If You Want to Go Up (Part Two)- You’ll Need to Give Up. The Role of Sacrifice.

“Great achievement is usually born of great sacrifice, and it is never the result of selfishness” – Napoleon Hill

Author: Robert A Felberg MD

Topics: Physician leadership, Career Advancement, Office Politics

Keywords: Financial independence, sacrifice, paying off medical student debt, doctor passive income, doctor early retirement

“1. You have get up to go up.     2. You have to give up to go up.     3. You have to grow up to go up.”

John Maxwell

Physician success is an elusive creature. Each doctor defines success differently. Some crave recognition or a larger voice in the future of healthcare. Others desire financial rewards. All are equally valid. There are some common elements seen in successful physicians- they possess Initiative, Willingness to Sacrifice, Maturity, and Vulnerability. The first post in this series introduced these concepts and reviewed Initiative, especially as it relates to “Personal Energy”. This post will discuss the role of Sacrifice- something that doctors are quite familiar with.

 [Editor’s Note: There are many great doctors out there. Unfortunately, being a superb clinician  does not equate into superb leadership. Physician leadership is a topic that is often overlooked in training and the lack of this professional skillset is a cause of many of modern medicine’s troubles. This post in one of a series from physician advocates LLC, advocatesmd and medical success central exploring the vital skill of physician leadership. Please sign up for the newsletter to be kept up to date.]

In “The 21 Irrefutable Laws of Leadership”, Maxwell explained the secrets to  “making it to the top” or “going up”. This involves Initiative– “getting up”, Sacrifice– “giving up”, and Maturity– “growing up”. I Also believe a leader needs to be Vulnerable– “You have to open up to go up.”


“The medical profession is a feat, it requires self-sacrificepurity of soul and purity of thoughts” – Anton Pavlovich Chekhov

Sacrifice is a common experience for all in the medical field. We all sacrifice tremendously to enter the field. Hours of study while our friends enjoy their youth. Two day shifts without sleep so our patients can rest quietly. Delayed financial return, crippling medical school debt, and constant derision from society about the myth of the wealthy doctor.

Since personal sacrifice is part of the daily experience of every doctor, I’m going to touch on another type of sacrifice that typifies a successful physician- Financial Sacrifice.

It’s my strong belief the financially secure doctors are better clinicians.  The reasons are pretty straightforward-  1. If you are making decisions under financial strain, you may choose what is best for your bank account and not what is best for the patient.   2. There are few stressors worse than financial stress.   If you are focusing on your financial condition, you are taking focus away from the patient’s condition.    3. If you are financially stressed, you are probably in some level of disagreement with your employer and feel less the complete control. This combination of anger, frustration, and helplessness is on the continuum of “burnout” and that never ends well.

For the reasons above- all physicians have the professional duty to achieve financial stability.

Which gets me to my point. Doctors are really good at sacrificing their personal life for their medical career, but they are terrible at making financial sacrifices. It actually somewhat unbelievable. How can the same person who was able to sacrifice all those great parties in college turn into the same person who can’t stop themselves from spending on lavish vacations? Shouldn’t the same reserve of fortitude that allows you to work 48 hours without rest seeing 27 patients each day give you the strength to buy a used Lexus over a new Mercedes?

 Here’s the problem with most doctors- You are not rich, at least not yet. Actually, you probably owe more in debt than you have in total assets. You likely have one of two false beliefs – 1. that you are rich  due to your salary or 2. you are entitled to certain luxuries because you are a doctor.

Being “wealthy” is the ability to spend more money than you earn without incurring debt. Basically, if your investments and passive income allows you to purchase more than your salary, you are wealthy.  If you are able to afford your lifestyle without working, you are “financially independent”. If you can afford your lifestyle without working and can spend luxuriously on your dividend returns alone then you are “rich”. Almost certainly, if you are a typical early-career physician, you are “destitute”- You owe more in debt than you have in assets. Having “zero” in personal worth would be a tremendous step up from your current negative net worth and will take several years of hard work to achieve.

