Sunday, February 26, 2012

Greedy Evil lawyers?

So how much do lawyers really make? They HAVE to be rolling in dough . . .

The answer to that question is that it depends. Where you are living, what you do as a specialty, and who you work for make huge differences in what your earnings actually are and when you get the reward. (This cartoon comes up in images if your search for 'evil lawyers' on

First of all, with the recession, there are many more lawyers graduating from law school than jobs available, particularly in the private sector. If you are watching a Law and Order episode, the assistant to the assistant DA (the chick) potentially makes 60K and the (male) assistant DA makes around 75k. The DA, herself/himself, usually an elected/political position, often has a salary around 100K. The public defender, which is usually the job of a first year lawyer without other prospects or just really interested in helping society, is 35K-40K. Keep in mind that many of them have loans greater than Hubby JD's 90K since I paid for his living expenses.

Moving to the private sector in a big firm, starting salary is 90-100K (adjust upward by 20-40K in a large LA/Chicago/NY city).  However, the firms and companies that are hiring in that range are VERY few. Only the top 5% of law students at good name schools even have a chance at interviewing for those spots. A small to mid-sized firm might offer 50-60K as its starting salary. A few people get positions in companies as 'in house counsel,' but it is also very rare. In house counsels make 80K-100K, but have an advantage of a less stressful environment due to the differing methods of repayment.

Some people go into personal injury/divorce/family law. They often have a low base salary 30-40K and may or may not get bonuses based on judgments awarded.  It is very 'feast of famine' for those people and only a few individuals in the country make those million dollar verdicts. Most people are seeing 100 'slip and fall' cases to get a single $10,000 verdict.  (Of which the lawyer usually gets 1/3).  Did you think they were doing such classy advertising on phonebooks because they think it makes them look like pillars of the community?

Even if you do get the 100K job, almost all firms have something called a 'billable hour goal.' Each lawyer is expected to do 1800 to 2200 billable hours per year. Something is billable when it directly works on a client's case. Lunch is not billable, and there are 'norms' for certain tasks. If it takes a lawyer 7 hours to do a task that usually takes 5 hours, they get 2 billable hours cut off. Making your billable hours often puts you eligible for a bonus; failing to make billable hours will often make you eligible for being out of a job.

To calculate that: 1800 hours over 50 weeks (vacation, sick time) is 36 hours a week. 2200 hours over 50 weeks is 44 hours a week. Now add some time for lunch, commute, having a dentist appointment - many people work 10-12 hour days to get it done. If you end up working 11 hours a day for 50 weeks 5 days a week would be 2750 hours to get that 1800 billable hours. That would drop their 1800 billable hour salary from $55.5/hr to $36/hr. Lawyers who need the 2200 hours will work 6 days a week for the same salary.

Hubby JD is a first year associate and easily spends 45 hours a week at work. Also, he was gifted with a 40 hour long project that is non-billable so he has been working on the weekends to complete it. Hubby JD arrives at 6am and leaves at 6pm. He works all day long without taking lunch (he eats at his desk) and on a good day bills up to 9 hours. At my request, he brought work with him to my 48 hour labor, though he was too nervous to work on it - we watched 12 episodes of Animal Cops and House Hunters instead.

So the morale of the story is that a very few lawyers will make 100K starting out of the gate. Everyone else is going to eke by at much lower salaries. Even if you are making a good salary, you are still going to have to work extremely hard to maintain your job. The inappropriately huge salaries are few and far between and not the norm, though they make great news clips.

