5 Reasons to Meet with a Financial Advisor Before Residency

We are approaching the end of fellowship year, have a signed contract for the first real physician job starting in August, and have only just now met with a financial advisor to talk about what to expect next. If I could go back in time and do this journey all over again, I wouldn't change too much (especially because not a lot of decisions were in our control, Ha!) but I would have met with Justin Berry before we left medical school so that Scott and I could approach these post-school years with a little bit more financial education.

We specifically wanted to meet with a financial advisor who was familiar with physician financial situations - the debt load, training schedule, first job benefits, and physician-specific financial options. I can't recommend Justin more highly for those in the Pacific Northwest, especially within the Portland, Oregon area. We arranged for some educational visits with Justin, at no cost to us, to learn about: loan repayment recommendations tailored to us, the difference between consolidation and refinancing, what types of private insurance outside employment benefits might be advisable, recommendations as we start to move into the adulting world (regular salaries and budgeting, renting vs. buying, first time home buyer tips, prioritizing savings, understanding hospital benefits, etc.), and how to approach future investments.

In an effort to save future doctors (more likely their significant others) the headaches that Scott and I have gone through, here are five reasons you should meet with a financial advisor (preferably one who specializes in physician finances) before you leave medical school and begin training:

1. Either the doctor or the spouse needs financial education.
There should be a mandatory adulting class in high school or college. It is inevitable that between you and your significant other, one is in charge of the finances and the other has no clue what the difference is between checking and savings (not pointing any fingers). According to our financial advisor, among his clients it's the physician who most often doesn't deal with the finances.

Set your marriage and residency up right by getting on the same page finance-wise and meet with a financial advisor who can help you talk through budgeting for your new income levels. Don't make the mistake of overspending because you're finally done with school. It's a long journey to financial independence, you'll get there, but you don't want to make it longer. Be frugal while you're used to being frugal.

2. Medical school loan interest capitalizes when you begin repayment. 
Ugh! Since neither of us had undergrad student loans, capitalization came as an unexpected shock. Throughout school we made modest efforts to keep our total loans at a low amount (namely: only taking loans to cover tuition, I worked full- time to cover living expenses, and an occasional loan payment when extra funds were available). That total practically doubled overnight after residency began and we made plans for repayment, when the accrued interest during medical school became principal (a.k.a capitalization... Google it!). If we had met with a financial advisor during 4th year, s/he could have helped us understand capitalization and our options for deferring or paying off loans, which likely could have saved us some money.

3. An amount of student loan interest is tax deductible.
Again, a helpful financial tidbit that I found out through experience after the fact, when we did our first tax return after graduation. Depending on current tax laws, a portion of your paid student loan interest might be deductible, which in essence is like getting that money right back in the form of a tax refund. When we graduated from medical school, $2500 in student loan interest payment could be counted as a deductible on your tax return. In December of that year we had only just decided on our loan repayment options and paid a very minimal amount back thinking we would save money. Had I known that I could have paid off $2500 in interest, before it capitalized (!), and seen a $2500 increase in our tax refund, I absolutely would have cashed in on that. I've tried to remember to share this fact every December to medical school significant others from our school since that mistake.

4. Repayment options are complicated, as are the reasons you might choose them. 
When my husband started his residency and the repayment decision needed to be made, I had no clue why I would choose one option over the other, except to choose based on what we could afford. There are standard repayment options and income-driven repayment options. A financial advisor can walk through why you might choose an income-driven option or when that wouldn't be a good idea. When we met with our financial advisor this Spring he said, "If you weren't taking the job that you were now, that repayment choice would have been a costly decision. Lucky for you, it's a moot point now." *insert big eyes emoji

5. Federal loan interest rates are high!
You would think that of all institutions, the government might be interested in offering market low rates to students. Nope! We elected during residency to make fixed payments to the federal loan servicer, with an average interest rate on our loans of 6.5%. After meeting with our financial advisor this Spring, he recommended a couple of private loan companies where we could refinance for closer to 3%. So I'll swallow the fact that I paid off our loans for four years at the higher interest rate and just tell you, it's absolutely worth your time to talk to an advisor about this.