So, unless you are completely debt free, own your house outright, and have saving and investments that can support your lifestyle indefinitely, then you are not even remotely rich. Where does the money come from that you are spending, if you are not currently financially independent? You may answer, “Well, my salary of course.” You’d also be dead wrong.

The assets you spend today, while you are still in debt are not coming from your present salary- They are coming from your future self!  You are indebting yourself to work more years in the future to pay for your current spending.

You are sacrificing your future retirement, financial stability, and happiness by emphasizing work/life balance, luxury, time off, and spending today. For every dollar you spend today, with the compounded interest on that debt, you need to earn 3-4 times more money in the future to pay it off. This is not the type of sacrifice you want to make.

Several physician personal financial bloggers post about this topic in the blog-o-sphere so I won’t go into depth. However, the basic ideas are as follows- Live frugally, earn aggressively, pay down debt determinedly, and invest wisely. Soon, you’ll be debt free and on your way towards building enough invested assets to be achieve financial independence. The alternative is unthinkable– saddled with debt, living paycheck to paycheck, unable to slow down or retire due to a combination of divorces, luxury cars, vacations, and an inability to conquer debt in your early career. Imagine being 62 and facing that future? It’s modern indebted servitude.


Here are a few tips to help you with the financial sacrifices you’ll need to make to succeed-

  • Looking at someone else and trying to determine their financial status is like looking into a fun house mirror. What you see barely reflects reality. You may look at your colleagues and see the new Condo and leased Mercedes. What you don’t see is the $450,000 in medical student debt and the inability to save a single dollar in their 401k. Ignore the financial appearance of others and any peer pressure to “keep up appearances.”

  • Calculate the actual cost of purchases. The typical doctor works 60 hours/week. Although most of us work far more than that. Take a look at your taxes from last year and determine your actual take home pay- after taxes, benefits, and tax-deferred investment. Then subtract non-negotiable spending like mortgage, student loan service, gas, life insurance and internet. That left over amount is your discretionary income. Divide your discretionary income by the number of hours you work annually- 3120 if 60hr./week. That’s your hourly discretionary income return.
    • For example, you earn $200,000 annually. You gross $157,000 when you take out your 401k, 457b, and traditional IRA. Then you subtract $10,400 for benefits leaving $147,300. You pay taxes in the 28% bracket + 3% state tax leaving $102,874. Then your mortgage, student loans, and utilities eat another 5000/month, leaving $42,874. You divide $42,874/3,120 hours worked annually= $13.74! That’s the spending money you earn every hour you work. Depressing right? No wonder your Dad votes Republican!
    • Now, when you go to buy something consider it in terms of hours you need to work to pay it off. Is that $270 dinner worth 19 hours of work? How about the $75,000 Mercedes vs the used Camry at $24,000? That’s an extra 3,711 hours of work or entire year of labor! Not including the interest you lose borrowing to buy the car, or the compounded dividends you could make investing that money instead. Would you really trade a year or more of labor to drive one car over another? Add a few cars, a few houses, a few luxury vacations, and college for your kids. You’ll be lucky to retire at 96!
  • “Work/Life balance” is for rich people. Sorry to be the one to break it to you, but you don’t have a work/ life balance option. You have a debt/future poverty issue. And the solution is to earn aggressively and pay off your looming debt now before you are buried in the avalanche of compounding interest.

You have a personal responsibility to become financially independent so you may practice your profession without conflict, burnout, or distraction.

You have to “give up” to “go up”. Learn to make the sacrifices you need to succeed, both professionally and from a monetary standpoint. Personally, I never felt a sense of loss hiking and camping with my family instead of flying first class to Paris. Over time, I just learned to appreciate the simpler things- like the peace of mind of financial stability. The stress relief of paying off my student loans in less than 5 years more than made up for anything I may have missed by luxury spending.  Soon, you’ll find your debts paid off, your wealth increasing, and your financial independence a source of freedom and strength. With sacrifice and hard work you be able to succeed… really succeed.

