Money, Time, Expense Reimbursements - HealthRex/CDSS GitHub Wiki

Personal Finance Primer (How to Make You a Millionaire)

  • Did you realize you have a second job that you are likely completely untrained for and making many common mistakes in? (Finance / Pension Manager)
  • How much does that fancy car or other luxury item really cost you? (Opportunity Cost)
  • Start saving at 25 vs. saving MORE at 35? (Unintuitive Exponential Growth)
  • Pay down debt or invest? Or both? (Math vs. Human Behavior - Asset Allocation vs. Leverage)
  • How will you react when your home and investments lose half of their value? (e.g., 2008-2009 financial crash) (Risk Tolerance)
  • How much total compensation are you getting from a job vs. your salary? How much do you take home vs. goes to taxes? (Mental Accounting / Compartmentalization - Tax Optimization)
  • Roth IRA vs. 401k/403b vs. regular (taxable) investment accounts? (Tax Preferred Accounts)

Workshop Presentation

Building Net Worth and Cash Flow (Real Life Report Card)

Most people live paycheck-to-paycheck, just trying to cover their monthly payments (cash flow). This is important to know where your money is going, but you also need to track your net worth every year. Though many of us like getting straight A's and padding our CV/Resume, banks won't care when you're applying for a mortgage/loan. They'll want to see your "real life report card" (e.g., debt-to-income ratio, credit score, net worth balance sheet).

Many of you are likely broke, with a negative net worth having more (student loan) debt than assets. This makes you poorer than a penniless homeless person living under a bridge. Compounding interest means time has an exponential impact. The sooner you can claw out of high interest debt and instead start investing, money starts working for you instead of against you, even while you sleep.

To achieve financial independence / retire, you need your passive investment income/growth to cover your expenses. A common heuristic is that you can safely withdraw ~4% of your retirement/investment savings per year. To achieve this in ~25 years, do not incur anymore debt and commit 20-25% of your gross income towards building your net worth.

Home mortgage, business, and education loans can be reasonable exceptions for incurring debt towards something that produces more value over time, while credit cards and car loans are not. https://www.whitecoatinvestor.com/how-to-think-about-debt/

Savings and Investing Prioritization Steps

Building your net worth can mean paying down debt, saving cash, or investing. If you're not sure which one to do next, these frameworks offer some simple and reasonable guidance. Though ultimately it's the total amount of margin that you put towards any of these steps that matters more.

  1. Emergency Fund (3-6 months living expenses in cash / savings)
  2. Employer Match (free money)
  3. High-Interest Debt (>6% Interest)
  4. Roth IRA / Tax-Advantaged (e.g., 401k/403b) Investing
  5. Regular Taxable Brokerage/Investing
  6. Low-Interest Dept Optimization

Broader FAQ

A broader FAQ intended for physicians, but applicable to any who will end up with a high income job after years of training. https://www.whitecoatinvestor.com/faq-frequently-asked-questions/

Covers a good range of other questions such as...

  • Should you buy disability insurance?
    • Probably once you have an income, since most of you reading this will have most of your wealth coming from your future income. How would you care for yourself if you suddenly became disabled in a terrible car accident?
    • Rule of thumb: Buying insurance is a money losing proposition (it has to be for insurance companies to stay in business), so DON'T buy extended warranties on computers and appliances that are replaceable. Instead, buy insurance when the potential cost of loss could be catastrophic and bankrupt you (e.g., health and liability insurance).
  • Should you buy (term) life insurance?
    • Yes, once you have someone whose life depends on your income (i.e., children).
    • While you're at it, setup a Living Trust and Will, which avoids a lot of red-tape to take care of your heirs/successors if you were to unexpectedly die in a global pandemic.
    • Note that your employer provided insurance does NOT really count. It likely covers way too little, and you'll lose it if you ever leave your job, which is exactly what would happen if you got sick.
    • Note the distinction between cheap term life insurance is what you want, and not expensive whole life insurance which looks like an investment but not worth it when you can just invest yourself without the extra fees.
  • What should I invest in?
    • If you have no idea as a trainee, at least just max out your Roth IRA every year and buy a low expense ratio total stock market index fund or target date retirement fund and forget about it. You can revisit and get fancier once you're out of training and earning more income to think about, but getting fancier is actually LESS likely to yield a better result. https://youtu.be/mW0HdLFXhRQ
  • What are common mistakes people make?
    • Lifestyle inflation, Trying to pick individual stocks, Waiting to "learn more" before investing, Panic selling during downturns, Overbuying house/car early
  • Should I buy a house?

    • As a trainee, almost certainly not. Even after you graduate and starting getting your first big paychecks, probably not immediately. There's enough likelihood you will move or change jobs shortly after starting your first one such that you should be sure you're going to stay in one place for many years before buying (otherwise you'll lose too much to the transaction costs of buying and selling property). Note that this doesn't mean you can't live in a house. Just means you may be better off renting frugally first. But you're just throwing away money on rent? True, but you also throw away money on transaction costs, property tax, mortgage interest, repairs/maintenance and opportunity cost of capital when you own. The money you save on those things could be invested elsewhere instead of your home.