We ended up refinancing all of our student loans through Earnest and have an aggressive goal to pay them off in 5 years. It means we need to be frugal for a little bit longer, but we think it will be worth it when we can start taking what would have been loan payments and start investing in our future.

Shameless plug: a lot of refinancing or loan consolidation companies offer referral bonuses, and Earnest is no exception. So we're including our referral link here. I'm not saying you have to go through Earnest. Do the research, talk with a financial advisor you trust, and see what's the best option for you. No matter what company you choose, there will probably be an acquaintance who has a referral link you can use.

If you choose to refinance, and Earnest looks like the best option for you, THEN feel free to use our referral link for $200 in savings on your loans.

https://www.earnest.com/invite/scott3034
Hey Physicians and SOs - Any other tips you would add?

A New Washington Chapter

Last week Scott signed a contract for his first full time job following medical training!

What a monumental event for us, because we've been building up to this new chapter for so many years - pre-med training, applying to medical school, medical school rotations, interviewing then SOAPing into residency, residency, interviewing then matching into fellowship. Now mid-fellowship year, Scott was offered two different jobs in two different parts of Washington state!

We had long talks about what was most important to us in this first job. We considered location, medical practice preferences, large organizations v. private practices, pay and benefits, potential life balance, opinions of current and former employees. We found that its difficult to look at this decision by logic alone and that everyone seemed to have opinions on what we should do. In the end, the decision came down to prayer and what felt best. Both offers were good, but after evaluating how we feel, one organization stood out to us as the better choice for us now.

So in August, after Scott's fellowship graduation, we will be moving to Kitsap County in the Seattle area for this next chapter in our life, and we're extremely excited! There are A LOT of loans to pay off before we will probably feel like we've moved on to a new chapter, but the thought of settling down in an area for awhile just feels so invigorating.

Hello from Vancouver!

Let's be clear, because we've been questioned several times - we didn't move to Canada. We're writing to you from Vancouver, Washington where we're living for a year while Scott completes a Sports Medicine Fellowship.

Backing up to Match Day (1.3.18)... We were on pins and needles to learn our match to one of the 10 Primary Care Sports Medicine fellowship programs where Scott interviewed. I was sitting at my work desk, yoga breathing, stressing out that we would experience something similar to the last match we went through for residency. DrH was cool as a cucumber waiting for match results and was elated when at Noon Eastern Time he received an email that he would be working with one of his favorite program directors at PeaceHealth in Vancouver, Washington. We love us some PNW!

I didn't as much about the fellowship application, interviews, and match process, but please send me a message if you are ever in the same position and would like some details and moral support. We're already advising medical school friends who are a year behind but going through the fellowship application process. We feel so much satisfaction when we can use our trials and experience to help someone have smoother transitions in their medical training.

After the match, DrH still had to finish up his last year of residency. Back in the day when we were interns and 2nd years, I remember hearing stories about graduating residents that complained and refused to come in for extra shifts. Hearing those stories I would comment to my husband, "Why are they being so difficult with staffing at the end of the year?" Now I know. Once a resident has their contract for a future job or fellowship, their mind is already in summer vacation mode. All of a sudden, staffing with your attendings seems so tedious! I know this, because DrH did the same thing. He's always been a little passive aggressive, but snark was coming out of his ears by the end of residency when Medical Assistants were giving him extra drop-in patients. EVERYONE could tell that he was looking forward to (read: needed) a month long break before fellowship began.

The "Brother Friendly" jacket strikes again.
Aurora Family Medicine Graduation June 2018

As graduation came closer, though, the realty of our move began to hit. We hadn't even left, and we were already missing the friends and the cheese curds that we would be leaving behind. It was really poor planning on our part to schedule two vacations in the last two months of residency, because every week we had friends that wanted to hang out with us before we moved and there was so little time to fit everyone we loved in. Milwaukee was SO good to us! Aurora Healthcare was so good for DrH. We've said it before, but the SOAP was the best thing that could have happened to our medical journey.