Bonus Hint: The easiest to reach financial independence is to earn more income. And the best way to improve your compensation package is to negotiate a better deal! Get a high quality market value report, develop a solid negotiation strategy, determine your anchor number, up your skills set, and consider a CME approved negotiation and professional skills seminar developed for physicians.

What do you think? Do you dream of an early retirement? Do you long for the day you can tell your boss to take this job and shove it? Or, do you think I’m crazy for living a modest upper middle class lifestyle and saving instead of partying like a rock star? Share your thoughts in the comment section




If You Want to Go Up (Part One)- You’ll Need to Get Up.

“Let him who would move the world first move himself” -Socrates

Author: Robert A Felberg MD

Topics: Physician leadership, Career Advancement, Office Politics

Keywords: Doctor opportunities, effective time management skills for doctors, advancement for a doctor

“1. You have get up to go up.      2. You have to give up to go up.      3. You have to grow up to go up.”

John Maxwell

John Maxwell is one of the best resources available for anyone interested in self-improvement and leadership. It’s amazing how little his work has percolated through the medical field where it could be well applied. I have listened to nearly every audiobook he has put out and have found each one to be valuable. There is no financial relationship between us. I’ve never met the man- I’m just an admirer of his work.

[Editor’s Note: There are many great doctors out there. Unfortunately, being a superb clinical does not equate into superb leadership. Physician leadership is a topic that is often overlooked in training and the lack of this professional skillset is a cause of many of modern medicine’s troubles. This post in one of a series from physician advocates LLC, advocatesmd.com and medical success central exploring the vital skill of physician leadership. Please sign up for the newsletter to be kept up to date.]

In “The 21 Irrefutable Laws of Leadership”, Maxwell laid out some of the simplest advice I have ever read about “making it to the top” or “going up”. This involves Initiative– “getting up”, Sacrifice– “giving up”, and Maturity– “growing up”. Although it’s been several years since I first read that book, this has always stuck with me as powerful advice. There’s not much I could add other than a leader needs be able to be Vulnerable– “You have to open up to go up.”

I’m going to explore each of these concepts- Initiative, Sacrifice, Maturity, and Vulnerability as it related to medical leadership and success. In this post I going to discuss Initiative. In future posts, I’ll review Sacrifice, Maturity, and Vulnerability as it relates to medical leadership.  After reading the series, please consider an honest assessment of your personality traits. There is a great amount of information and mentorship available, but first you need to “know yourself” before you can really benefit.

Initiative amongst physician really takes two forms, Energy and Innovation. I will focus on Energy for the rest of this post.  Energy is one of the “4 E’s and one P” of leadership often discussed by Jack Welch. To succeed and move forward, you need to be energetic- you need to have a high level of enthusiasm, stamina, and personal fortitude. You also need to avoid the opposite of “energetic”, i.e.; laziness, apathy, and a tendency to shirk work and responsibility.

Energy as it relates to medical leadership has a few characteristics. The first is embracing challenges and accepting the work that needs to be done. When your business partner calls in sick do you spend 40 minutes whining to whoever will listen about the unfairness of it all? Do you internally seethe in anger at the injustice? Or do you quickly get over the change in plans and rally your team to get the work done? Although, you may feel like acting the first way, the second course of action is clearly the role of a leader and will lead to personal success.

“Action creates opportunity”- Unattributed

A bias towards action characterizes energetic people. When given two choices, they will choose the one that leads to increased value and mutual benefit over the one that defends the current status quo. They are willing to take the risk to grow the business over protective policies designed to just hang on to a shrinking share.

Another, often overlooked characteristic of Initiative is personal fortitude or “grit”. This is the quality that leads to perseverance and an optimistic outlook when faced with adversity. It’s my belief that this personality trait is learned through experience. How else is it possible for a doctor to learn to cover a 36 hour shift or see 27 patients in a day? Clearly, it’s not something you can do the first day of internship. You slowly gain the experience and confidence facing continued challenge and triumphing over it. This leads to a personal sense of accomplishment and a reservoir of fortitude. Your dad was right- mowing the lawn in the rain does build character.

