I was doing a procedure on a child last night, and the mother said to her son: “I want you to be a doctor, make lots of money and buy me a house.”

Of course, it was 11 p.m. on a Friday night, and I was making my riches doing a procedure on an anxious four-year-old in the emergency department.

Doctors make a good income after they finish 25 years of education and training and accruing some variable amount of debt and choosing a specialty with a variable amount of income, but there is another side to this mom’s wishes for her son.

Debt is a problem. College and medical school debt runs into the hundreds of thousands of dollars for many. Private universities costing 60k per year and medical school 80k per year, for many there is a lot to pay back. Doctors are trained to be comfortable with debt being told they’ll “be able to pay it back.” Rich doctors have the good fortune of having family financial support — but for most, the debt cycle begins.

Career choice is a problem. Do you follow the money to a higher earning field or choose what you “want” to do or dreamed of doing as a child? This conundrum is faced by some who follow the money and become richer. Others may choose to ignore the financial reality and hold onto their passion. Easier to be a financially richer doctor if you choose higher-paying fields.

Financial growth is a problem. Doctors who care for patients and do the same care all get paid the same. So after your training, you take a job making 250k per year and feel rich. Standard financial advisers will tell you what you can afford in a house, cars, hobbies. etc. But beware, as advice is often based on salary growth or cost of living increases going forward.

What they don’t tell you in medical school is that all clinicians are reimbursed the same for the same care. Doctors in practice 35 years and those in the first year get paid virtually the same for seeing a patient and doing the same thing. (As an aside, this is overly simplified — as you get paid less to care for the poor, and you get paid more if you negotiate better or have a good lobbyist …) Essentially, your income will not grow as a clinician, and the government will continue to reduce physician reimbursement. Rich doctors understand this, and poor doctors don’t.

So how do you become a rich doctor?

1. Don’t overpay for college or medical school. High price “name” schools may look good on the resume, but they won’t automatically raise your MCAT score or get you into your dream residency program or impact your income down the road. Doctors who went to Harvard get paid the same to see a patient as everyone else.

2. Choose a career you love and not one you hate for more money. Longevity in medicine is very difficult, and the money won’t get you there, the love of what you do may. Talk to physicians in various fields over fifty years old. Are they doing what they trained for? Are they happy? Do they still enjoy patient care?

3. Buy your first home with no more than a 10 to 15-year mortgage and stay in that house. Your income won’t go up and your expenses will. This reality is what blindsides most physicians. Your income is fixed, but your kids are going to private school, college, getting married, etc. And you will make too much for “scholarships” and have to pay full fare. Think about how much you have to save for all these expenses and base in on your first paycheck. Kid’s college tuition alone bankrupts most physicians or requirements longer careers. Don’t forget about retirement either. You must put adequate funds away; there is no corporate pension plan remember.

4. Don’t become a workaholic to make up the difference. Sadly, the only way to make more money in medicine is to see more patients, work more and do that extra shift. If you are doing this to pay the bills, then it won’t work. Burnout, divorce, suicide, depression run rampant among physicians. Workaholism, also part of our medical training, may destroy or at least hinder your life. You will be on a dangerous path that many pursue unknowingly. You will also have strong reactions to the many hoops physicians now must jump through with the EMR, quality metrics and regulations that impede productivity without benefit to patient or physician. You see more patients and put yourself at greater risk for malpractice, which emotionally devastates any physician. By the way, you aren’t allowed to complain — you’re a rich doctor remember! Seriously, emotional support of empathy for physicians is virtually non-existent. You are a top earner; how can you complain or have concerns?

5. Don’t choose being an employed physician just because it’s “easier.” Employed physicians struggle with loss of autonomy, decision making and are often thrust into #4 for the good of the company and their own income. Of course, being employed is great for many physicians, but it’s because they understand #1-4. The other option is to own your practice and make your own schedule and better control your income while creating equity. If you don’t own your practice, develop a skill that will allow you balance in your work life: research, administration and/or corporate leadership roles are where many physicians turn to add value and longevity outside of direct patient care.

Being a physician is still a great career and gives one an opportunity to provide an income for your family while directly serving others. You see a reality and truth in your patients that most have no concept. Being rich is not only in the money that you will earn but in being able to balance your income and life to be a better doctor, parent, spouse, and advocate for your patients. However, the path is not easy, and don’t believe anyone who tells you it is or should be. By the way, if you are thinking of being a nurse practitioner or physician assistant or any health care provider, then all the same rules above apply.

I am not rich financially so please learn from my mistakes. It may save your life and make you happier no matter what specialty you have chosen.

Mick Connors is a pediatric emergency physician.

Image credit: Shutterstock.com