The day after graduation, we struck out in our moving van to make the 33 hour drive, just DrH and I. This move went much better than expected (minus one Honda window fiasco and the fact that the Vancouver/Portland housing market is crazy). We're now settled into a really comfortable apartment overlooking the Columbia Rive. It's only fellowship orientation week, but we're crossing our fingers  that this will be a perfect location for us over the next year.

Also, here's hoping that I do a better job of documenting our adventures here!

Hello, Match Week... I mean 2018!

I'd like to say that we're excited for the possibilities of this new year, but at the moment we're trying to distract ourselves from nervousness.

2018 is the year that Scott will graduate from residency. Yay! This year I'll turn 35. Is another cruise calling my name? Apparently this year we're going to Hawaii twice... that we know of. *wink wink All good things.

But the big piece of news that we're waiting for with bated breath is the Primary Care Sports Medicine Fellowship Match that happens THIS WEEK.

Let's back up a second. Last you heard from us on this subject, Scott had just completed some interviews in Texas. In total, he applied to 17 programs, was invited to interview at 10, and attended all 10 interviews (can we say expensive Q4?).

Side Note: If you want to hear a great story, ask me (not Scott, it's not as funny when he tells it) about his final interview with a program that partners with his alma mater's athletic teams.

His final interview offer came mid-October, most interviews happened in October, and his final interview was mid-November. In the end of November, we discovered this incredibly informative video on how the match algorithm works to match perspective residents or fellows to programs. I'd like to give a raise to whoever proposed this video idea and/or produced it. This video completely eased our minds on what would happen after Scott submitted his rank order list, because before we viewed this video I was under the assumption that the program rank order list had some weight or even drove the match. If anyone is going through the Match, I feel like this video should be a mandatory watch.

In December, Scott's rank order list was due. We submitted a list of all 10 programs where Scott had an interview in the order of favorite to we'd still throw a party if we match to this program. Then we sat back and put up our feet, and I made a three week long countdown chain. Yep, I'm still a child. On each ring of the chain I had written the reference to a patience/trust scripture with the intention of easing our minds as we waited, but it totally backfired on me when most of the scriptures said, to the effect, "Don't be depressed, God will support you in your tribulations." To which Scott replied, "What in the world do you think is going to happen to me on Match Day?!"

Maybe some day, after the match, I'll talk about our experience keeping touch with programs after interviews were over. It's a complicated game where you have to let programs know that you're interested in attending their program, without saying specifically where you intend to rank those programs. This is a subject that I wish we had had some helpful advice on from current fellows, but at the moment, we're not exactly qualified to give that advice ourselves. Maybe next week.

So in an effort to fake it ‘till I make it, I'll say we're optimistic that 2018 will be our best year yet. 

Life Snapshot: October 25

Hard Eight in Roanoke, TX with the Lansfords

Wisconsin Tidbits: If you're looking for an excellent bed and breakfast in Door County, Wisconsin look no further than Garden Gate Bed & Breakfast. Door County has been on our bucket list since we moved to Milwaukee, and while we didn't quite time the fall foliage right, we did have a relaxing trip with wonderful eats.

What I'm Reading: The War That Saved My Life by Kimberly Brubaker Bradley (highly recommend the audiobook)

Part of My Spiritual Study: Christlike Attribute Activity from Preach My Gospel

On the Telly: Poldark, Season 3 (finished via PBS Passport)

Favorite Eats: Edy's Slow Churned Strawberry Ice Cream (never has strawberry ice cream tasted SO GOOD!)

Dr. Hubs: DrH is a traveling machine recently. It is fellowship central over here right now. By next month, he will have interviewed at 10 different Sports Medicine Fellowship programs. If you ever find yourself in the fellowship match process and want advice, we're full of opinions now. 

Goal for Next Week: Recognize when I'm overwhelmed and need to stop and listen (mantra: Proverbs 3: 5-6)

My favorite moment from this last week: Traveling to Texas with Scott while he interviewed, then spending time with cherished friends and family. We had the best hosts, and while I didn't feel like we were able to spend adequate time with anyone, it was a blessing to give them all hugs and get a little caught up on each others' lives. 