Many physicians lack personal energy for many different causes. The most common manifestations are laziness and shirking of responsibility. Often physicians express the combination of sarcasm, insult, and blaming best defined as “snarky”- a defensive mechanism consisting of low-level attacks with the hope that the requesting person avoid the unpleasantness in the future. It’s sort of the personality equivalent of porcupine quills.

All of these low energy traits have one attribute in common- they are geared towards short term benefit. They all trade immediate gain against long-term relationship, future program development, or care delivery improvement. Leadership is primarily focused on the future, often at the cost of the immediate. It’s easy to see why low-energy physicians are considered to have poor advancement and leadership potential.

Here are some tips to help you “Go up by Getting Up”:

  • “I wasted time and now doth time waste me.”- Shakespeare. Learn the difference between “restorative rest” and “dawdling”. I love surfing the net and posting cat pictures to facebook as much as everyone else. But, I do those activities after I get my important work done. At the same time, learn to take useful breaks during the day- whether that involves meditation, pleasure reading, or contemplative walking.
  • Pomodoro is more than fancy talk for tomato. It’s amazing how much you can accomplish if you just focus. The Pomodoro technique leverages this idea. You set aside 25 minutes of uninterrupted, highly-focused work. Then you do it. Then you take a short break and do it again. After a while, your task is done, but it’s done so much more quickly than you ever imagined possible. As a neurologist, I could lecture for several hours about how this method ideally harmonizes brain function and neurotransmitter regeneration, but suffice it to say- it works and is the “secret sauce” to my success (tomato pun intended).
  • “As a man thinketh in his heart, so is he”- Proverbs 23:7. Much can be said about how your inner thoughts influence your life. Try to pay attention to your “inner dialogue”. If your thoughts turn negative or start to move towards the “snarky” beliefs mentioned above, try to get a handle on them. Change your inner dialogue to one of action, teamwork, success, and triumph. This may take practice, but will lead to solid personal fortitude. Consider “As a Man Thinketh” by James Allen. Be aware that J. Allen was a man of his times and several of his characterizations would be considered outdated by modern criteria. Nonetheless, it’s an excellent read.
  • Develop an Internal Locus of Control. People with an external locus of control believe that they have very little power over what happens to them and that external forces- the hospital, the government, fate, luck, karma, vast hidden conspiracies- have ultimate control over their lives. Those with an internal locus believe that, although unable to regulate every circumstance, they have considerable influence over the events in their life. Work to achieve an internal locus of control. This will give you a sense of leverage when facing difficult times and the motivation that will give you the energy to achieve.
  • Dedication trumps motivation every time. We all have passions. Many of us attempt to turn these passions into businesses or careers. Yet, despite being passionate, many of us fail. Not because the idea is poor, but rather we lack the energy to follow through. The reason is that passion relies on motivation and motivation is an uphill battle. You are fighting entropy, laziness, and 2 million years of human evolution trying to convince yourself to do something out of love when there are other activities that lead to actual gains.

Rely on dedication instead.  This blog is a great example –   I am tremendously passionate about teaching and helping the next generation of doctors succeed.  But, when I first started, I could barely convince myself to complete one post monthly. Finally, I stopped treating the blog like a hobby and approached it like a business. I set a goal of 4 blog posts weekly. Now I rely on dedication rather than waiting for the proper mood to strike with much better results.


Initiative is one of the personality traits that characterize successful physicians. By embracing change, challenges, and action you will quickly become a physician leader.  Like all physician professional and medical business skills, changing your approach to obstacles and building personal fortitude can be difficult at first and is something you can master with practice and experience.  Having a solid skillset will give you the tools you need to implement the changes you desire.  Up your skillset and consider taking a CME approved course designed for physicians. Through study, practice, and hard work you’ll be able to achieve your dreams and succeed… really succeed.

What do you think? Is there a formula to physician success? Do you have any advice? How have you overcome procrastination? Share your thoughts in the comment section below.