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Physician finance

This Chart Should Change How You Think About Investing

Haseeb Aslam, MD6 min read

Bar chart of average annual real S&P 500 returns by period, from 1928-1948 through 2013-2025. Flat periods sit near zero. Boom periods sit above 11 percent. Source: Damodaran, NYU Stern.

You have seen the long-term averages. Stocks return about 10 percent a year before inflation and roughly 7 percent after. That number is true over a century. It is also useless for planning the next fifteen or twenty years of your life. The chart below shows why.

Bar chart of geometric average annual real S&P 500 returns: 1928-1948 about 2.4 percent, 1949-1968 about 12.7 percent, 1969-1984 about 0.5 percent, 1985-1999 about 15.1 percent, 2000-2012 about minus 0.8 percent, 2013-2025 about 11.8 percent.
Geometric average annual real total return, dividends reinvested. Source: Aswath Damodaran, NYU Stern, 1928-2025. The dashed line is the full-period average, about 6.8 percent.

From 1928 to 1948 the real return was about 2.4 percent a year. That window includes 1928, a very strong year. Leave it out and 1929 to 1948 was about 0.6 percent. From 1969 to 1984 the real return was about 0.5 percent. From 2000 to 2012 it was negative, about 0.8 percent a year. Those are not short blips. They are stretches longer than most physicians' peak earning years.

Then come the boom periods: about 12.7 percent, 15.1 percent, and 11.8 percent. The market does not deliver a smooth 7 percent. It delivers clusters of almost nothing and clusters of very high returns.

Real return matters because inflation is the silent tax. A nominal 7 percent return with 3 percent inflation leaves you with about 4 percent of buying power. In the flat periods the chart shows, even that was hard to get.

Why this hits physicians differently

Most of us start serious saving after residency or fellowship. That is often age 32 to 36. Student loans, a house, kids, and the first real paycheck arrive together. The compounding clock has already run for a decade while other people were adding money in their twenties. A twenty-year stretch of near-zero real returns that begins when you are 35 leaves you at 55 still waiting for the market to do the heavy lifting.

A faceless figure in scrubs beside a line chart of real S&P 500 value from 1969 to 1984. The line ends near where it started. The chart is labeled: markets can go sideways for 15 or more years.
Real value of $100 at the end of 1968, through 1984. It finished near $108. Sixteen years, almost no gain after inflation. Source: Damodaran, NYU Stern.

Sequence of returns risk makes the problem sharper. The order of good and bad years matters once money is moving in or out of the portfolio. A lump sum that just sits there ends in the same place either way. The order does not matter until you add money or take money out.

If the bad years hit when your balance is largest, near the end of accumulation or the start of withdrawal, you sell more shares to raise the same cash. Those shares are gone when the recovery comes. Physicians who want the option to cut back at 50 or 55 have a longer withdrawal horizon, so the sequence risk window is wider.

Split chart. Same twenty years of returns, ten at 12 percent and ten at minus 2 percent, in two orders. High savings of $80,000 a year ends near $1.88 million if the strong years come first and near $3.68 million if the flat years come first. Low savings of $20,000 a year ends near $470,000 or $920,000.
Illustration, not a forecast and not your account. Ten years at 12 percent and ten years at minus 2 percent. Contribution at year-end. Strong years first leaves the high saver near $1.88 million. Flat years first leaves the same saver near $3.68 million.

Savings rate beats return chasing

The variable you control most is the share of income you save. A high savings rate shortens the time you need strong market returns. If you need the market to return 10 percent real every year to hit your number, you are exposed to the flat periods. If you save enough that a 4 percent real return still gets you there, the flat stretches become survivable.

This is the math behind the freedom number. Annual spending times 25 is a rough starting point under the 4 percent rule. The actual number moves with your savings rate, your expected real return, and how early you start. The chart makes the case for building the plan around a conservative real return assumption rather than the historical average.

Two paths. High savings, a long time, and a plan built for 4 percent real can reach a freedom number even in a flat stretch. Low savings, a late start, and a plan that needs 10 percent real can leave you still working.
A map, not a promise. The savings rate is the lever you can set. The next fifteen years of the market are not.

The same logic applies to side income. Extra shifts, a 1099 project, or rental income increase the savings rate without requiring the market to cooperate. Practice by Choice lays out the freedom number, the timeline, and the yearly priorities. The free Practice by Choice planner runs the same arithmetic on your numbers. The Freedom Prescription and Stethoscope to Freedom cover the same roadmap in shorter form.

What to do with the chart

Stay invested through the flat periods. Selling after a decade of nothing locks in the poor result and misses the next cluster of strong returns. Keep a cash or short-term bond buffer equal to a few years of spending once you are within five years of needing the money. Measure progress in savings rate and years of spending covered, not in whether this year's return beat the long-term average.

If you sell options for premium, the same periods matter. Cash-secured puts and covered calls can generate income in sideways markets, but the underlying shares still need to hold value over time. Defined-risk rules and position sizing matter more when the broad market is delivering near-zero real returns for fifteen years. Option Selling for Beginners and The Premium Collector are written for that environment. The free options scanner scores a cash-secured put or a covered call against those rules. It does not pick the ticker.

Four takeaways: long flat periods are normal, savings rate beats the average return, sequence risk hits late savers harder, and the freedom number is the worksheet.
The short version. Then run the numbers in the planner.

The chart is not a reason to abandon stocks. Over very long periods they have outpaced inflation. It is a reason to stop treating the long-term average as a delivery schedule. Physicians who finish training later, who carry debt into their thirties, and who want the option to work less have less time for the market to average out. The response is higher savings, a realistic return assumption, and a plan that still works if the next fifteen years look more like 1969 to 1984 than like 1985 to 1999.

Run your numbers with the planner. Read the short version in Practice by Choice or The Freedom Prescription. Then decide how much margin you actually have. The chart does not change the arithmetic. It just stops you from assuming the arithmetic will be kind.

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Educational only. Not financial advice. Not a recommendation to buy or sell any security. Period returns are geometric averages from Aswath Damodaran, NYU Stern, S&P 500 total return after CPI, 1928-2025. The sequence chart is an illustration with made-up yearly returns, not a forecast. Disclosures.