Show Notes
In this episode I interview pseudonymous attending anesthesiologist The Physician Philosopher. His blog covers lots of topics pertaining to holistic physician wellness, including personal, financial, mental, relational, etc. We dig into some of his personal perspectives on life and money, formative events in his professional career, how to find a good financial planner, and more.
Show Transcript
Justin: 00:00 Welcome to the Anesthesia Success Podcast. I’m your host Justin Harvey. This week our guest is a blogger and an attending anesthesiologist at a major academic center. My friend, the Physician Philosopher, I had the pleasure of meeting at the physician Philosopher a couple months ago, not at an anesthesia conference, but actually at FIN CON, which is a conference geared towards finance writers and content producers. Uh, I really felt like he and I were attacking the same problem from different angles and he’s coming from a medical professional, obviously in me with a finance background to address this question of how do we equip physicians to use their finances to help bring them freedom in the midst of a very demanding profession rather than having money be a perpetual stressor. So I’m very excited to have the physician Philosopher. Thank you, Sir for joining us today. Absolutely. I appreciate you inviting me on. Yeah. And I know you’ve been on the podcast tour of late. How’s that been for you? Dusting off the microphone.
Physician Philosopher:00:53 Yeah. So it’s been really interesting actually. I like this, uh, this medium of podcasting a lot. It’s very different from blogging, but I’ve, I’ve really enjoyed it..
Justin: 01:12 That’s right. That’s right. So, uh, we’d love to hear a little bit about your background. So obviously you’re a, you’re an attending anesthesiologist, but you’ve got to this angle of physician financial and holistic wellness that you feel very strongly about. So maybe tell us a little bit of your story and what are some of the influences that have informed this passionate trajectory.
Physician Philosopher:01:30 So, um, I grew up in the South and moved around quite a lot as a kid. I think I moved probably 10 or 12 times before the age of 10 and a lot of that had to do with my dad having some, some disability additionally because my dad ended up losing his job after basically making some safety complaints and going over someone’s head because he thought it was so concerning. And when he lost his job, he got blackballed from the nuclear engineer industry for about 15 months or so. And so during that time my parents didn’t have, you know, a large emergency fund. They weren’t very high and financial literacy. And so, uh, my family ended up declaring bankruptcy when I was in elementary school and we moved down south. I guess I was living up in New Jersey at that time. When that happened, we moved down south back where all of our family was and I live with my grandparents for about a year and a half.
Physician Philosopher: 02:21 And you know, we rang up credit card debt. We ate out a lot, you know, and it was just a very humbling experience going from, you know, having a lot to, having very little. And my parents persevered through that set really good examples, but you know, that kind of started my journey in terms of money and then, you know, of course that was years ago and kind of shaped me a little bit, but I didn’t know anything about finances until a few years ago when I came across some, some websites and books. But yeah. So I guess a little bit more about me. I obviously write it, the physician Philosopher.com. I am, you know, and I’m big on physician identity and not losing yourself in that. So I guess I’ll say that and congratulations on your one year anniversary by the way. Saw that come across my
Justin: 03:00 feed the other day. I’m pretty sure it’s a great milestone.
Physician Philosopher:03:02 Yeah, we, uh, I’m, I’m really excited about it and uh, it’s been a fun journey so far, but uh, you know, a lot of what I preach on that website is not losing yourself in, in being, you know, who you are in terms of just being your job. I always tell people when they asked me to say something about myself that, you know, I’m a god fearing husband, a father of three. I’m an author, an inventor. I’m a passionate sports fan. I love craft brews and I happened to be a physician anesthesiologist, you know, and I don’t want that to define me. I’m passionate about my job and, and uh, and I tried to be really good at it, but it’s not who I am. So, you know, I kind of lead with that. Excellent.
Justin: 03:37 So you said an inventor. I’m curious, what have you invented or what are you working on?
