WCI’s Continuing Financial Education 2020

I was very much looking forward to traveling to Las Vegas to speak at WCICON20 earlier this month but ended up unable to because of the whole devastating pandemic thing, but Jim and crew have released the conference e-course today. I and several other folks who couldn’t make it in person recorded our talks for inclusion after the fact, so there are over 34 hours of lecture worth 10 hours of CME.

Due to horrific computer glitch, I lost audio during my original recording and had to the majority of it again a second time while juggling my infant and 4-year-old, so I welcome you to check it out and see if you can feel the undercurrent of my electronically induced suffering. The struggle is real.

The course is included in the conference fee, so even if you went in person you should still check it out and hear the extra talks. I already enjoyed the talk from Morgan Housel (author of the upcoming The Psychology of Money) earlier today.

For everyone else, the cost is $100 off through April 21 with code CFEINTRO (which is already embedded in this totally monetized affiliate link).

Coronavirus: The Hammer and the Dance

Another excellent follow-up from Tomas Pueyo about the need to stop doing half-assed mitigation measures.

On one side, countries can go the mitigation route: create a massive epidemic, overwhelm the healthcare system, drive the death of millions of people, and release new mutations of this virus in the wild.

On the other, countries can fight. They can lock down for a few weeks to buy us time, create an educated action plan, and control this virus until we have a vaccine [ed: or treatment].

Governments around the world today, including some such as the US, the UK or Switzerland have so far chosen the mitigation path.

That means they’re giving up without a fight. They see other countries having successfully fought this, but they say: “We can’t do that!”

We can do better together with decisive action and cohesive government intervention/support.

Humans are a communal species. While we need to be alone, right now, we should act together.

Maxims for Academic Medicine

Highlights from Joseph V. Simone’s “Understanding Academic Medical Centers,” published way back in 1999 (hat tip @RichDuszak):

  • Institutions Don’t Love You Back.

A wise colleague once told me that job security was the ability to move to another job (because of professional independence).

  • Institutions Have Infinite Time Horizons to Attain Goals, But an Individual Has a Relatively Short Productive Period.

There is little incentive for an institution to rapidly cut through the bureaucratic morass. An institution will always outlast a dissenting individual, regardless of the merit of the case.

  • Members of Most Institutional Committees Consist of About 30% Who Will Work at It, Despite Other Pressures, and 20% Who Are Idiots, Status Seekers, or Troublemakers.


  • Institutional Incompetents and Troublemakers Are Often Transferred to Another Area, Where They Continue to Be Incompetent or Troublemakers.

They force others to pick up the slack or repair their mistakes, reducing everyone’s efficiency. If this continues for long, those who are consistently unproductive may become the majority because the competent learn that the institution sees no virtue in hard work and collaboration.

  • Leaders Are Often Chosen Primarily for Characteristics That Have Little or No Correlation with a Successful Tenure as Leader.

Examples of such criteria include a long bibliography, scientific eminence, institutional longevity, ready availability, a willingness to not rock the boat, or to accept inadequate resources. Choosing leaders is not a science, but it is surprising how often management skills, interpersonal skills, and experience are undervalued.

See: Academic Medicine & The Peter Principle.

  • In Recruiting, First-Class People Recruit First-Class People; Second-Class People Recruit Third-Class People.

Some hesitate to recruit a person who is smart enough and ambitious enough to compete with them. Others want a position filled at any cost because of “desperate” clinical need or other institutional pressures. If that approach continues for long, the third-class people will eventually dominate in numbers and influence and ultimately chase away any first-rate people that remain.

  • In Academic Institutions, Muck Flows Uphill.

Leaders often try to ignore or deflect the unpleasant mess, but the longer it incubates, the harder it will be to sanitize.

See: the dropped balls nationwide with current COVID-19 pandemic.

  • Personal Attitude and Team Compatibility Is Grossly Underrated in Faculty Recruiting.

A faculty member may be very productive personally but create an atmosphere that reduces the productivity of everyone else.

