There’s a pretty well known book called “Die with Zero” by Bill Perkins, which suggests that the best thing to do with money is to spend it all while we’re alive. I read a lot of texts on personal finance, so I had to pick this one up. The premise was compelling, but I couldn’t help but wonder: Does this apply to doctors?

The main point of “Die with Zero” is that the goal of life is to maximize your experiences and accumulate as many subjective and individualized “life experience points” as possible. In doing this, your goal should be to die with $0 to your name. Any money that you leave over is money wasted that was not used to maximize life experience points.

Notably, dying with zero is not mutually exclusive from helping others with your money, like providing for your kids or donating to charities. Instead of waiting until you die, Perkins says, give your money to those you want to help now, when they can use it the most.

This approach requires finding a balance between using your life energy to make money versus using your life energy to gain life experience points. Most people are saving too much for the future due to an irrational fear of living beyond their savings, especially when they are young. But Perkins argues that when you are young, you should take bolder risks because you have more time to rebound.

So, should doctors die with zero? Reading the book, and even summarizing it now, I don’t flat out disagree with any of the points above. But still something just felt not quite right to me. And when I look at the list of basic tenets above, I really don’t have too much of a problem with the idea of maximizing life experiences. But the idea of choosing spending over saving bothers me a bit. Especially when I apply this idea to physicians.

It seems to me that physicians are not saving nearly enough for the future: Data show that almost 40% of doctors between the ages of 50-55 have a net worth of less than $1 million, and only 11% of doctors in that age range have a net worth of $5 million or greater. Sure, $5 million sounds like a lot. But remember the 4% withdrawal rule. That comes down to a retirement “income” of $200,000 before taxes annually. The majority of doctors I speak to in this age range want more retirement income than that. They also want to retire soon. Therein lies the problem.

Now, why is the average doctor in this position of lower-than-expected net worth? It’s because of two things: spending too much, and saving too little.

Remember, the average physician salary is greater than $200,000. If you can’t save enough for your nest egg with that salary, then you have a saving problem, not an income problem. 

(And yes, I know that it seems like that’s easy for me to say as a plastic surgeon at the higher end of the physician income spectrum. And it is easier with more income. But the average is more than enough. Just ask any non-physician.)

Add this inept average saving by physicians to the delayed gratification of training, and I fear the call for doctors to “die with zero” becomes irresponsible.

Perkins also says that young people should be taking more risk. His point is that there is disproportionate risk when making big decisions for young people — but instead of choosing life experience, they often magnify the worst case scenario and avoid taking the risk, to their overall detriment. 

He uses the example of someone who wants to become an actor but is working a boring but stable office job. If that person is 20, it makes sense to go for it! There are plenty of boring office jobs to choose from if acting doesn’t work out. Plus you have no one depending on you. But if you are 50 years old with a family, the risks are greater and it would not add up to take that chance.

Point well taken. But does this rule apply to doctors?

When most future doctors are starting medical school, they are around age 21 (assuming a straight course through college and no time off … which is not always the case).

At that young age, medical students take out hundreds of thousands of dollars of unsecured debt with no income and no prospect of substantial income for a minimum of seven years, often more.

Over those 7-10 years, we go through rigorous education, competitive selection processes, and burnout-inducing hours. If we falter at any point along the course or decide medicine is not for us, our future income suffers. But our debt remains. 

This all demonstrates that future doctors take a HUGE risk when we are younger. And I would argue that the risk is even bigger than the ones that Perkins talks about in his book.

So, should doctors die with zero? Ultimately, no. The majority of doctors are at much greater risk of reaching zero way before they die (or working beyond when they want to in order to keep their nest egg from reaching zero).

So, the messaging needs to be administered carefully. And I think timing is the most important factor. If I had read Die With Zero when I was just starting my financial journey, it would not have been the message that I needed to receive. At that time, I was on track to end up as a burnt out, overspending, under-saving doctor. And this book may have given me the message that my delayed gratification was justified to almost any extreme — even if it was unintentional.

When I look back to my younger medical school and residency years, there was spending on experiences and things that brought me great joy. But there were just as many expenditures that did not bring me joy and were very ill-considered. Without understanding this key difference, it could be easy to misconstrue that all spending while younger is justified. But in reality, some mindfulness toward minimizing debt and saving is important for young doctors as well.

I have to admit that if I skew on one side or the other of the "die with zero" spectrum, it is probably on the conservative side. I grew up seeing money evaporate and our lives change very quickly, so it’s hard for me not to want to save as much as possible just in case — even when it looks excessive. For me, the value in the book is that it reminded me that money is only as good as the happiness it can bring you, your loved ones, and others in the world.

That means it’s okay to spend it! Wisely and intentionally of course. But only once you have enough saved and invested to reach your financial goals and to protect yourself from a financial disaster.

Do you think doctors should die with zero? Share your reasoning in the comments!

Jordan Frey, MD is a plastic surgeon in Buffalo, NY at Erie County Medical Center and the University of Buffalo. His clinical focus is on breast reconstruction and complex microsurgery. He is also the founder of The Prudent Plastic Surgeon, one of the fastest growing finance blogs. There, he shares his journey to financial well-being with a goal of helping all physicians reach financial freedom, practicing on their own terms.

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