On My Mind: The Young Women were learning about Christlike attributes this month and as usual the first lesson of the month had us go through the above linked activity where we gauged how we felt we are doing that day in each of those areas. I started to realize as we were going through the questions, that Christlike attributes are not obtained, like on a checklist, but you have to constantly work for all of them. I came to this realization because I totally expected to be lacking in patience and charity, which I was, but did not expect for humility scores to be at an all time low.

Then throughout the last couple of weeks, I've received eye opening reminders that I'm not listening or being humble - like that time when I was frustrated and damaged a garage. Yeah, that wasn't good. Or the time when I felt a prompting last week and didn't act on it. Then realized later I was needed. #facepalm

I'm human, but I want to be better than that.

4 Tips for Your DrH Sports Medicine (FM) Fellowship Application

I am crossing my fingers that we never have to go through another match process after this fellowship match! This match game creates anxiety for both me and DrH. Luckily for you, you can learn from our mistakes and hopefully have a smoother experience applying for Sports Medicine Fellowships.

Here are four tips you need to know before starting your fellowship application. Keep in mind that the process may change from year to year, and that my DrH applied to the primary care fellowship which may have different requirements from other specialties. 

Tip #1: Know The Timeline

Assuming your DrH will be participating in the ERAS Fellowship Application and NRMP match, you'll want to understand the timeline for applications. This year, the application opened up in June. This means that in June, DrH can start sending Letter of Recommendation requests and inputting CV information, but the application cannot be submitted until July.

Another note from this year, is that while an applicant could technically press the submit button on July 6, 2017, applications aren't actually sent to programs until July 15. In other words, all applications submitted between July 6-15 arrive in the hands of fellowship coordinators and directors at the same time. Programs interview only 10-12 applicants out of the 100 or so applications they receive. So while the deadline for application submission is in the fall (Sept/Oct), It seems like it's in your DrH best interest to plan to submit the application in early July.

UPDATE 9/14/17: From our experience so far, most programs review applications in September/October and interview in October/November, though DrH did get a few early interview offers that were scheduled in August/September/October. This year the rank order list deadline is December 13, so interviews must be over by that point. 

Tip#2: Request More than 3 Letters of Recommendation (LoR)

Many programs ask that you submit at least three LoRs, and some programs want those LoRs to be from specific individuals (like program director, two physicians who have supervised DrH in clinic, or an orthopedic surgeon). You'll want to look at individual program application requirements which can either be found on the program's website or in the program information when you search for programs (some programs don't list requirements at all). Note that after LoR are uploaded by the author, the system takes some time to process those letters (up to 5 business days). While letters can not be included in the initial application submission unless they are uploaded and processed, you can "apply" them to previously submitted applications once the LoR is finally complete. 

Because our LoR authors experienced some technical difficulty in uploading their letters, DrH had to choose between submitting incomplete applications on-time or submitting a full application to programs late. He chose to submit on-time and email programs about the forthcoming documents. 

That being said, I would recommend asking for more letters than needed in the event that something like this technical delay occurs. Talk to those LoR authors in the end of May/beginning of June to confirm that they have enough experience with you to feel comfortable writing a positive recommendation. Then, send out the LoR requests as soon as the application opens in June, and send reminders if the LOR isn't uploaded by the end of June/first days of July.

Tip #3: Include Conferences, Event Coverage, and Elective Rotations as "Experience"

Instead of uploading your DrH's curriculum vitae (CV) as an attachment to your application, ERAS has you create a CV type document that will become the application. This includes filling out sections on personal information, education, experience, among other fields. While the ERAS instructions don't explicitly say to do this, based on AMSSM recommendations, sports medicine fellow applicants should include conference attendance, event coverage information, and related elective rotations in the experience section on the application. More up to date recommendations about what to include in sections of the ERAS application are listed on the AMSSM Fellow website. 

Tip #4: Provide Signed Code of Ethics Form

Many programs may consider the application incomplete until they have received a signed AMSSM Fellowship Code of Ethics form, which is odd really, because there's no place that we found to include it in the ERAS application. We recommend being proactive and sending that signed form by email to program coordinators after the application is submitted in early July. That way there's nothing holding them back from reviewing your application and offering your DrH an interview.

