Six Pills or Six Accounts: What Managing Heart Failure Taught Me About Investing
Key Points:
- Optimization vs. reality: Just as with heart failure care, evidence-based investment plans are often derailed by real-world barriers.
- Sustainability beats perfection: A simpler, “good enough” plan that’s actually followed will always outperform a perfectly optimized strategy that gets abandoned.
- No shame: Whether you value optimization or simplicity, you deserve an investment plan tailored to your real-life priorities and goals.
Managing chronic heart failure with reduced ejection fraction is part of my bread and butter. In a perfect world, all my patients are on the 4 evidence-based “pillars” of heart failure therapy – medications that have unequivocally been shown to dramatically alter the natural history of the disease, prevent hospitalizations, and help people live longer, symptom-free lives.
Sometimes that happens – I have patients who embrace the challenge, checking their blood pressure twice daily with 100% adherence to their medications, calmly dealing with the expected side effects, following with me regularly as we titrate doses to evidence-based goals, and we celebrate the improvement in their heart function and quality of life months later.
Far more often, my patients end up on sub-optimal regimens. One of the pillars may be an unaffordable Tier 3 drug, and they don’t qualify for manufacturer copay coupons/patient assistance programs. Or they can’t handle the complexity of managing six pills a day for heart failure alone. Or they lose their prescription drug coverage and end up hospitalized with acute decompensated heart failure after a month of non-adherence.
If you care for patients in the U.S., you understand this reality of implementation failure. The question is how you deal with it. Do you beat yourself up for failing your mission? Do you blame your patients? Do you focus on the patients who are able to help themselves and give up on the patients who can’t? Or can you find peace in doing whatever you can to meet patients where they are, even though you know it won’t achieve the best outcomes?
In financial planning, there is a similar implementation challenge for investing (with thankfully far lower stakes). Like physicians, great planners will try to steer clients toward evidence-based strategies. We use tools such as asset allocation, tax-optimized asset location, historical investment returns, and personal assessment of risk tolerance/capacity to create an optimal investment plan.
Like a heart failure regimen, this optimal plan can work wonders but often becomes unwieldy and intimidating for even a sophisticated physician investor. Instead of having six pills, you now juggle six different account types or investments. Instead of prior authorizations, you might have to deal with account maintenance/tax forms each year that take valuable time from more important things in life. While planners strive to optimize return on investment, an investor might struggle with the increased complexity and hassle of an optimized investment portfolio and abandon the plan when things get tough.
My philosophy to both heart failure and investing – I will always shoot for optimal regimens whenever possible for both my heart failure patients and my financial planning clients. But when reality limits optimization, the “good enough” plan that is sustainable will ALWAYS lead to better outcomes than the perfect plan that is abandoned. I will never shame a patient or client for imperfection. And I will always prioritize the “goals of care” discussions to ensure we never forget what all this is for.
So where do you fall on the spectrum? Are you a physician investor who embraces the challenge of optimizing for a goal that excites you? Or are you a physician who wants a more simple plan so you can focus on more important things in life? Either way, I can help you create a sustainable financial plan to help you achieve your goals – just like we do for our patients. Get started here.
Stanley Liu, MD, FACC is the Founder and Principal Financial Planner of DocEmpowered, LLC. He is also an independent practicing cardiologist, an award-winning medical educator, and the 2024-26 Advocacy Chair of Maryland’s American College of Cardiology Chapter.
Do you want the power to serve your patients, family, and community on your own terms? If you need an evidence-based financial plan to help make that power a reality, book a free discovery call here.
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