Physician Philosopher:03:40 So I guess that’s a bit of a tease there because, uh, I have some nondisclosure agreements outside. I can’t really talk about it too much, but it’s great. It’s Germane to my, my field and regional and. Okay. So I guess I can say that.
Justin: 03:52 So it’s a device. Cool. So tell us little bit more about your blog is obviously that’s something that takes a lot of perseverance. You’ve got to sort of shout out into the void for a while until some people start hearing and then it gains momentum. So tell us a little bit about that process of how you got into that and what it looks like to sort of persevere into something that you hope will one day come to fruition. But at the outset obviously it’s really tough.
Physician Philosopher: 04:16 Yeah, it has been tough. I think that like so many things in life, blogging is all about consistency. And so I started out pretty early on, you know, having done a little bit of homework before I started my blog. But I mean, I’ll be honest with you, this is just Kinda my personality. Um, I see a goal, I see something I want and then I just don’t achieve it and I just go after it. Um, and so I decided I want to start a blog and you know, a week or two later I had a blog, but from the onset I decided that I was going to publish, you know, three times a week because I didn’t want people to not know when my content was coming out. So I published on Monday, Wednesday and Friday and I want it to be consistent and so I always try to stay two weeks ahead of my blog schedule so that if something comes up, like our, you know, our recent move, I didn’t write for seven or 10 days and by the time I came back I was, you know, I saw a few posts left that could, could get published, but it has been a journey because when you start writing, you know, not only are you writing with a voice into the void, but you’re, you’re also terrible at it.
Physician Philosopher: 05:11 And so, you know, I mean I still, I still think I’m, you know, some ways finding my voice, you know, and, and honing my craft. But I certainly think that things have gotten better since I started. But when you start, yeah, you’re exactly right. You know, people don’t just trip and land on your blog. I mean you have to actively go out and promote and recruit them. And it’s been a year in November, like you mentioned. So it’s been a, it’s been a good journey so far.
Justin: 05:33 Yeah. That’s great. And it’s funny, blogging is similar to podcasting and that you have to learn basically on a stage in front of a bunch of people that you don’t know make all your mistakes, all their people are watching and then get better over time.
Physician Philosopher: 05:43 That’s exactly. That’s exactly right. Fortunately in blogging, I can go back and revise my post. Yeah. Yeah.
Justin: 05:49 I know there’s some other experiences that you’ve had that not only have motivated you to pursue financial wellness and holistic, I would say wellness for yourself,
Justin: 05:58 but also to use a blog as a mechanism to try to help the medical community. So I love to hear in your, I’d say in your training years and beyond, what were some other things that you ran into that really motivated you to do something as difficult as right three times a week as a busy physician to be able to help others?
Physician Philosopher: 06:17 Sure. Yeah. So there are lots of examples, but the two that I share the most often would be my experience with disability insurance as a beginning fourth year medical student. And I’m the advisory group that came in at the end of my fourth year. So I, I’m in my fourth year, very, very beginning of my fourth year, end of my third year. I had my first kid and uh, when we had her, I thought that the responsible thing to do as a father was to get disability or excuse me to get life insurance. And so I approach somebody who was the brother of one of my medical school classmates at the time. I knew nothing about this stuff. And so, you know, I thought that was a pretty reasonable source of information, you know, I wouldn’t think that my, you know, my classmates brother would host me, but, uh, asked for, you know, life insurance, term life insurance.
Physician Philosopher: 07:02 I knew that much at least. And uh, he said, yeah, of course. Yeah, we can get you some awesome term life insurance. But a while we’re at that, we should probably just get you to just disability insurance. I said, well, you know, I don’t know how that stuff works, you know, but I don’t really have an income to protect. So I, I don’t really feel the need to get that right now and I don’t think I can afford it. As you know, a fourth year medical student with no income. And he said, no, no, no, it’s fine. Let’s just, let’s just do it. And I said, no a few times. He ended up talking me into it. Well, the background is that I have in essential tremor and I take propranolol for because I’m an anesthesiologist, I do regional anesthesia that set me up for getting denied from this company, which didn’t seem like a big deal at the time until I became a resident.
