The “Rich Doctor” Myth

Considerations for the Next-Generation of Potential Providers

By Brian J. Knabe MD CMP™ CFP™


Brian J. Knabe MDAlmost 2 decades ago, Fortune magazine carried the headline “When Six Figured Incomes Aren’t Enough. Now Doctors Want a Union.” To the man in the street, it was just a matter of the rich getting richer.

The sentiment was more precisely quantified, according to health economist and financial advisor Dr. David E. Marcinko MBA CMP, in the March 31, 2005 issue of Physician’s Money Digest, who with Editor Gregory Kelly reported that a 47-year-old doctor with $184,000 in annual income would need about $5.5 million dollars for retirement at age 65.

Of course, physicians were not complaining back then under the traditional fee-for-service system; the imbroglio only began when managed care adversely impacted income, or when the stock market crashed in 2008; or with passage of the Patient Protection and Affordable Care Act [PP-ACA] in 2010 or its’ full implementation in 2014.

And now, in the post-Trump era?


Rich Doctors


  1. More on the Doctor Salary Conundrum
  2. Doctor Salary v. Others [Present Value of Career Wealth]
  3. Are Doctors Members of the Middle Class?
  4. Taxing the [not so] Rich [doctors]
  5. Doctor – Are You on Your Way to $5.5 Million?


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8 Responses

  1. Brian,

    In as much as physicians constitute 14% of the so-called, and often maligned “one-percenters” [$388,905 earned-not passive income/year]; we still seem pretty fortunate.



  2. New ways the rich are hammered by taxes–new-ways-the-rich-are-hammered-by-taxes

    The government is hitting the rich with more taxes, but is it fair?

    Dr. Kirk


  3. Who pays the 3.8% investment tax?

    It isn’t you; or even most doctors.

    The bulk of the burden of a new tax on net investment income falls squarely on the top 0.1 percent of Americans.

    But, they also reap an exclusive tax benefit.



  4. Habits of the Wealthy

    As published by Thomas Corley in Rich Habits [The Daily Success Habits of Wealthy Individuals]:

    • 44% of the wealthy wake up at least three hours before work
    • 80% are focused on accomplishing some single goal
    • 81% maintain a to-do list, and 67% write down that list
    • 88% of the wealthy read 30 minutes or more each day for education or career reasons
    • 78% network five hours or more each month
    • 76% exercise aerobically four days a week
    • 70% eat less than 300 junk food calories per day
    • 67% watch one hour or less of TV per day.

    Lon Jefferies MBA CFP®


  5. Flush Times for Financial Advisors

    Riding on the coattails of a near 30 percent rise in the S&P 500, financial advisors saw their compensation grow by 16.5 percent in 2013 to an average $240,000, according to’s annual advisor compensation survey.

    So, forget about medical school. Become a product salesman; er financial advisor.

    Dr. David Edward Marcinko MBA CMP™


  6. Rich Doctors?

    Are you in a financial position to do what you want to do when you want to do it? Could you afford to retire, care for ailing parents or reinvent your medical practice?

    Wealth buys the freedom to decide how you spend your days. My investments gave me the safety net to leave my conventional surgical practice and launch into a career as an author and speaker and consultant promoting better medical outcomes.

    Here’s the dirty little secret. Most physicians are economic slaves to their practices. Our high incomes do not reliably translate to high net worth and the freedom wealth buys.

    Income vs Wealth

    Practicing physicians earn top dollars. The U.S.Bureau of Labor Statistics culled data from tax records to conclude that nine of the top ten earners in the U.S. call themselves “doctor.”

    Indirect evidence supports the assertion that physicians fail to build wealth. In a recent survey, half of physicians are behind where they would like to be in retirement planning. Professional medical associations are exploring how to asses competency in older physicians who continue to practice because they cannot afford to retire.

