Pay it Forward!

Chris McNeil, MD

“Pay It Forward” was a movie released in 2000. It is also an act of kindness that took off during COVID season. People started paying for coffee for the person behind them in the Starbucks drive-thru. Heck, anytime you can earn a bit of karma, why not? What I wanted to discuss this month was paying it forward to your children and grandchildren.

 

Typically, when I talk to someone about “passing it along” to their future generations, the first discussion is about legacy planning, setting up a trust fund, and ensuring assets are passed along to the next generation in the most tax-efficient way. Many of our grandparents handed us a U.S. savings bond 50 years ago. While that was a kind gesture, typically, when we try to cash it in we find out that it was not even close to keeping up with inflation. What I think is more valuable to pass on to our children and grandchildren is a strategic education about responsibility, money, and investing. Sort of along the lines of the fishing proverb: if you give a person a fish, you feed them for a day; if you teach a person to fish, they will eat for a lifetime.

 

Here is a (noninclusive) list of things to consider discussing or implementing with your children and grandchildren should you wish to teach them to fish for themselves. You have to start somewhere.

 

Establish fiscal responsibility early. Make them contribute to your family’s life obligations. Clearly, when children are younger, this means house chores or cleaning. Rewards with an allowance are great, especially if you don’t encourage the lesson that every effort is rewarded with money. Make them use their earnings for childhood purchases, like the impulse aisle in front of the grocery store check-out. At least for my kids, the constant begging for stuff was only curtailed when they knew they needed to use their own money. This helps teach them, on a small level, how to value the time they put in to earn their allowance.

 

Establish traditional checking and savings accounts. If we want our kids to function in the real world, exposing them early to the ways of the world seems to make sense. This allows for a discussion of the magic of compound interest. I don’t know about you, but until recently, there was no magic in my savings account. Now that interest rates have risen, a return on cash in savings accounts is a good place to start teaching about investing.

Consider opening a Uniformed Transfer to Minors Account (UTMA). Once they are a little bit older, expose them to investing with baby steps. A UTMA account allows minors to receive gifts and allows the custodian of the account to manage and invest it until the minor is an adult. This can be an excellent tool to engage your kids in investing. When my wife and I first opened these accounts for our kids, we gave them each $500 for Christmas. We told them the catch was they had to pick a stock or investment and buy it in their new UTMA account. As they saw their accounts go up (or down—both good lessons) it created countless conversations about investing. They can follow the accounts on their smart devices. As their accounts have grown over the years, they now make their own contributions from their allowances and jobs and have an appreciation for how money can grow if invested properly.

Expose them to the real world. We all have debit cards or an Apple Pay equivalent and have to budget our money for life’s expenses. Encourage the kids to contribute, even if in small amounts, to future purchases. Teach them how to plan for expenses, transfer money from one account to another, and use their debit card for purchases. Even if you plan on paying them back for their debit card purchase of the hotdog at the after-school event, make them learn to use the card on their own.

Talk to your kids early about college and the costs of education. Even if your kids are lucky enough to have you pay for their college education, understanding the costs involved will give them an appreciation for their future education. If your kids will incur student loan debt, discussions of responsible decision-making (how much that pizza purchased with student loan money will cost 15 years from now in accrued interest) can go a long way.

Involve them in your adult discussions about money and debts routinely. This was by far the most impactful experience we imparted to our kids. We all develop our own individual psychology about money and debts. This is learned behavior that many of us picked up from the values our parents instilled in us. If you are like me, I grew up without financial resources and that led me to be very debt-averse and conservative toward investments. Most of us discuss with our partners what values we want to instill in our children and these typically involve ethics, education, and responsibility. Consider the financial values you want them to pick up from you. They will inevitably pick up something from how you live your life and how they hear you speak about money and finances. Your lead will be not only by discussion but by example. Consider involving them in your discussion about budgeting for life events, big purchases, job changes, college savings, rebalancing your retirement accounts, etc. You do not need to discuss the dollar amount if that is uncomfortable. Involving them in the broad concepts is the important part. And showing them an example goes a long way.

 

Sometimes I think children are too sheltered from the real world. Showing them the ropes doesn’t mean they need unfiltered reality. However, general guidance on financial topics can go a long way to ensuring they become the responsible and independent adults we all hope for. Pay it forward to your children and grandchildren by teaching them to fish.

 

Dr. Chris McNeil, the author of this article, is an emergency physician and former emergency medicine residency program director who transitioned his career to finance. He owns a registered investment advisory firm, VitalStone Financial, LLC, and specializes in financial planning for physicians.

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EDITOR’S MESSAGE

What this says to me, ultimately, is that perhaps the most important key to patient safety is having adequate amounts of trained physicians in proximity to real, sick patients. This is an idea so anachronistic it just might work.

Sadly, what I have learned in my travels doing locums is that generally, staffing companies and hospital administrations don’t really see this as a priority. Understaffed emergency departments are everywhere. And if they aren’t understaffed in the daytime, they often are at night when the sense of being overwhelmed feels vastly worse, and approaches hopelessness as the night drags on to day.

Somehow the shiny glitz of computer prompts and policies is far more alluring to those in power than the mundane reality that human doctors are the way to keep people safe. But systems press on and add new departments, new outpatient procedure labs, new imaging centers, and all the rest. I get it. Those shiny things generate cash.

Nevertheless, particularly at the front door of the hospital, the public face of the hospital, the emergency department, we need physicians. And sometimes, excess physicians so that people don’t have to wait to be seen by an already overstressed doctor caring for three critically ill patients. (Obviously we need more space for the huddle masses yearning to breathe, but that’s another topic altogether.)

If we really want to keep our patients safe we also need other species of physicians. We need the specialists who do the things we aren’t trained to do, and honestly shouldn’t be expected to do. Unless one practices in general guidance on financial topics can go a long way to ensuring they become the responsible and independent adults we all hope for. Pay it forward to your children and grandchildren by teaching them to fish. a large urban center, every day at work is a mystery of specialist availability. In my job we have no ophthalmology, no oral surgery, no neurology on site, and perhaps most terrifying of all in terms of urgency, many days and nights we have no urology.

The paradigm of simply transferring what we don’t have works only until nobody else has those things either. And suddenly safety goes right out the window.

As our volumes explode and our patients implode, there’s simply no better way to keep them from crossing the River Styx than for us to have enough people doing the job. No amount of pizza parties, award certificates, ice-cream sundaes in the cafeteria, or photo opportunities will make things better. And none of that will help those physicians who are stressed to the breaking point by trying to do a hard job saving dying patients. Especially while being pressed to improve their metrics while administration considers bare-bones staffing adequate without asking the opinion of those seeing the patients.

Most important, when our hospitals hold themselves out as havens of safety for the citizens of the community, they owe it to those patients (or customers if they prefer) to truly make things safer. Especially when they bill them to the point of financial hemorrhage.

The only fair thing to do, the only proper thing to do, is staff the places with enough human physicians with the training, experience, dedication, and passion to do the job right. And to do it laying eyes and hands on the people who need them.