Tuesday, February 14, 2012

Feeding your infant: opportunity cost of breastfeeding

Finally posting this - sorry about the delay. Hopefully Child2 will be born any day now . . .
Scenario #7: Jane MD, pumping for 3.5 months, storing for 3.5 months, formula for 5 months
** I rented a hospital grade pump, purchase equipment directly from the hospital, and personally had  an extremely abundant supply of milk**
Pump rental (40x4 months): $160
4 month supply of disposable breast pads: $20
3 nursing bras $17 x 3 = $51
Storage bags 735 for 4410 oz: $147
Formula needed for 5 months: $430
Hours spent feeding the baby for 1 year: 490 + 595 = 1085
Total: $808 for 1085 hours of work

My child never latched, despite taking all the lactation classes, seeing four lactation consultants, and helping teach mothers to breastfeed myself. First my milk supply was too low for what the baby wanted, then when it came in, it flowed too fast for him to swallow. So I pumped every day for 20-30 minutes 6-8 times a day. I had the most supportive work environment at the hospital after my 6 week maternity leave- separate pump room with hospital pump, dedicated time, on call lactation consult, ample freezer/fridge space. My boss/colleagues not only encouraged me to pump, they expected it. I was able to pump daily for 3.5 months and store 3.5 months in my freezer. One thing . . .

I could not wait to stop!

Any article you read about breastfeeding always discusses that women are failing to meet the 'goals' of recommended duration (6 months in some places, greater than a year in other places) or percentage of women breastfeeding. There is alot of discussion about the wonders of breastfeeding, its bonding potential, how the children do better in school, get more affection and so forth. (Incidentally, almost all of those correlations except less illnesses shrink to insignificant amounts when corrected for race, education, and socioeconomic status)

Truthfully, the prenatal decision to breastfeed is the best predictor for actual breastfeeding. If you went through your pregnancy not planning on breastfeeding, it's unlikely that you will decide in the hospital - no matter how much information the hospital and lactation consultants give. Equally, the first five days are the times that determine 'successful' versus 'failed' breastfeeding. So if you make it past five days, why doesn't everyone make it that 6 months to a year?

One of the major theories is when women go back to work, they return to breastfeeding-unfriendly environments. Their employers do not give them privacy/space/time, and this affects their decision to end breastfeeding. While that certainly is true, I feel this does not acknowledge the other hidden cost of breastfeeding - loss of time. Pumping is time consuming, and ideally you need to do it at least twice in an eight hour day. For the average working mom, that would be your lunch break and your morning/afternoon fifteen minute breaks. Each time the woman has to go pump, she loses productivity and breaks up her day.

Wait! It's the mom's choice, you can't claim that she is losing productivity.
Imagine you take a personal phone call during work. You talk for 20 minutes and do not do any work. What if you do that three times a day? Do you give up all your breaks for the phone calls? Do you skip lunch meetings? Do you miss networking with your colleagues during lunch? Are you unavailable while you make these phone calls? Add in that you just were 'on vacation' for two months. Moms who are returning to work want to prove they are back in the saddle when nothing breaks up that feeling like needing to pump.

We'll assume your time is worth $6/hr for minimum wage after taxes. If you just pump twice a day at work, you are down 40 minutes five times a week. If you are pumping 7 times a day, consider it 2.3 hours of time or $14 of time in the day beyond usual feeding of the baby. Consider it the price of sleep/energy/other activities you could be doing. Now this is a minimum recognizing breastfeeding as unskilled labor. Put it in real dollars by your own salary - when your job is $20 per hour.

I personally felt a sense of resentment toward breastfeeding, even though I had every possible resource and no one told me about feeling this way. Why didn't anyone tell me breastfeeding would feel like a chore and I would feel my day was disrupted?  How professional can I feel attached to a milking machine 2-3 times a day? (My fellow physicians, who delivered that year, all shared the various frustrations, shame, and helplessness they felt often during their breastfeeding experience, so I know I was certainly not alone.)

Make no mistake, I fully support breastfeeding and will be doing it with every child. I just want to give a voice to this struggle working moms feel. A mom's time is VALUABLE and there is NOTHING WRONG with feeling a sense of loss over the time you are putting into breastfeeding.

Next up: Greedy evil rich lawyers . . . or not?

Thursday, February 9, 2012

Dangers of Cesarean Sections on the Today Show

Oh my G-d! I just saw this horrible horrible Today Show clip today about the 'unsafety of C-sections.' Yet everything they said about the study was WRONG and inaccurate.