Not a tip, but so you're aware here is a list of fees we had to pay for the application alone:

- The application "token", which allows your DrH to start inputting information into the ERAS/EFDO application tools, will cost around $115. 

- Requested transcript and MPSE from DrH's medical school, which cost DrH $12

- When you finally submit to programs, the fee total will be based on how many programs applied to and there will also be one time fees for transcripts. You can see the breakdown of fees here. If you happen to submit to a second set of applications after already applying once, you do not have to pay the transcript fees again, AND the system will take into account the number of applications previously submitted.
Total, we spent close to $350.

We're planning on this being an expensive year with visiting rotations and interviews: airfare, transportation, and lodging all over the country. Another reason why I'm not eager to do this match process again anytime soon. 

Residency Update: Preparing for Fellowship

Years ago I wrote a post about prepping for a career in Sports Medicine, and I admitted in the post that it was likely too early to be writing a "how to" post considering that at the time DrH was only in his second year of med school. This post is it's sequel, and writing this is making me rethink my post titles. Instead of Part 1 being "How To Pursue a Career in Sports Medicine," a more apt title would be "Path from Medical School to Sports Medicine" or "How to Distinguish Yourself as a Sports Medicine Candidate in Medical School." Then Part 2 could be "Path from Residency to Sports Medicine Fellowship," with maybe a subtitle of "How to Speed Date at the Fellowship Fair." Anyone is welcome to submit other suggested titles for consideration.

I should say that the longer I've followed Scott on this journey and listened to the stories of others, the more I realize that our path has not been a standard one. In fact, I'm not sure that there is a standard path to sports medicine. It all depends on what direction or specialization you want for your career and how ambitious you are to get there if you don't have someone providing a schedule of opportunities for you.

That being said, I still feel like the Part 1 post is accurate and includes helpful links. If you or your DrH is interested in pursuing a Sports Medicine fellowship, the ticket is demonstrating early on that the student/resident is interested in a fellowship by participating in sideline experience, research, clubs, and electives.

AMSSM 2017 Fellowship Fair

Now that my DrH is ending his second year of residency, he finally got the chance to attend the annual conference of the American Medical Society for Sports Medicine. As a side note, I asked DrH if he wished he had gone to the conference and fair during his first year as a resident (PGY1) and he gave a resounding yes! It would have provided him with extra motivation and direction on how to approach applying for fellowship. It also would have meant more time to casually talk to a variety of fellowships long before he would have felt the need to have his opinions finalized for the approaching fellowship application period.

For six years now, the AMSSM annual conference has included a fellowship fair where programs from across the United States are invited to have a booth for a VERY LIMITED amount of time on one of the final days of the conference to answer questions about their program. At this fair in 2017 there were over 100 programs represented in a large hotel conference room. Each program manned a booth (seen to the left) for one hour in the morning, 30 minutes around lunch, and 30 minutes before the close of the day. Don't be fooled into thinking that those are misprinted times. Conference staff will shew anyone out of the room when the allotted time for program mingling is up. *My fingers are crossed for you that this changes in the future, and they instead give you a half day or full day to meet the programs.

To add to DrH's tight schedule of program speed-dating, he had signed up for the conference's student and resident specific workshop on "How to Apply, Interview and Match Well" which happened to be scheduled at the same time as the first hour of the fellowship fair. Seriously, conference organizers?! During the first entire half of the fair, many of the potential fellows were tied up in a different room getting advice on the impending application.

Still, DrH was determined to talk to all of his favorite programs. The night before the fair, he prioritized a list of program visits to maximize time in getting his face in front of those representatives. He got up early the day of the fair so he could try to catch programs before and after the application workshop (which he said was helpful, but nothing that was said was surprising), and tried to get into the fair early and stay late, when possible, for the shorter afternoon sessions.

All in all, he talked to 17 programs. SEVENTEEN! I honestly don't know how he did that. The night before I was thinking, "how many programs can you have a conversation with in one hours total time? Five to ten, maybe." I wasn't physically watching him, so I don't know if all 17 conversations were meaningful or seemed to leave a positive impression on the programs; but knowing DrH's personality I would imagine that they were fun, casual visits. Slow clap for DrH!

