JAMA article on Net Worth Shock and Mortality

[VagabondMD]

Really great thread and probably one that should be summarized and read by aspiring physicians, med students, residents, early attending (heck, all docs and their spouses), etc.

I am going to defend the @WCI usage of the emotionally charged word, "poor", in the context of describing doctors who have a negative net worth and are not sufficiently motivated to change their status. In the same way that Dave Ramsey has certain phrases and buzzwords that are a "kick in the pants" for those on the wrong financial path, I believe that @WCI has used this effectively to correct the course of physicians on the wrong path, too.

In a general population, I do not believe that comparing a cardiologist making $500k per year and not making a dent in his/her $600k student loan debt is not comparable to a homeless, panhandler, even though the net worth of the cardiologist is substantially lower. The cardiologist has an education, intelligence, skills, a network, and other non-tangible resources. Even if something happened that he/she could never practice medicine again, he/she could easily find a six figure job and maybe even a better long term financial outcome. The panhandler does not have these advantages, and it would be a true miracle to find himself in a six figure job, lottery odds no doubt.

Which leads me to @Zaphod, whom I had the honor and pleasure to meet at the WCI conference last month. He is truly a great guy in person, and I am impressed with his story, his grit and determination, and what he has accomplished. When he has the time, I think he should write a book (or have a blog, which is apparently the fashion these days) because I think he not only has the story but the personality and unassuming nature to inspire others from disadvantaged backgrounds. He certainly inspires me!

[Complete_newbie]

Zaphod is chill. Loving Cali life. Told him many times to start a blog but too busy surfing lol

[Complete_newbie]

May be if p<0.005 converting crap to stone tablets; gold better

[q-school]

Complete_newbie wrote:

By first statment I mean people have biases which come from whatever they “want” / are selling.

No there are not – every field in medicine is on the backs of research and research is based on numbers while controlling biases (which started this whole thread). So I disagree.

I don’t have data on poor financial knowledge of physicians but people have published surveys in journaks highlighting it plenty – go read those.

I don’t have clarity but I don’t just follow things if WCI says it or some one else. Look and analyse it objectivrky; many don’t and just take statwments at surface value ( heuristics lazy whatever you wanna call it). See many posts by zaphod, dmfa on just explaining amortization of loans to people here. It’s grating.

I don’t make love to data at night but how do you make objective decisions ? BP over 140 is high ? Why?I’m assuming you use numbers to make those decisions in your oractice. That’s what I’m getting to. Doesn’t mean I’m obsessed with it but it is the Socratic way is it not ?

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remind me how far in practice you are?

there is no data regarding Tylenol for headaches.  we can't agree on definition of hypertension.  we can't agree on treatment protocols.  this area has as much data as any other area.  recommendations are reversed in subsequent revisions of guidelines.  we try to find 'ideal patients' for studies, but general applicability to patients with multiple illnesses is unknown.  we don't test medications in geriatric populations.  women generally underrepresented in studies.  side effects generally accepted as underreported.  publication bias.  impact factors.  lots of reason for concern over data.

anyways you are free to draw your own conclusions of course.  i was just perplexed by the statements you made (and kind of still don't understand what you were saying anyways).

i think most people in practice for some time acknowledge that data is helpful, but generally there are few areas where data provides a definitive answer.

certainly they continue to practice medicine, but recognize that there is at least as much art as science.  ymmv.

have a good day. 

 

[Complete_newbie]

So we should stop doing research ? Tylenol doesn't need data - it works, what data would you want? All the rest are short comings of studies which most mention. Doesn't mean they are less useful than blanket statements. SpaceX wouldn't be doing extensive DATA driven studies if they thought conjectures were enough to shoot people to mars.

I have more faith in numbers than blank statmeents/people. So should physicians because that is evidence driven. Who's arguing about art vs science? I became Dr. because I believe in science. You can interpret that however you want.

[docnews]

Love this discussion because in the weeds of subjective definitions we get at the heart of the issue. I've seriously liked comments on both ends of this spectrum. Here's my 2 cents:

First these definitions are in respect to money - not resources or ability. A famous person who can make tons just showing up at events and those with access to free food might be rich in these other regards.

Rich = having some money that is yours alone and not owed to anyone. How much necessary is a matter of perspective.

Poor = not having any money that is not owed to someone else. It might be offensive to those starving to death to consider a resident physician also poor but in purely money terms they are both poor.