Here is the situation: there was a large study that recorded all births in New York City from 1995 to 2003 and now people are analyzing the data. This data is presented in short form at national specialist meetings - called abstracts or posters - this week at the Annual Meeting of the Society for Maternal Fetal Medicine.

Out of 800 abstracts and posters, two of them have specifically made the news. Abstract #13 and Abstract #474 headed by Dr. Erika Werner from Johns Hopkins. You can go to the Society for Maternal Fetal Medicine meeting site at, click on the top option above the cowboy boots and then search 'Werner' or look in posters to find those poster/abstract numbers.

(In case you were wondering, there are also abstracts at the same meeting that says there is no difference in survival/complications from C-sections, and Dr. Werner's group published a paper in December 2011 using the same data on term children that suggested C-sections are PERFECTLY safe for term children and the forcep method might be superior in some cases.)

About the study, looking at the data, in preterm infants from single babies born at 25-34 weeks gestation, they compared the Apgar score at 5 minutes, the risk of brain hemorrhage, and the risk of respiratory distress syndrome between vaginal and c-section births. All of those things are VERY short term outcomes. (If the Apgar score is zero at 10 minutes, that is bad but it means very little otherwise.) They also excluded all of the babies with congenital abnormalities, birth weight below 500 grams, and need for vacuum or forceps. They used some statistical techniques to take into account ethnicity, diabetes, blood pressure, maternal education, insurance status, and pre-pregnancy weight.

So what did they find?
Csections and vaginal deliveries of these 'healthier' premature infants, small or normal size for gestational age (SGA/AGA), had somewhere between 1.7-2 times higher risk of respiratory distress syndrome. Apgar scores corrected to being the same, seizures, brain bleeds, and infection occurred at the same rates.

What does that mean?
It means that a premature 'healthy' premature child in their age range has a double risk of needing oxygen compared to a vaginal delivery of the statistically/demographically same child delivered vaginally. For example, if the risk of needing oxygen is normally 1%, it is 2% with a c-section. If it were 10%, it is somewhere between 17-20% of needing oxygen. I say 'needing oxygen' because that the most typical cause in a premature infant for getting diagnosed with 'respiratory distress.' Other things you might have heard of that require oxygen, transient tachypnea of the newborn, meconium aspiration, persistant pulmonary hypertension all are disorders of term infants which pretty much leaves respiratory distress and congentital abnormality as your other causes of oxygen requirement in a preterm infant.

Okay, so c-sections are dangerous, just like they said on the Today Show!
Actually, they left out a TON of information on what this means and then tried to talk about C-sections in general being bad for full term babies. Typical alarmist talk-show hosts. The study they are referring to addresses none of these things. It only looks at those babies very narrowly and only from viewing annonymous hospital records. Note that the author is from Johns Hopkins in Baltimore, not New York City. All of the information they used can be pulled from the electronic medical record of the delivery check-boxes. It has nothing about prenatal care or clinical situation that caused each C-section.

That is important? YES! Here is why -
C-section Scenario: The mom is 28 weeks pregnant, has a fever, and her water just broke. The baby on the monitor is showing bizarre patterns that may mean it is not getting enough blood/oxygen from mom. Every hour her water is broken this early, the risk of life-threatening infection for the mom and baby increases. The OB gives the mom a dose of steriods to mature the baby's lungs, puts the mom on antibiotics, gives some meds to hold off labor, and hopes the baby can wait 24-48 hours which you need for the steroids to take affect for the baby.

16 hours after the dose of steriods, the baby starts showing even more abnormal patterns on the monitor. Mom's heart rate and fever are up too. The OB knows the mom and baby are on the border of being deathly ill and has to make a decision. Labor has not started yet, so she can induce the mom and hope the baby will deliver in the next 2-3 hours. Of course, it could take 24 hours you cannot tell how long it will take. The OB has no control of exactly what point the baby passes from being someone that can be saved to someone that cannot. It could be 10 minutes, 3 hours, 12 hours. The baby has to survive the labor and delivery which will last an unknown time. The longer they wait, the higher chance the mom has of bleeding to death during delivery as her blood may not clot properly due to the infection, despite maximum antibiotics.