Physician Philosopher: 07:41 And there was now a guaranteed disability insurance product that you could get. It didn’t require a medical exam. It didn’t matter if you had medical problems and the only stipulation for that is that you can’t have been denied before. And so because I got denied as a fourth year medical student, I to this day cannot get personal disability insurance. I’ve applied twice now, um, have been denied twice because of the same reason. And so that was all, you know, looking back now, you know, classmates brother was, you know, trying to put food on the table and earn a commission, you know, and he was probably pretty new at the job, didn’t know what he was doing, but regardless, it’s impacted my life forever. So that was the first experience. And then 12 months later we had a group come in as a fourth year med student for our intern bootcamp.
Physician Philosopher: 08:23 And during our intern bootcamp they brought in people that talked about various things they thought would be helpful or impactful during your, uh, your upcoming residency years and attending years because they brought into financial advising group and it felt really slimy. I didn’t know anything about it back then, but it just felt so slimy. And I, I just, you know, sat through the lecture, didn’t really listen. I know some of my friends signed up for their, for their help with student loans and financing and investing and personal finance, that sort of stuff. And not two to three years into residency, big headlines came out that this advisory group, the lawyer that ran it was in jail for fraud. And uh, and so
Justin: 08:58 that is a very dramatic example. It’s not always that bad just for our listeners out there.
Physician Philosopher: 09:01 Yeah. But, you know, it was a fascinating thing because, you know, for an injury, for an industry that’s so regulated, um, for things like that to happen and to even be possible really opened my eyes to, oh well, you know, no matter how much you want to lean on someone else for financial advice, you need to learn at least a little bit of this stuff.
Justin: 09:19 Absolutely. Could not agree more from your childhood. You had this significant experience with bankruptcy and then through as, as an ms four and then in training more kind of jarring experiences. So it sounds like this puts you on this trajectory. You know, you kind of put this thing in your cross hairs and you said I’m going to let you know, even recently you mentioned you were, you were thinking about becoming a financial planner yourself and getting a series 65. Tell us a little bit about sort of how that came to be and where you’re at with that now.
Physician Philosopher: 09:46 Yeah. So, um, you know, we’ll touch on this a little bit later I think, but you know, I kind of break physicians up into a few different groups, you know, which are the, do it yourself investor, the person that wants a little bit a professional health to dot the i’s and cross the t’s. They know a good bit but they just want a professional to help them. And then someone that doesn’t care to know anything about any of this stuff. And so my thought process back when I originally signed up for the series 65 was my experience is that most people, most physicians don’t fall into that first group that do it yourself group. And so there are two other groups of physicians that need financial help. And I wanted to potentially be a person that can help provide that with the least conflict of interest possible.
Physician Philosopher: 10:22 And so I signed up for the series 65 and then, you know, in talking with a couple of other, a personal finance bloggers that happened to be a financial advisors, they kinda discouraged me from it honestly because they didn’t want me to run into problems with FINRA. And I’m a very outspoken, opinionated person. And uh, and so they thought that fender probably wouldn’t look lovingly upon some of my comments. This is a tough space to have opinions. Turns out, yes it is. And so, and so that, that, you know, as part of the limitation. And the other thing is that, you know, I do have the website but also have a lot of work. Um, it’s probably where the majority of my work is trying to make a curriculum at the medical school and residency where, you know, where I practice during the day. And I felt like if I had to disclose to them that, hey, by the way, you know, you know, I’m pursuing becoming a financial advisor, or I’ve passed this series exam, or you know, I’m working on become a CFP or any of those things. I felt like they would think that I was there talking to them just so that I could later solicit their, their service and uh, I didn’t want to have that conflict. And so for those two reasons, the regulation and, you know, the perceived conflict of interest, I decided not to pursue it.
