Bill Perkins’ book Die With Zero has become well known for its central idea that we should aim to die with no unused money because any leftover dollars represent missed opportunities to live fully. The concept is interesting and it definitely pushed me to think differently about wealth. But as a physician, I walked away with mixed feelings. Perkins writes for a general audience. Our financial reality is not general. So should doctors actually die with zero?

A quick background

When he wrote the book, Bill was 50 years old. He is not a financial advisor. He made his money as an energy trader and it sounds like he made a lot of it. The story behind the book traces back to a moment early in his career when he proudly told his mentor he had managed to save just over one thousand dollars while living on a modest salary in New York City.

He expected praise. Instead, his mentor told him he was doing it wrong. Why save aggressively in his twenties when his income would almost certainly rise later? That question sparked the philosophy that eventually became Die With Zero.

The basic tenets of Die With Zero

Here are the main principles Perkins outlines in the book:

• The goal of life is to maximize meaningful experiences and accumulate as many personal “life experience points” as possible
• Any money left over at death is wasted potential that could have funded those experiences
• Giving to children or charity is encouraged, but earlier giving is more beneficial than leaving money behind
• Life requires a balance between energy spent earning money and energy spent creating experiences
• Most people save too much early in life because they fear outliving their assets
• Younger people should take bigger risks because they have time to recover

These ideas are not unreasonable on their own. Yet when we apply the last two principles to physicians, things become more complicated.

Should doctors save less for the future?

In short, no.

Doctors are not saving too much. If anything, we are saving far too little. Nearly 40 percent of physicians between 50 and 55 have a net worth below one million dollars. Only 11 percent have reached 5 million.

And while 5 million sounds like a comfortable number, remember the 4% withdrawal rule. It converts that $5M into roughly two hundred thousand dollars per year before taxes. Most doctors I speak with want more retirement income than that. Many also want to retire much sooner than they currently can.

And why is the average doctor in this position of lower than expected net worth? (Remember, you can calculate your expected net worth for your age here.) It's because of two things:

• We spend too much and
• We save too little

Remember, the average physician salary is greater than $200,000. If you can't save enough for your nest egg with that salary, then you have a saving problem, not an income problem.

(And yes, I know that it seems like that's easy for me to say as a plastic surgeon making the higher end of physician income. And it is easier with more income. But the average is more than enough. Just ask any non-physician.)

Add this inept average saving by physicians with the delayed gratification of training and I fear the call for doctors to “die with zero” becomes dangerous rallying cry.

Should young doctors take more risk?

Perkins argues that young people magnify worst case scenarios and avoid taking healthy risks. That may be true in many professions. It does not apply well to medicine. Future doctors routinely take on hundreds of thousands of dollars in unsecured debt with no income and no guarantee of matching into a residency. We spend seven to ten years working long hours under intense pressure with no real financial safety net. If something goes wrong, the debt remains while the income disappears. That is a far greater early-career risk than the examples offered in the book.

Because of this, the idea that young physicians should take even bolder risks feels disconnected from the reality of how much risk we already take before earning our first attending paycheck.

So should doctors die with zero?

The concept itself is not flawed. It is useful to be reminded that money is a tool for creating meaningful experiences. Where the philosophy becomes tricky is timing. If I had read this book early in my financial journey, the message would have landed poorly. I was on track to become an overspending and undersaving physician. I spent plenty during school and residency. Some of it brought real joy. Much of it did not. Without the discipline I later learned, I could have easily convinced myself that any spending in my twenties was justified.

For that reason, I think Die With Zero is best for physicians who are already on the path toward financial independence. I fit that category now. I still lean conservative with saving because I grew up watching money disappear quickly. It is difficult not to want a large cushion. That is why the book served as a good reminder that money only matters to the extent that it improves our lives and the lives of those we care about.

Once you have saved and invested enough to reach your goals and protect yourself from financial disaster, spending more intentionally becomes not only reasonable but healthy. At that point, using money to build experiences like this is one of the most worthwhile ways to use it.

What do you think? Should doctors die with zero? Where are you on the spectrum? How do you plan to spend your money? Let me know in the comments below!