If the OB performs a C-section, she/he can get the baby out in the next 10 minutes. Jane MD will arrive with her delivery team and all the supplies to resucitate the infant. In fact, the OR has the best equipment for preterm delivery and even an emergency C-section has 5 minutes warning. That means Jane MD will have the life and lung saving surfactant in the OR during the delivery, which will make the baby's immature lungs be able to pass oxygen. The goal is to get the baby the surfactant before 10 minutes of life - most babies under 30 weeks will need to be intubated for respiratory support no matter what and require oxygen. If the baby got steroids and surfactant at the right times, the time on the ventilator with oxygen is often much shorter. (Did you notice that the 5 minute Apgar isn't concerning me at all?)

Vaginal delivery scenario: The mom is 28 weeks pregnant and her water just broke. The baby looks fine on monitor. The OB gives the mom steroids and antibiotics. The OB uses different drugs to prevent labor from starting a full 48 hours, but when the contractions start, they can't be stopped. The mom still doesn't have a fever and the baby looks good on monitor. It takes 4 hours of labor for the baby to be born. Jane MD is called in time and is able to give surfactant before 10 minutes of life and the baby does not spend a long time on the ventilator.

These two babies and moms were very similar, but the clinical situations were very different. The c-section scenario was much sicker. If the vaginal birth baby had started to look bad on the monitors, she would have had a c-section too. Obviously, some women will come with a 28 weeker and deliver immediately vaginally without antibiotics or steroids but those women are also often sicker and will often receive an immediate emergency c-section. The study didn't tell us if the c-section babies were more likely to have steroids, which prevent respiratory distress because the study did not examine that as an outcome.

Basically, it all comes down to clinical situation. C-sections can be done quickly and remove a baby that is in distress almost immediately. Vaginal birth is much less predictable, so C-sections are going to be favored for sicker, premature babies. Thus is is not surprising their oxygen needs/respiratory distress issues will be higher. The study is looking at the past without having any control of what decision was made or why it was made.

I am not saying that vaginal deliveries for preterm babies can never be safe. If the baby is stable, they are very safe. If the mom or baby is not stable, it is important to be in as control as possible of the situation and get the baby out ASAP. Would you want to have a conversation with your doctor like this, "You/Your baby is showing bad signs of illness, let's just wait a few hours to see if you can delivery vaginally."

To make matters worse, the Today show medical correspondent then tries to link ashthma to respiratory distress syndrome - which it is not. Smoking, African American descent, low socio-economic status, multiple respiratory infections, and genetics are linked to asthma. Not respiratory distress syndrome. Asthma rates are going up in general on all populations so also NOT related to respiratory distress.

Even worse, she goes on to suggest that women don't want to 'feel' the pain of labor and that is why the C-section rate is so high. She says everyone should be getting a VBAC (vaginal birth after C-section). She knows NOTHING! VBACS can be very safe if you are a good candidate - had only 1 c-section, not with high blood pressure, not overweight, not diabetic, not carrying multiples, not getting an induction, had good prenatal care, are white, and have an OB that will be in the hospital 24-7 to change you over to a C-section if something goes wrong. (There is a 1% chance the uterus will rupture and without prompt C-section and management, both the mom and baby could die).

Don't let the Today Show scare you. If you have a question about C-sections or what they showed on TV today, ask your OB/GYN. If you want to know what pediatricians think, ask them or comment on my blog.

Monday, February 6, 2012

January expense report

I'm posting this now for a few reasons. First of all, I generally sit down and go through every single transaction once a month, though I check our account 2x weekly. As we are about to embark on the delivery of Child2, I wanted to make sure financially everything was going to plan. Next, it gave me a last chance to re-calculate the how much wiggle room we will have for the additional daycare expense and rental expense as our family expands.