Justin: 11:27 Yeah. Yeah. That makes a lot of sense. Something you mentioned earlier, I just want to jump back on real quick on a more personal note. You said you started having kids in Med school, which is really interesting. I’m sure you know, very demanding time to do that. A lot of doctors out there, you know, in med school in training are probably trying to decide, you know, when does it make sense to start a family? How does that fit into the career context? How did you and your wife kind of walk through that and, and how did that thinking sort of shape your trajectory as a family?
Physician Philosopher: 11:53 Yeah.
Justin: 11:54 So this kind of ties into what I said about my personality earlier where, you know, if there’s something that you, I really have aspirations for dreams or hopes for that I just chase after it. And having kids was something that was really important to my wife and me. And you know, I think there are two schools of thought here and I hope I don’t offend anybody, but the, uh, the two, the two schools of thought are, you know, to wait until you’re settled down and you have your finances in order and you’re in your career to start having children. And I think that that might make training, you know, a little more palatable because you don’t have the stressors of being a parent on top of, you know, learning your craft and all the stress that comes with working in medicine and being married. And so that’s one school of thought.
Justin: 12:31 And the other school of thought, which is the one that I fall into, is that I wanted my family to come first and foremost, and so I want to have as many years with my kids as I can. And so I knew that I would want to have kids someday and I didn’t really see a great reason to wait if we could afford it during training because, you know, when my youngest kid turns 18, I will be 48. I have three kids, um, and so, you know, I’m going to have lots and lots and lots of years with them after that, you know, when they’re adults spending time enjoying time with them. And, and that was a very intentional decision for that reason. Now was it hard? Yes. Would I do it again? Yes. But yeah, so my wife and I, we sat down. And the other thing I have to mention of course, is that I’m married to a saint.
Justin: 13:13 My wife is. I’m forgiving, compassionate and understanding person that I’ve ever met. And so she, she saddled a lot of this when I was in residency and was unavailable or unhelpful. You know, when I was home, so I was tired, I was tired or you know, as Abi, but she’s really what made everything work. But uh, yeah, it was a really intentional decision. We prayed a lot about it. Um, you know, decided to, to kind of start the journey. Yeah, that’s great. I know I got married in June and uh, my wife and I are just starting, she’s a ca one here and we’re just starting to think about what does it look like for us. And it’s really great to hear your perspective. I think that makes a lot of sense.
Physician Philosopher: 13:48 You know, I have some friends who are know, obviously, you know, female physicians with physicians and leaders in my hospital that had kids during training to and made it work. Um, I, I really do think it depends a lot upon the residency that you’re in if you’re a woman physician and in terms of the support that you get through that process.
Justin: 14:05 Yeah, makes sense. You know, you’re in the academic world, you’re training young physicians all the time. I’m sure. I’m sure you use a lot of different, you know, probably the, the full spectrum of financial acumen from people who are really on top of it to people who don’t know up from down. So maybe tell us a little bit about how you interact with some trainees in that context and some of the advice that you try to share with young physicians.
Physician Philosopher: 14:28 Yeah, sure. So yeah, I’ve definitely seen the span of the gamut here. Um, I’d say that most residents and medical students know very, very little about personal finance or physician finance. There is a small portion that know a lot about student loans. There’s a small portion that knows a lot about, um, maybe investing or budgeting. They’re very, very, very few people that know a lot about all of those things. And so there’s just a huge need for anyone in academics that has a passion or an interest in this subject to teach this to, to the learners that they’re surrounded by. And so I’ve tried to do that, but yeah, it has been interesting because there’s just this huge need. And um, at some places there’s a lot of support for it at other places there is some resistance because this is such a taboo topic.