Annoying people are the black holes of camaraderie and joy.

Moral Humility & The Ethical Career

From Maryam Kouchaki and Isaac H. Smith’s “Building an Ethical Career

So how can you ensure that from day to day and decade to decade you will do the right thing in your professional life?

The first step requires shifting to a mindset we term moral humility—the recognition that we all have the capacity to transgress if we’re not vigilant. Moral humility pushes people to admit that temptations, rationalizations, and situations can lead even the best of us to misbehave, and it encourages them to think of ethics as not only avoiding the bad but also pursuing the good. It helps them see this sort of character development as a lifelong pursuit.

We all have a personal opportunity to make being good an active choice. I’ve always loved the view that being an ethical person isn’t a character trait but an endless series of (often challenging) conscious choices. We see so many examples of people who are good in some capacities but not others precisely because it’s sometimes easier and sometimes harder to make what are–at least in hindsight–clearly right or wrong choices.

Preparing for ethical challenges is important, because people are often well aware of what they should do when thinking about the future but tend to focus on what they want to do in the present. This tendency to overestimate the virtuousness of our future selves is part of what Ann Tenbrunsel of Notre Dame and colleagues call the ethical mirage.

Counteracting this bias begins with understanding your personal strengths and weaknesses. What are your values? When are you most likely to violate them? In his bookThe Road to Character, David Brooks distinguishes between résumé virtues (skills, abilities, and accomplishments that you can put on your résumé, such as “increased ROI by 10% on a multimillion-dollar project”) and eulogy virtues (things people praise you for after you’ve died, such as being a loyal friend, kind, and a hard worker). Although the two categories may overlap, résumé virtues often relate to what you’ve done for yourself, whereas eulogy virtues relate to the person you are and what you’ve done for others—that is, your character.

I often wonder how many of my goals or projects fall firmly into the wrong camp.

Many factors go into choosing a job—but in general people tend to overemphasize traditional metrics such as compensation and promotion opportunities and underemphasize the importance of the right moral fit. Our work and that of others has shown that ethical stress is a strong predictor of employee fatigue, decreased job satisfaction, lower motivation, and increased turnover.

And this brings us to a nice medical dovetail. How many physician jobs now exist within a bureaucratic or corporate structure that is counter to how we feel a physician should be forced to practice medicine and that is counter to the best interests of both the practitioner and patient? How did we ever let a 15-minute appointment become normal? For anything?

And lastly, helpful litmus tests: publicity, generalizability, and mirror:

Three tests can help you avoid self-deceptive rationalizations. (1) The publicity test. Would you be comfortable having this choice, and your reasoning behind it, published on the front page of the local newspaper? (2) The generalizability test. Would you be comfortable having your decision serve as a precedent for all people facing a similar situation? (3) The mirror test. Would you like the person you saw in the mirror after making this decision—is that the person you truly want to be?

These are important things to consider before any big decision. Yes, they’re basically all the golden rule–but how often do you forget to use it?

Coronavirus & Distance

There have been lots of good articles about the novel Coronavirus and the embarrassing state of America’s public health response.

This one from Vox has some excellent charts.

This one on Medium breaks down some of the underlying relationship mechanics of social distancing measures and spread as well as how one estimates the number of hidden (but transmitting) cases in a population (which does require some assumptions).

Here’s what I’m going to cover in this article, with lots of charts, data and models with plenty of sources:
— How many cases of coronavirus will there be in your area?
— What will happen when these cases materialize?
— What should you do?
— When?

When you’re done reading the article, this is what you’ll take away:

The coronavirus is coming to you.
It’s coming at an exponential speed: gradually, and then suddenly.
It’s a matter of days. Maybe a week or two.
When it does, your healthcare system will be overwhelmed.
Your fellow citizens will be treated in the hallways.
Exhausted healthcare workers will break down. Some will die.
They will have to decide which patient gets the oxygen and which one dies.
The only way to prevent this is social distancing today. Not tomorrow. Today.
That means keeping as many people home as possible, starting now.

Important reading.