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Debtrimental to Your Health by Douglas Carlsen, DDS

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Debt is a huge obstacle to a doctor's retirement savings, with the home often the largest financial sinkhole.

We find it quite possible to have almost $19,000 in personal and practice debt per month. $228,000 per year requires $350,000 pre-tax income assuming 35 percent federal and state taxes. This does not include food, utilities, clothes, vehicle maintenance, gas and other day-to-day expenses. As soon as the practice loan is paid off, many doctors "trade in" the $800,000 starter home for the $1.5 million home. Along with much higher mortgage and home upgrade and maintenance costs, that $7,000 per month savings is completely gobbled up.

Is debt normally this bad? No, yet $10,000 per month liability is common for young doctors before purchasing a practice. And I've seen much worse than $19,000 monthly debt payments for older docs. Lisa Knowles, DDS, believes in guiding the entire, messy, human dentist. Her business, IntentionalDental Consulting focuses on communication strategies to strengthen practice numbers, and leadership evolution training to strengthen the dentist. She blogs about oral and systemic connections as well as leadership in dentistry at www.Beyond32Teeth.com. In this interview, Knowles offers expert commentary on health and stress issues related to the typical dentist's debt obesity.

Let's look at a young, high-consumption doctor's debt possibilities:
$100,000 of revolving credit card debt $1,200 interest per month
Auto leases for two vehicles $1,500 per month
Student loans ($450,000) $3,200 per month
Mortgage ($800,000) $4,300 per month
Home upgrades and maintenance at $24,000 per year $2,000 per month
Practice loan ($600,000) $7,000 per month
Total per month
$19,000
Carlsen: Debt issues normally cause stress, with subsequent health and mental problems, throughout a doctor's career. The young dentist struggles under the weight of large student loans, the mid-career doctor needs to ramp-up retirement savings along with saving for college—often under the stress of much higher mortgage and home costs, and the late-career dentist has the jitters over retirement funding with corresponding market conditions and the practice sale. Can you comment on the various stress-related issues at these different ages?

Knowles: Right out of dental school there is an overwhelming desire to get some things—materialistic things. For me, I felt entitled to it. After working so hard in school and finally being "free," I immediately leased a new car. Many students feel this same sense of entitlement upon graduation. It's dangerous because entitlement purchases only add to the stress created by initial debt. A few years later when I bought my first practice and building, the stress levels increased 100-fold.

With nearly a million dollars in debt hanging over my handpiece, I felt compelled to succeed so that I could pay off the monstrous burden. And, I had no idea how much money I would make despite a guestimate from the former practice owner. Debt impinges on our freedom and strangles our freewill. Minimizing debt is paramount and should be the first agenda item upon graduation. In my opinion, learning to delay gratification and resist incessant sales pressures is the best thing any new graduate can understand. Most of us are pretty good at buying and gratifying ourselves and not so good at the other side of the spectrum.

Midlife upgrades can rip away someone's financial freedom again. Just as things are starting to get paid off, the old entitlement and competitive beast sneaks in again and taunts us to buy more things—and bigger things—to keep up with the other doctors on the block or to house the long list of things we have purchased along the way. Once again, we plunge down into debt, only this time, with a more carefree attitude about being able to pay off the debt. Unlike before, now we know how much our practices can produce and we tell ourselves we deserve the bigger house and the better car because we have worked so hard in our practices and made great headway on our previous debt, and because we can "afford" it. Unfortunately, we do not always plan so well for catastrophic events or economic downturns. Then, the reality of an over-committed lifestyle hits us right in the face.

Through midlife and on towards retirement, we try to figure out how to survive the choices we have made if they were not particularly good ones. We look for ways to turn away from our pain with drugs, alcohol, food or other escapes. The stress snowballs and we can end up in very difficult, and even more stressful situations because we failed to look far enough into the future. This is not unusual and has become the American way: buy now, pay for it later. When later does not turn out quite how we anticipated, we blame others for the situation, and again, take the anger, frustration, and intolerance out on our bodies.