Physician Philosopher:15:11 And so one of the big things that I really try to harp to the residence is that I do not want money to be taboo and I’m a very transparent, very open and honest person to a fault. And so I tell them, look, if you have a question about anything money related, I will be happy to tell you my perspective, my experience. Um, you know, I don’t tell them that I’m going to give them the answers because I don’t think that that’s my responsibility. I think it’s my job to teach them that these are the options. And then to let them make an educated decision. So I never give personal financial advice. I say, you know, hey, does it make more sense to, you know, put money into the market and hope it does well or to put guaranteed money towards your seven percent interest that you’re getting back on the loans you have. And for them that’s an easy decision. I don’t need to tell them which one of those things is right, but I think the big, big, big part of this is as an attending physician, making sure that money is just like I’m teaching somebody to intubate or discussing the physiology of the heart or the lungs. Um, it is a topic that’s necessary to be a good physician and so the residents and medical students need to be comfortable asking about those things. So I try to, I try to provide that environment.
Justin: 16:18 Yeah, absolutely. That makes a ton of sense. And obviously I think your blog is predicated upon this premise, but as your finances fall into order, that’s one less thing you need to stress about and dedicate active emotional energy towards and allows you to be a better clinician and a better husband and a better parent. And it just has this positive feedback loop that is a, a great thing in the life of a busy doctor.
Physician Philosopher: 16:40 Yeah. No, I, I agree. I think that, I mean obviously my tagline on my website is wealth and wellness and so I very much believed that these topics are intrinsically linked and that having one without the other is extremely challenging, you know, and, and we know that nowadays there’s a physician burnout problem, 42 percent of doctors are burned out and some specialties as high as almost 50 percent and you know as physician depression and money’s the number two cause for that. And so these, these things are not unrelated. Unfortunately they’ve been tossed into this bucket of like touchy feely off topic, taboo topics and so they don’t often get discussed for that reason. I think the main, main reason why is because attendings aren’t comfortable talking about it because they don’t know this stuff themselves.
Justin: 17:19 I’m curious, what’s the current climate like either with your institution or in general as far as getting information with people coming in and sharing or presenting or you know, who is it that’s getting in front of you and your peers and how do you find that, that advice in that context? Is that, is that productive or is it currently you find, you know, kind of like the advisor who got thrown in jail a few years ago? Is it, are those the people that are, you’re getting in front of or you know, how’s it, what’s the climate like?
Physician Philosopher: 17:46 Uh, you know, I can only speak to my experience. I guess I could speak to a couple. Um, so we had a visiting professor we brought in recently who has a very successful, um, curriculum at his school. So Jason when I was talking to him, kind of have a sense for what his experience is, which is that he brings in professionals that have the least competent of interest in a given topic and then have that and then have them talk on it. And of course he sits in the audience and he, that’s the slides before they go up and make sure that, you know, what’s being presented is fair and accurate and not misleading. So that’s kind of one perspective, but Jason has a ton of support where I work. Um, you know, it’s been a little bit of an uphill battle, you know, because I just don’t think, I don’t really, I don’t think people really started realizing how important these topics were until recently.
Physician Philosopher: 18:31 And so it wasn’t that these people didn’t want to help, it’s just that they didn’t understand how big the need was. And so, you know, I’ve had the opportunity to speak to a couple of residency programs, like you can’t fit everything you need to learn about the stuff in an hour. It really needs to be attended to 1:10 to 20 our curriculum and ideally you would bring in experts that have at least conflict of interest and talk on it. But finding those people is extremely challenging. And so we’re in the process of making a curriculum at my institution, um, and my, my residency in particular, hopefully we’ll get our foot in the medical school door at some point for fourth year med students. The design should be, in my opinion, having experts come in and talk about it. And then having people that are also physicians that have enough knowledge about this stuff to prevent badness from spreading because we all know that in any given field there are good and bad professionals. Uh, and so that’s the same for physicians as it is for financial advisors. And so it’s really important to get the good ones in front of these people, but they also have to be interesting to listen to. They can’t just, it’s just like finding all of that, you know, like my forte, my forte, gold standard criteria we’ll talk about later for an advisor and someone that’s also entertaining to listen to you that gives good stories and brings them in a is it’s tough.