    The Reasons Physicians Fail to Build Wealth

    What keeps physicians from building wealth? Here are the reasons usually cited:

    * Medical school debt
    * Late start on earning and savings
    * Failure to protect assets against know and overlooked risks
    * Poor tax planning
    * Getting investment advice from the wrong people
    * Fraud and theft.

    This is like saying patients become obese because they eat too many donuts. It may be true, but it fails to tell the whole story.

    Further it fails to lead to sustained solutions that deliver different outcomes. Budgets work about as well as diets.

    The Real Causes of Unrealized Wealth

    I believe that physicians’ failure to build wealth is a symptom of a deeper financial ill: their dysfunctional relationship with money.

    Physicians as a group are intelligent people who:

    * Tend to overestimate their ability to manage money, and underestimate the level of difficulty of the challenge.

    * Lack insight about what they do and do not know. Turn to money to solve non-financial problems, like alleviating their their guilt about spending so little time with their families.

    The real barrier to financial freedom comes down to a conspiracy of silence around money. For physicians, money is the ultimate taboo topic. You cannot fix problems that you cannot talk about.

    Here are three reasons physicians avoid conversations about money:

    1. The culture of medicine. Just as the government calls for the separation of church and state, medical ethics calls for a separation between the care a patient gets and a patient’s ability to pay. We physicians learn to avoid conversations about money to uphold this ethic. As a practicing physician I often thought that delivering medical services was like ordering a meal off of a restaurant menu without any prices. Small wonder health care costs spiraled out of control!

    2. Lack of formal education. Physicians get no courses in business or financial management in medical school or in residency.

    3. Awareness of their vulnerability. Physicians experience themselves as financial prey. They turn to people they trust–their colleagues–for financial advice. I include myself in the group of physician who have fallen for “DDD’s”–dumb doctor deals.

    The Path to Wealth

    Physicians have the ability to build wealth.

    As Einstein said, problems are not solved on the level at which they are created. The solution begins with physicians’ willingness to tolerate the discomfort when discussing money.

    Here are three steps to help physicians achieve financial freedom:

    1. Coach physicians to proactively engage in conversations with patients about the costs of medical care.

    2. Explore – with compassion–the forces that drive spending. Here are some things that struggling physicians say to themselves.

    “I deserve nice things.” You know the sacrifices you and your family made to answer this call to medical service. When physicians finally start earning their 6-figure incomes, they feel that it’s time to splurge.

    “I can save lives and I’m smart; that means I can manage my own money.” You cannot see into your blind spot.

    “There will always be more than enough money.” This physician fails to plan, trusting that there will be a bright financial future. Without a plan, money tends to wander off.

    “You invested in a marijuana farm with a 200% return? Count me in! Physicians can follow trusted colleagues into marginal investments.
    “Look at me!” This physician wants to maintain the appearance of success at the cost of building true wealth.

    “Sure, I trust you.” Physicians’ trusting nature makes them easy targets for embezzlement, fraud and ploys.

    “I’m embarrassed.” Many physicians wonder how smart people like themselves could make such ill-informed choices. Disclosing mistakes can be painful.

    “Mother Theresa took a vow to poverty; I should, too.” This physician does not feel worthy of wealth.

    “Show me where to sign.” Physicians are often unaware of their power to negotiate contracts, or lack the skill and experience to execute.

    3. Replace wealth-eroding beliefs and habits with new wealth-building tools and skills. Just as we have mentors to guide us through the art and science of caring for patients, mentors and coaches helped me change my beliefs and behaviors around money. I offer my son–headed for medical school–basic financial literacy lessons I never got. I hope he aligns his spending habits with Einstein’s insight, “Compound interest is the eighth wonder of the world. He who understands it, earns it; he who doesn’t pays it.”

    Wealth-building is not a do-it-yourself job for most physicians. If you or a family member had a rare medical condition, you would not treat it yourself; you would seek the help of the expert. Manage your wealth with the same strategies you use when you manage your health.

