medical school and the intense hours of residency work, many physicians feel entitled to "catch up" immediately after starting their own practice. "Physicians so often put off doing things for themselves because they are used to doing things for others. This can reach a point where they want their delayed gratification now, which can lead to an overextension of finances," Dr. Gautam says. Many doctors don't buy a starter house, but rather their dream home. "This basically commits them to a heavy workload in order to support the purchases they have made," she says.

There's a tendency among physicians to feel that, "If we study hard, work hard and achieve a certain amount, then we never have to pinch pennies," Dr. Gautam explains. "I think ultimately doctors are not very good business people. We don't see money as something we need to learn to manage. We have the assumption that we will have the top dollars because we work hard. But it doesn't always translate this way," she says.

Mysterious Money:The dangers of self-diagnosis

"We are not taught about money, and then we start to earn it without really knowing about it. A lot of doctors wait a long time before investing or saving in other ways, which is obviously counterproductive," Dr. Gautam says. "But physicians have a strong sense of not wanting to be found lacking in some area of knowledge."

Dr. Gautam sees how this lack of knowledge can impact physicians right from the beginning of their careers. "Medical students are graduating with a huge amount of debt. Many of them focus solely on dept repayment, because of the lack of knowledge of how they can both do that and invest for the future at the same time."

In her personal life, Dr. Gautam ensured her three now-teenage sons were money-savvy from the start. "I taught them the "80-10-10 rule" where 80 per cent of their allowance money was available for them to spend, ten per cent was to save for the future and the remaining ten was to give to charity," she shares. "My kids have told me that this was an excellent idea, and we have recently started to talk about investing." It's a financial strategy that carries over to her work, given that Dr. Gautam often advises her patients to take a look at their childhood attitudes towards money in order to gain perspective on why they approach finances in a particular way.

~ Don't try to catch up all at once.It is important to reflect on how you can manage your money to gain the biggest reward, both now and in the future.

"People need to stop, reflect and gain insight into what is driving their financial attitudes and decisions," says Dr. Gautam. "Getting help from someone with the right experience and knowledge can help settle some of the anxiety about money."

~ It's okay to indulge in so-called status symbols, but remember to balance these expenditures. In Dr. Gautam's experience, some younger physicians are now rejecting societal expectations in an effort to spend more time with family or on their personal interests.

"I think ultimately doctors are not very good business people. We don't see money as something we need to learn to manage. We have the assumption that we will have the top dollars because we work hard. But it doesn't always translate this way."

Keep that financial stress in check

~ Take the plunge and seek help. Whether you talk to a counsellor, a trusted friend or a colleague, asking for help is the first step to getting back on track.

~ Solicit advice from the experts. Talking often and openly with your MD advisor can really help to get you and your finances in a healthier state.

~ Break it down. Stressful situations can seem overwhelming when you look at the situation as a whole. Instead, try breaking it down into manageable pieces.


Dr. Mamta Gautam runs a private psychiatric practice in Ottawa, Ontario. and has special expertise in the area of physician health, a field she has helped to pioneer. She is chair of the expert advisory group to the CMA. Centre on Physician Health and V/ell­ being, co-chair of the CPA section of Physician Health and Well-being. current president of the local chapter of the Federation of Medical Women, and the mother of three teenage sons. Dr. Gautam is also the author of the book IronDoc, which offers practical stress management tools for physicians.