Justin: 19:37 Yeah, absolutely. Um, so I think this is a good, a good inflection point for us. So you mentioned conflicts of interest and one of the problems you know is that advisors have conflicts of interest. And this is true, I think with even the most pure transparent fee model is not 100 percent devoid of conflicts of interest. But as a consumer, what you want to do is manage conflicts of interest to the extent possible and you know, in medicine you’ve got the stark laws where you can’t self refer business and there’s financial equivalents to that and ways to discern who’s getting paid for what. So I want to now talk a little bit about how do you go about choosing an advisor if, if I’m not in the do it yourself camp and I’m one of the other, you know, 90 or 95 percent of physicians out there who, who wants to engage an advisor either on a one off basis or maybe in an ongoing relationship. How do you begin to answer that question of who, who’s, who’s one of the good guys and who should I not be doing business with?
Physician Philosopher: 20:31 Yes. I wrote about this in a post. I think it’s called, do I need a financial advisor? The simple truth, you know, I break, I break it down into four criteria, three of which in my opinion are nonnegotiable. And so the gold standard is for things and we can talk about what each of these mean, but a fee only who is a US number one, number two is a fiduciary, number three is in my opinion, in assets under management versus you know, a flat fee. So we’ll talk about that. So a flat fee model and then experienced working with physicians. So the three that are nonnegotiable, negotiable in my opinion are fee only fiduciary and they have to have experience working with physicians or at least have someone available to them that has a vast experience working with physicians. You know, not everybody has experienced coming into any field.
Physician Philosopher: 21:10 So I’m not gonna require that somebody on day one, but they better be working with someone that does. Those are the criteria. And the reason why is is what you said, you know, managing conflict of interest. So I do agree that any financial advisor has a conflict of interest. But the best way I can make this understandable for people that don’t talk personal finance all the time is that, you know, of looking at a pharmaceutical rep at my hospital, pharmaceutical reps are no longer allowed to provide free lunches or a free pens or any other products or items to physicians. And the reason why is because the hospital viewed that as a conflict of interest. And so a corollary to that would be, um, you know, of course this pharmaceutical reps were giving you advice on which medications to prescribe, which were always the ones that came from their, you know, their company.
Physician Philosopher: 21:52 Um, and so the corollary to that in the financial industry is a fee based advisor who sells insurance products. So they’re giving you financial advice and in that advice they’re going to tell you what kind of insurance products you need. And then in turn, they’re also gonna be the ones that can sell it to you. So a fee based advisor can sell commissioned insurance products. And that doesn’t make a lot of sense. It’s like getting your medication recommendations from a pharmaceutical rep and then versus a fee only who works only on fees and does not sell commissioned insurance products, and so that’s kind of number one. Number two is the fiduciary. A fiduciary simply means that the person is bound by by law and ethics to do what is best for you, the person that they are advising, and I think that the scary implicit assumption in here is that the fact that I have to mention that means that there are financial advisors out there who are not fiduciaries, who are not ethically or legally bound to do what is best for you, and so you really do want somebody that has a fiduciary, a agreement, or as part of a group that requires them to be a fiduciary or is passing an exam that requires them to be a fiduciary.
Physician Philosopher: 22:50 If someone has a fiduciary and the fee only, they should be very proud to say that on their website. So it’s not usually very hard to to find that out. They’re very proud to tell you because it’s the right way to do business. And then the assets under management model, which you know, you, you and I talked a lot about Finn Con, the way that this works is basically, you know, if someone has a certain amount of assets, you know, say in an IRA, they have a million dollars and their advisors charging them one percent assets under management fee. That means that there’ll be paying one percent every year on that million dollars. So they’ll pay their advisor $10,000. Now it doesn’t come from a check that you’re right and then give to the advisor. That would be too transparent. It comes instead from the funds that they are managing and so that $10,000 is swept out of the million dollars and then you do that every year.