We work more to pay for materialistic things when our bodies really need sleep rather than things; we caffeinate ourselves to do more; we smoke or take stimulants to keep going when we really need to rest; we take drugs to help us sleep because we cannot shut down our brains that are over-stimulated or on perpetual overdrive; we drink alcohol to help us cope with our frustrations with ourselves and with others who take advantage of our fears and greed; we put off exercise and time for ourselves because we have filled our lives with things to maintain, things to do and things to experience. In all, we ignore ourselves—we ignore our deep needs. We throw ourselves under the bus to be run over by a set of societal norms that are literally killing us—sometimes slowly with diseases like inflammation and ulcerative conditions; sometimes quickly with heart attacks and cancer.

Carlsen: What mental health and stress solutions are available to doctors at these ages?

Knowles: We can recognize the lures early on, recognize early health warning signs, and work to prevent stress as much as possible. Prevention, prevention, prevention. It's like realtors saying "location, location, location" is everything in selling properties. Prevention is the best medicine for potential mental and physical wellness. The hardest part, it seems, is for dentists to see themselves as damaged. We are so used to pushing ourselves beyond normal, that a little pain or suffering seems normal.

I find many dentists are unaware of on-going health problems in their own bodies. Just as our patients say, "My teeth are worn down because they are old and I used them a lot," dentists tell me their backs hurt because they use them a lot or because they played a lot of sports in the past and have had many old injuries. Yes, this may be true, but then there's the "and what is that telling you?" component that can be challenging.

Mental wellness tips:
1. Remember that you are worth an hour a day. Take at least an hour for yourself to workout, rest or play.
2. Learn how to slow down your brain through one of several methods: stress reduction protocols, yoga, tai chi, meditation or breathing exercises.
3. Avoid the temptation to be everything to everyone.
4. Avoid the temptation to buy materialistic things when you really need emotional things.
5. Surround yourself with people who want to be healthy and encourage you to lead a balanced lifestyle.
6. Remove those relationships that zap your energy and suck the life out of you.
Admitting to pain and possibly shifting down a gear is hard to do. If we recognize it early and shift down one gear until healthy again, we last longer, but if we ignore the pain, our bodies will ultimately put us in park for a while.

Seeing the early warning signs is crucial to our long-term ability to participate in dentistry. Sometimes this takes an outside eye to help us determine our abilities or inabilities. A spouse, a physician, a friend or a colleague may be the one to see our health from the helicopter view. Furthermore, dentists often see no way out.

Despite feeling the migraine pain or seeing a hypertension diagnosis, we rationalize away the warning signs and tell ourselves we will take care of ourselves once it slows down, or once we pay off the car, or once we get our child graduated. Unfortunately, this is reactive thinking rather than proactive thinking. If we want our patients to take responsibility for their health and their lifestyles, I firmly believe we must first take care of our own. Our struggles and journeys will certainly help them.

Physical wellness tips:
1. Incorporate deep stretching into your workout routines. I personally prefer yoga because it has both a mental and physical component—it's a double bonus when time is precious.
2. Burn off the cortisol from your fight or flight workday with some type of aerobic exercise. That could be fast walking or long distance biking depending on your fitness level.
3. Get at least seven to eight hours of sleep each night. This is your regeneration time. If you cannot sleep, at least rest and avoid fight or flight activities..
4. Assess your health at a micro level. There are blood panels that can be done to help you find micro-nutrient deficiencies in your body.
5. Eat well. This is broad, but the nutrition advice now is very different from the no-fat diet days from yesteryear. It is hard to keep up, but worth investing some time in knowing about Paleo diets and green smoothies among other things.
6. Listen to your body. It's smarter than you. If you are getting early warning signs like insomnia, digestive disorders, headaches, weight gain, or teeth grinding, take heed and bravely do something differently despite a lot of pressure to keep doing the same thing. Don't wait for a heart attack to be your wake up call. Wake up a bit earlier and exercise, meditate or go for a walk..
Dr. Douglas Carlsen has delivered academic-based financial education since retiring from private practice in 2004 at age 53. He has no connection with any company or individual and speaks his mind freely.

Carlsen is very interested in speaking to your study club! Contact at 760-535-1621 or drcarlsen@gmail.com.

Over 25 videos available: search Dr. Doug Carlsen YouTube. Additional Carlsen Dentaltown articles are at: www.dentaltown.com. Search "Carlsen." Carlsen website is at www.golichcarlsen.com.

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April 2024
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