So now DrH is fine tuning his CV, writing his personal statement (several different versions, because apparently the workshop recommended to make it less of a letter of intent and use less cliche stories), and requesting letters of recommendation from AMSSM physicians that he has worked with during residency. He's also scheduling two-week visit rotations with two top fellowship programs for this fall. Fellowship applications open up in June but aren't submitted until July. Then after the application period closes in September he will (fingers crossed) start to receive many, many interview offers. The fellowship match (yep, another one of those algorithm love connections) happens in January 2018.

We'll keep you posted.

How To Pursue a Career in Sports Medicine

Even before medical school began for us a year and a half ago, Scott mentioned that he believes his specialty of preference would be Sports Medicine. Scott is a sports fanatic, in fact, he says if it's a sport, then he plays it. He'd also like to sell that t-shirt slogan to Nike. During his undergraduate studies, Scott worked as an aide in a physical therapy clinic for athletes and LOVED it! He really enjoyed working with active people of all ages who were anxious to get back to the performance level they were at before an injury. He feels like these athletes were more motivated in their recovery than maybe a non-athlete would be.

We are only in the second-year of medical school now - so he's still on-campus hitting the books - but I've already started my attempt to map out what it would take for Scott to become a doctor of sports medicine. I can almost guarantee that it is too early to have this much research done considering that my student-doctor has yet to do a clinical rotation, but it doesn't hurt to have all my resources in one place.

If you're wondering what the process is to become a team physician and if you have what it takes, check out American Medical Society for Sports Medicine (AMSSM)'s brochure - Sports Medicine Specialist: Could It Be A Career for You?

The brochure linked above says what I've read before - that most team physicians complete family medicine residencies and follow up with a sports medicine fellowship, since "90% of all sports injuries are non-surgical." Family practice residencies are a plenty and often need applicants. Scutwork.com has reviews of programs from around the nation from past/current residents. Since this forum has information provided by residents, it wont be complete or sometimes very detailed, but it will be informative.

To find a list of all accredited Sports Medicine Fellowship programs visit, AMSSM.

And by chance, Morgan stumbled upon this list of open residency postings  at the American Medical Association website which could be invaluable when finding residencies or fellowships that need to be filled later in the game!

Scott had an interview with the Oregon State University team physician to ask him about his path to working with OSU. When the interview was done, Scott felt even more in love with the profession, but he also felt like the path to becoming a collegiate team physician would be more difficult than even becoming an orthopedic surgeon (super competitive!).

Next up: 3rd year rotations lottery!

UPDATE 10/2014: At this point Scott has completed a few audition rotations in his fourth year of medical school and has further insight into what type of residency to apply for in order to better position yourself for a career in sports medicine. Orthopedic surgery, family medicine, and physical medicine rehabilitation are specialties that work with athletes. Each specialty will have some areas of practice that is not sports related, so there are trade-offs with each. Scott has decided to go the family medicine route because of the doors that route opens for overall practice. He had previously considered PM&R, but has heard from residents that it is more difficult to get into a sports medicine fellowship coming from a PM&R residency. This is because many of the sports medicine fellowships are primary care based.

When looking for a family medicine residency that will prepare the resident for acceptance to a fellowship and career in sports medicine, look at the residency curriculum and faculty. This information is found outside of FREIDA, directly on the residency website. Look for sports medicine rotations in multiple years of the curriculum, faculty that have sports medicine research interest or are on a local/national sports medicine boards, and athletic event coverage.

TIP: We had initially looked only at residencies where there was also a sports medicine fellowship; however, we discovered that some of the best preparatory experience was available at unopposed residencies without a connected fellowship. The key here is not having to compete for learning and CV building opportunities with other residents or fellows. Unopposed residencies allow the students to participate in all interesting cases at the hospital, and typically train the residents for more procedures. Without a fellowship connected, students will have more access to sports related events and cases because they don't have to compete with a fellow to participate.

The upside of having a fellowship in the same hospital system as a residency is that it may improve your network and potential to match with that fellowship, but it's not guaranteed. In fact, we've heard from some fellowships that have preferences for selecting outside of their connected residency.

UPDATE 6/2017: Preparing for Fellowship