      Sensational but pointed commentary on why the house you live in is more of a consumption item that you're deciding to spend money on, and not a value generating asset/investment. https://youtu.be/-KhBRpKCfvQ?si=wRsb3QDnP8XCYB1e

      Analytical breakdown to weigh whether buying or renting makes more sense. https://youtu.be/Uwl3-jBNEd4?si=DBeNrSFt2z3_5kRp

The above is all pretty simple and mundane, and completely NOT a get-rich-quick, Silicon Valley approach to land millions of dollars from venture capitalists to build a business and cash out after a billion dollar valuation. Having an entrepreneurial spirit to translate your research discoveries into practical businesses can be a great high variance outlet. Nonetheless, the simple (but not necessarily easy) approach above is perfectly effective and entirely likely to result in you becoming a millionaire by your 40s.

Building wealth is surprisingly simple (you've learned much harder things in your primary studies), but that doesn't make it easy. (Losing weight is also simple, but extremely hard, as it's driven more by our human behaviors.) Building wealth requires income, a plan and systems. Even better to have automated "pay yourself first" systems to avoid decision fatigue and behavioral errors (that's why 401k/403b paycheck contributions and paying down mortgage debt into equity are such reliable methods).

Time vs. Money

Particularly for clinical fellows, beware that your time is now much more valuable than money. Don't grind away on admin tasks that can be delegated. Feel free to buy software, tools, etc. if they make your work more effective and efficient. Rough rule-of-thumb: if we can pay $100 to get back an hour of your time to do more work that only you can do, it's worth it. Try working through this online survey to assess what your time is worth. Grad students, maybe don't do this, as it will be too depressing. I still value your time though!

FYI: All of the above should be considered for educational entertainment purposes. I am not a financial advisor, accountant, or lawyer, so always make decisions for your own individual situation.

Being Paid for Speaking/Presentations

Not an expectation for anyone, but a natural part of an academic job is to communicate your results and teach others about complex topics. If you do this well enough, eventually organizers may offer to pay you to present at conferences and other venues.

I haven't fully organized my thoughts on this topic, but below is adapted from some notes I shared with current/former fellows who were navigating this and trying to figure out how much to charge once they started getting invited for talks as fellows/junior faculty.

  • For academic conferences, won't get paid so much, but can reasonably expect 4 figures + travel.
  • For medical school / hospital grand rounds / education type programs, I've usually been offered $600-$1,000 without even asking.
  • If it's some place local that I can drive to, I'm happy enough with $1,000, and I'll often do for free if it's virtual or easy to get to and back and for some non profit purpose.
  • If it's a for-profit company then should easily be multiple thousands depending on setting.
  • I was once offered $6k by Adobe to give a talk, but I blew it because had a schedule conflict.
  • I've been paid $3k for guest talk at a medical retreat + resort. Given how quickly they agreed, I probably underbid.
  • For a private hospital group in SoCal, they invited me and said their speaker budget was $5k. I said I would take it and even deal with travel myself. - They were so happy with the result that they invited me back to do it again for another $5k.
  • I had a goal to get paid five figures for my AI in Medicine talk. A speaker agency contacted me in 2024 and did offer $12k for some company convention, but I got greedy, asked for $15k, and they ghosted me.
  • Another corporate company hosting a summit saw our research featured in NY times and agreed to $15k just in 2025. After the session, the organizers were very happy with the result and told me I was undercharging.

If you look at some speaker bureaus, it's not totally crazy. There are people who charge $50k to $100k+. https://speakabout.ai/speakers

You don't have to produce a dedicated landing page to describe services you offer, but having sample videos online is critical for prospective organizers to decide whether or not you would be a good match to hire. (When I organize conferences and symposia and consider guest speakers, I very explicitly look for any online video of them presenting to make sure they won't be a dud that will be boring or tedious to listen to.) https://www.healthrexlab.com/request-speaker

I got invited by a medical society for special lecture after they heard about my well honed presentation (and saw my recordings on YouTube to confirm that it would be a good session). They said default budget was $1,500+ travel. I said if they could make it $5k I would go, if not, I would recommend other names. They came up with the money, so I flew out.

Another colleague invited me to present and chair a conference session out of state. They offered registration and travel expenses, but at this point, I've largely decided I won't travel without additional fee (takes too much work time otherwise).

I'm making these heuristics up, but some minimums I now look for as of 2025. Note that these are for myself. The standards would be completely different for a trainee (where getting paid at all, hundreds to thousands is a great place to start).

  • Local stuff: Free to $1k fine, depending on audience
  • Fly somewhere same day, $2-3k
  • Fly somewhere and need to spend a night, $5k
  • Fly across country and need to spend 2+ nights, $10k+. (I also consider other value, such as when I presented at HIMSS a few years ago to get more visibility and a video recording that I use to propagate further to groups likely interested. It was also in Orlando, and thought I could use it as an excuse to go to Disney World with family. Turns out they couldn't make it, so didn't work quite as well as I had hoped.)