Monthly expense estimate (JaneMD salary 5,100
January expenses
Rent + gym + housecleaning $1188
Cellphone + internet $160
Car lease $190
Home/car insurance $125
Daycare $670-770
Utilities $160
Car Gas $150
Groceries/Toiletries $800-1000
Personal expenses $500
Charities/religious $400
Onetime expenses $300
$100 + autosave $42
Total budgeted monthly expenses $4643

I really can’t claim to be such a great budgeter that I was within $1 of my estimate.  This particular month, due to pregnancy issues, we had to send Child1 to daycare every day instead of 4 days a week. In the winter, our heat is covered, so we came under budget on those. Groceries/toiletries were a little high because I had to replace a frying pan and buy a replacement infant carseat after a car accident. (Insurance will reimburse us for the $75) Our charities looked high this month because all of our end-of-the-year donations appeared on this months statement.  I also never account for our autosave account that our bank has since I treat it like adding a dollar to each transaction and just place it under onetime expenses.

What did we do with loans this month?
Hubby JD Salary $4700 + FSA reimbursement $770 = $5470
Savings $1300
Minimum loan payment $1650 (Jane MD’s started this month)
Extra loan payments $2000 + $1300
Total $6250 ($1300 savings + $4950 loans)

If you are really into math, you’ll notice we had $10,570 input and paid in expenses/loans/savings $10,892. Since most of Hubby JD’s salary is always accounted for, we were able to make an extra $1300 in loan payment from the excess from JaneMD’s salary and the FSA dependent care reimbursement - or you could say the amount covered our usual savings.  I always reassess the situation right before my payday to see how much we can put in above our goal of an additional $2000.

For February, if we are lucky, we’ll break near even on the month.  Gas will be down because, I will be on maternity leave, and my parents are coming to help with the baby for a week. While Child1 will be out of daycare that week, we’ll spend the equivalent on dog kenneling. The community will cook meals for us, but we will be throwing a party for the community and paying a moyel, putting us behind. I’ve saved gift certificates for buying the party equipment which could help. Most of our baby stuff is nearly new, so we won’t be buying much for Child2 – thought I can’t account for the grandparents plan . . .

Really, next time will be the Breastfeeding: Opportunity costs.

Thursday, February 2, 2012

Cutting costs

If you're noticing I'm posting a little early this week; it is because my second child is due any day, and I didn't want to get very far off my usual weekly posting.


I've read alot of frugality blogs, books and online yahoo/msn articles about trying to save money or get out of debt. Many of them or those commenting on them suggest drastic measures. "One of you should quit your job." "Move into a studio apartment." "Form a daycare commune" "Grow your own vegetables." "Get rid of your cellphone plan, go prepaid."

I am willing to discuss those issues that some people would recommend to trim the fat off our budget.

Suggestion #1: quit your job, stop daycare, and go down to one car.
Yes, that is theoretically possible, except those expenses added together are not even close to my salary. If we got rid of our family car, which we currently lease because we keep growing, we would save $190 a month and $100 on gas. Our daycare expense is about $700/month and will probably be in the range of $1200 when we have two kids in daycare.  That comes out to $1490 versus my $5000/month salary.  This does not consider the hassle factor of trying to get places while my husband is at work. We also go to a private home daycare which provides food and diapers, absorbing some of those costs as well. If I went half time, I would lose my disability, sick time, paid maternity leave, and 401k match.

Suggestion #2: Get rid of your unlimited data/phone plan and internet.

So this expense is a combined total of 160 a month for two cell phones and the lowest level of internet available. We have to have unlimited minutes and data because Hubby JD's job requires it. They also give him a salary reimbursement of $60/month on the phone. As a hospital employee, our plan also gets a 12% discount.  Even more, we are on a payment plan for the phone equipment, which will end in a little over a year so our price will go down more. Since we don't have cable, we will watch a few shows online and do probably 3-4 hours of work/blogging weekly on the computer, making the internet worthwhile. Without a home phone, we do not have long distance charges either.