So a negative net worth must be "poor" in money terms, and any positive net worth has the potential to be deemed "rich" depending on the perspective.

As for the article, it shows that one's life savings near retirement needs to be more conservative for one's mental health to avoid seeing it cut in half.

[Donnie]

I don’t know about you guys, but I blame Bill Clinton for this. We have devolved to the point where we use words based on what they mean to us and how they make us feel. I reject this notion, and I urge the like minded people to fight back!

Poverty line is defined by income, not net worth. Sure you can use words incorrectly to make a point if you want, but it’s still wrong. By definition a definition is not debatable.

[Zaphod]

Donnie wrote:

I don’t know about you guys, but I blame Bill Clinton for this. We have devolved to the point where we use words based on what they mean to us and how they make us feel. I reject this notion, and I urge the like minded people to fight back!

Poverty line is defined by income, not net worth. Sure you can use words incorrectly to make a point if you want, but it’s still wrong. By definition a definition is not debatable.

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Agree!

Net worth=wealth, which is entirely different than income. You can be low income and very wealthy and vice versa. Also agree there isnt great language on this for the whole spectrum.

 

 

[Anne]

I think it's interesting that people think that the definition of poor is set in stone (although I agree, the term has been abused here) but that the definitions of wealthy and rich are up for debate.  Per Merriam-Webster, they are essentially synonyms, although wealthy nearly always pertains to money/material goods whereas rich can be used in a broader sense (e.g. rich soil).   But somehow people think that wealth=net worth while rich=income....why?  Because Robert Freaking Kiyosaki says so?  I'm going to stick with the MW definition, that they can be used interchangeably, to mean an abundance of resources, means, or funds.

[Zaphod]

Anne wrote:

I think it’s interesting that people think that the definition of poor is set in stone (although I agree, the term has been abused here) but that the definitions of wealthy and rich are up for debate.  Per Merriam-Webster, they are essentially synonyms, although wealthy nearly always pertains to money/material goods whereas rich can be used in a broader sense (e.g. rich soil).   But somehow people think that wealth=net worth while rich=income….why?  Because Robert Freaking Kiyosaki says so?  I’m going to stick with the MW definition, that they can be used interchangeably, to mean an abundance of resources, means, or funds.

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I think its just the finance/tax definition. In reported literature like IRS or any broad categories you have, income/wealth are reported separately like I have posted above. Wealth meaning assets/etc...income just meaning income.

[Anne]

Yeah...the question wasn't whether wealth=income, it's whether wealthy=rich

[Zaphod]

Anne wrote:

Yeah…the question wasn’t whether wealth=income, it’s whether wealthy=rich

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I think thats where it starts to trend into the "it depends" stuff.

[White.Beard.Doc]

Even if I have a high net worth today I could be wiped out tomorrow.  So I am "potentially poor".

[Complete_newbie]

Anne wrote:

I think it’s interesting that people think that the definition of poor is set in stone (although I agree, the term has been abused here) but that the definitions of wealthy and rich are up for debate.  Per Merriam-Webster, they are essentially synonyms, although wealthy nearly always pertains to money/material goods whereas rich can be used in a broader sense (e.g. rich soil).   But somehow people think that wealth=net worth while rich=income….why?  Because Robert Freaking Kiyosaki says so?  I’m going to stick with the MW definition, that they can be used interchangeably, to mean an abundance of resources, means, or funds.

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So that was my orignial premise in the thread. Apparently it is set in stone per few prominent posters.

[The White Coat Investor]

Complete_newbie wrote:

Anne wrote:

I think it’s interesting that people think that the definition of poor is set in stone (although I agree, the term has been abused here) but that the definitions of wealthy and rich are up for debate.  Per Merriam-Webster, they are essentially synonyms, although wealthy nearly always pertains to money/material goods whereas rich can be used in a broader sense (e.g. rich soil).   But somehow people think that wealth=net worth while rich=income….why?  Because Robert Freaking Kiyosaki says so?  I’m going to stick with the MW definition, that they can be used interchangeably, to mean an abundance of resources, means, or funds.

Click to expand…

So that was my orignial premise in the thread. Apparently it is set in stone per few prominent posters.

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Until someone invents some new words, I'm just going to agree to disagree with both of you. I guess that puts me in the Kiyosaki camp, not a place I'm terribly comfortable hanging out! I think the best, although imperfect, measurement of poor vs rich is net worth, not income.