For for-profit companies, I would ask for double or triple or more if they want additional customization or prep work. The above minimums are assuming I can walk in with one of my well-honed talks in the can, ready to deploy. Producing a new talk, session, or workshop is a substantial effort. Easily 10-20+ hours to prepare a new 1 hour session. I use $500+/hr as a benchmark for something being worth extra consulting time. From their perspective, if you deliver a high-value session for 100 people, the "ticket price" per person is still easily worth it for large groups.

At this point, I'm pricing at a level so that some people will say no. I've been doing so many talks such that the travel has been too exhausting and impeding regular work. Early on, price may be less important than getting booked to gain the experience to refine your product (presentation). As long you're being paid more than you've ever gotten before, just take it and set a new bar for yourself. Do such a great job that it triggers others to invite you to the next thing. (Assuming you even like public speaking.)

If they won't name first price, I'll throw out one based on the above structures. But I've learned not to negotiate back and forth once I've hit my acceptance threshold (people will just get annoyed having to haggle, and drop you in favor of someone easier to work with).

The "Referrable Speaker" is a practical book if you are interested in developing this. Not about flashy marketing. It's about creating one particularly strong and valuable workshop/presentation. What you want is each time you do it, it's SO good that 2+ people in the audience refer/book you for the next thing, triggering a snowball that grows as big as you want it to https://www.akadrewdavis.com/product/the-referable-speaker-andrew-davis-michael-port

I often don't charge for Stanford affiliated events (including my magic shows). Stanford entities usually can't pay me extra anyway, as it would be considered part of my job as a faculty member. Depends on setting and prep needed.

If you consider education (both to students and to society) as part of a professional mission, then the goal is not to maximize income. It is instead to make deliberate choices about how to allocate the scarce and valuable resource of your time and expertise.

Resources and Reimbursement

Laptop

You'll need a Stanford-encrypted device to work with patient data. Minimum spec recs (2024):

  • 16GB+ RAM
  • 512GB+ SSD

To order a new device:

  1. Get authorization from Dr. Chen.
  2. Just pick something from an (online) store and have admin staff purchase for you. There are internal IRT request methods (linked below), but they have often been a disaster with dropped messages and lack of follow through. The flip side is that you will have to take care of the initial software, encryption, and network compliance setup that IRT could do.

Other Purchases

For other work-related purchases (e.g., extra monitor for desk, office chair, software licenses, etc.), probably easiest to just find the thing you want on the web and email the link to the admin staff to purchase for you. This way you won't have to incur a credit card charge and be stuck waiting potentially months to get reimbursed. Just CC me on the request so I can confirm the appropriate charge account, and make sure the items are delivered to the office (not home) to make it clear they are business (not personal) expenses.

Heuristics to consider on whether you should spend money on something research-related:

  • $100, just do it, you don’t even really need to ask me
  • $1,000, let me know, but should be very doable if it’s related to our work.
  • $10,000, we could do it, but need to talk about it to plan how to make it work.
  • $100,000, we can’t do it unless we get a grant or other funding for it.

It costs ~$100,000 per research paper that comes out (mostly people's salaries/stipends). With that perspective, you can see why spending another $1,000 to enable a good study is easily justifiable. Still confirm with admins if planning an expense. If you don't document it in the right way (e.g., put it on someone else's credit card or a gift card or on your personal email or home address), you will get hassled (and maybe blocked) in the reimbursement processes after the fact.

For online services (e.g., ChatGPT, Claude Code, PaperPile, etc.), recommend setting lab/group accounts and just get yourself added as a user/member. Allows for consolidation of reimbursement paperwork (otherwise you'll have to haggle with admin processes over $30 bills).

Stanford Medicine Box

For undergraduates or those with previous Stanford University Box accounts, you will need to convert to a Stanford Medicine Box. To do so, opt-in to Stanford Medicine Box via this form here: http://med.stanford.edu/box/opt-in.html

Conferences / Travel

If you want to attend a conference, the lab will generally cover expenses if you lead a first author paper or oral presentation accepted at the conference (or have "credit" from a recent first author paper published in a journal). If you get a paper accepted at a conference, you're also in a very strong position to find a (student) travel award to cover expenses.

Stanford policy is that any travel expenses (airfare, hotel) have to be booked through internal systems (you're not supposed to just book a hotel online yourself).

  1. Before your trip/conference, have our admin support book the travel for you and potentially fill out the following form: https://web.stanford.edu/group/fms/fingate/docs/certification_student.pdf

  2. Keep a receipt of all expenses

  3. After your trip/conference, email our admin support (see group website) and copy Jonathan with line items and a total expense to be reimbursed.

If you end up staying longer than the conference dates on travel for personal reasons, be sure to coordinate with admin team up front, as it will limit what flights and nights you can be reimbursed for. They need to capture flight comps for the travel plans:

Flight comps should be:

• Leaving the day before the conference starts

• Directly from the Bay Area to the conference location

• Leaving the day the conference ends (if not possible to leave that evening, show why)

• Directly back to the Bay Area

Publication Expenses

If you get a paper accepted for publication with an option for Open Access, generally okay and better for us to just pay for Open Access (increases accessibility and citations) in the vain of open science practices.