Suggestion #3: Stop using frivolous services like house cleaning, dry cleaning, and the gym
If we stopped getting out apartment cleaned twice a week, we could save $100/month. However, I work 50 hours a week and Hubby JD works 45 hours a week. The exhaustion and toll of being a resident and law student in a messy house put a strain on our marriage before we started using her 2.5 years ago.  Our cleaning lady comes when we aren't home, has a flexible schedule, isn't bothered by our dogs, and brings her own cleaning supplies. Hubby JD gets his 20 shirts professionally laundered and pressed once a month for $35-50. I'm not sure where in my free time I would be able to fit this in, either. Our gym is $88 for the whole family and provides free babysitting. Unlike some people, we use the gym 4-5 times a week, each of us, even at 9 months pregnant. This investment pays for itself in babysitting per month. I treat the gym like rent for a non existent extra room in our apartment for our imaginary home gym.

Suggestion #4: Move to a smaller apartment and cut your rent down.

I'm really not sure how much smaller we can safely go and have not plans on finding out. Our current apartment is 850 square feet and will soon have 4 people and 2 dogs in it. It lacks closets so we had to convert the 2nd 9 x 10 bedroom into a walk-in closet. This is also the place where our 11 month old sleeps in his pack and play. We do not even have the space for a crib, which we didn't purchase. The area we live in is about a dollar per square foot and, due to proximity to Hubby JD's work and religious community, moving to a different area is not an option. No, we also don't have our own yard space to grow a garden in my free time either. We will be talking about our next rental decision in a future post.

Suggestion #5: Hire a nanny
We are not at critical number of child mass to make that work, even part time. I am anticipating a full year of two child daycare to cost a total of $14,400.  Add in the cost of gas, we might get up to $15,500. It is likely we'll have to have 4 kids to reach critical child mass to pay for one, particularly if you want someone reputable. Hubby JD also gets some FSA dependent care pre tax money that goes into this which does help a little.

Suggestion #6: Use all coupons and big box stores
This is not that helpful for several reasons. We don't get a paper, the items we buy generally are generic and not couponable, and our apartment is too small to make the membership worthwhile for bulk store purchases. Remember, we have next to zero dining out expenses for a reason. Daycare provides Child1's daytime food and both of us brown bag it to work. I discovered Hubby JD was occasionally buying 1 or 2 soft drinks per week out of a vending machine. He is not allowed to do that anymore and now has his own 24 pack of soft drinks under his desk bought in bulk.

Suggestion #7: Bike to work. (Thank you Mr. Money Mustache's blog,, for this one)
We live in the midway point between the two hospitals at which I work, each is 15 minutes away. We trade off who takes Child1 to daycare depending on our work schedules. We are only 1 mile from Hubby JD's office, but, between sharing the daycare drive and his need for professional clothing to look professional, he'll drive the one mile. (He once attempted the bike thing and let's just highlight the failure of biking in heavy traffic wearing a 3 piece suit) We often trade cars during the day to get the one with the carseat to daycare, but my commute from one hospital passes his office and his trip to daycare passes my other hospital, thus minimizing gas.

Suggestion #8: Stop saving for retirement and liquidate your 401k savings
This idea has always struck me as a bad idea. Your 401k is pretax; mine has employer match of 4%. If we stopped contributing, I expect we'll be taxed at about 25-30%, which removes alot of its benefit for paying off loans. Both the hubby and I will have to retire some day and we have this on autosavings. It's very much a 'rob the future' to pay for the present situation. We're still paying a huge amount into our loans and able to save for retirement.

I know this was a post discussing what I 'won't' do, but I think it is important to discuss which decisions were made and how they came about. Everyone is entitled to an opinion of what constitutes a sacrifice and what does not.  Everyone has a level of sacrifice they are willing or not willing to make. Now you know mine.

Next post: Breastfeeding Part 2: opportunity costs