    Financial advisors know about the complexities of “referred financial pain” the same way you know about the association of right shoulder pain and an inflamed gallbladder. Could you acquire this knowledge? Absolutely. The real question is whether you want to invest the time and effort.

    Physicians can achieve financial freedom. With the economic stresses posed by Obamacare, now is the time for physicians to take control of their financial destiny.

    Vicki Rackner MD


  7. Vicki,

    Well said. Now, compare the above to these statistics according to a 2013 survey of physicians on financial preparedness by American Medical Association [AMA] Insurance. They are alarming:

    • The top personal financial concern for all physicians is having enough money to retire.
    • Only 6% of physicians consider themselves ahead of schedule in retirement preparedness.
    • Nearly half feel they were behind
    • 41% of physicians average less than $500,000 in retirement savings.
    • Nearly 70% of physicians don’t have a long term care plan.
    • Only half of US physicians have a completed estate plan including an updated will and Medical directives.

    Hope R. Hetico RN MHA


  8. Have you heard the story behind the invention of chess?

    The inventor brought the chess board to the emperor of China, and the emperor was so impressed he said he would grant the inventor one wish. The inventor had the simple wish of receiving one grain of rice for the first square on the chess board, two grains for the second square, four grains for the third square, eight grains for the fourth square, and so forth. Sounding like a fair and modest proposal, the emperor agreed.

    However, it turns out that filling the last 10 squares on the chess board would have required 35 quintillion grains of rice – more than enough to bury the entire planet. Unamused, the emperor had the inventor beheaded.

    Who knows whether the story is true, but the point is that with compounding, grains seem small at first, modest in the middle, then suddenly overwhelming. In the investment world, what enables compounding? Time.

    Let’s review the rule of 72

    The rule of 72 states we can divide the number 72 by the rate of return we achieve, and the resulting number will tell you how many years it will take your money to double. For instance, if we obtain a 9% rate of return, it will take eight years (72 / 9) for our investment to double in value.

    So what rate of return can we expect when we invest in the market? From 1920 thru 2014, the S&P 500 (a typical measure of the stock market) has returned an average annualized rate of return of 10.31%. Coincidentally, 72 divided by 10.31 equals 6.9835. Thus, if we had invested in the S&P 500 in 1920, our money would have doubled every 7 years.

    What would happen if on the day your child, grandchild, or great grandchild was born, you invested $1 in the S&P 500 but kept it a secret. Assuming the infant lived to age 84, the dollar would be worth:

    $2 at age 7
    $4 at age 14
    $8 at age 21
    $16 at age 28
    $32 at age 35
    $64 at age 42 (still not a big deal, right?)
    $128 at age 49
    $256 at age 56
    $512 at age 63
    $1,024 at age 70
    $2,048 at age 77
    $4,096 at age 84

    Over one life span, $1 grew into $4,096. Impressive! Now let’s add three zeros to all figures mentioned. In this scenario we invest $1,000, and after 84 years of the child’s life, you would have $4,096,000 in the investment account. Of course, I suppose you could invest $10,000 rather than $1,000 …

    How To Make Your Family Line Rich

    The key, of course, is time. The child will have many urges to withdraw and spend the accumulated amount throughout his life. For this reason, the chances of success for this project likely increase if you can find a way to not tell the child for as long as possible.

    How fun would this be? Imagine 84 years down the road, long after you are gone, the young heirs in your family line – who may have very ordinary finances at the time – suddenly get such a massive infusion of assets that they could then use to maintain the family’s stability for generations to come. All due to an amazing, mysterious great, great grandparent with the incredible financial foresight to take advantage of compounding.

    Now, imagine you stipulate that the heirs can have access to the funds only if they take a fourth of the resulting investment account and repeat the process!

    Think of compound interest as a bunch of tiny personal employees that work extremely hard for you and mate like crazy!

    Lon Jefferies CFP MBA


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