Physician Philosopher: 23:31 And as azure money grows, of course that that amount of money goes up naturally. This industry recognizes that, you know, that’s not exactly a great selling feature. And so as you get more money, they typically will decrease your arm, your AUM. So less than one percent, one percent of the industry standard, the problem is for do it yourself investors. We’ve kind of realized that if I take that $10,000 and put it back into the market and passively managed index funds, that I’m going to save that $10,000 and let it continue to compound on interest instead of going into my financial advisors, bank account’s going to keep, can stay in mind. That doesn’t sound like that big of a conflict except for that there are lots of decisions where you would do a financially reasonable thing, but maybe encouraged by a financial advisor operating underneath an AUM to not do it.
Physician Philosopher: 24:14 And some classic examples would be like say you want to diversify and invest in real estate. Well, if you put money towards real estate and not towards your assets that are being managed, that is money that the financial advisor doesn’t get a percentage of. Or if you take your social security at a younger age, uh, that will actually prevent you from taking money from assets that are being managed by the advisor and give them more money when the advisable things usually to delay taking social security until age 65 or 70 because you get a bigger payout and use the assets that you have. But I can’t. It’s really tough for a financial advisor underneath. You have to recommend that because that would mean that you are taking money from your assets that they taking a percentage of.
Justin: 24:54 I think another way to express it might be there’s, it’s a conflict of interest. So I’ve worked under both of these. The fee only model and the fee based model and the fee fee based firm for whom I worked was, I would call it functionally fee only. Sure. So we got paid based on the money that we managed. We could sell an insurance policy. We very seldom did. We weren’t selling policies with big commissions a very little whole life except for in strategic situations, which was appropriate. It was generally term life only and very plain vanilla. It frankly, it wasn’t even worth the commission because it was so much trouble for us to do it, but we did it anyway as a convenience to our clients. So there’s, you know, having seen both of these and acknowledging these inherent. Yeah, it’s true. There are conflicts of interest. I think the important thing to do, and I’d be interested in your perspective, the important thing to take out of this is understand where your conflicts of interest for your advisor are going to be and just manage them. I think it’s probably the same in medicine. What’d you say?
Physician Philosopher: 25:52 Yeah, I do. And it’s exactly what we talked about earlier. I think that no matter how hands off you want to be with your finances, that it is your responsibility to at least do a little bit of homework to understand these things and if you understand where the conflicts are, then I think that you can make reasonable decisions. You know, I don’t mention the assets under management versus flat fee only as like a non negotiable. It’s not one of my non negotiables because I think that there are reasonable advisors out there who do operate under an AUM and they provide good advice and do the right thing and they act as a fiduciary, but the consumer has to know where those conflicts are. So if if advice that leans one way or the other is given, they can say, well, you know, maybe I need to get a second opinion or maybe we need to talk about this more.
Physician Philosopher: 26:32 But I think that the tough, the tough, the sticking point for me is that if there’s someone out there who you can go to to ask similar advice from or questions to to get advice from and they work under a flat fee where you just pay them by the hour, the quarter. However, the agreement is set up and they just. They’re only conflict is that they want to do a solid surface for you. They want to give you a solid surface so that you come back. Now they can log more hours and the conflict, that’s the conflict there is that, you know, if it’s an a flat, hourly fee, they’re going to want to try to work as often as they can on your stuff. You know, and so, but like you said earlier, there’s no model out there that exists that does not have, you know, at least some conflict.
Justin: 27:08 Right. And another helpful thing to acknowledges some physicians or anyone is wired to be able to do this themselves and to stay in the market when it crashes and to do their own financial planning and to cruise around on white coat investors blog and figure out how to do the backdoor Roth and make sure that they’re in a tax optimized situation if they have self employment, income, et cetera. Some people are always just going to do that and others recognize or believe there to be value in working with a professional in that context. So it’s a lot more than just the money management and the AUM mechanism is a way for an advisor to get paid for, for all of the holistic financial care and advice that they provide in a, in a perfect world where the advisor is actually worth their salt.
Physician Philosopher: 27:51 I agree. Um, you know, and I’m actually going to have a post coming out in the next few weeks on this. I’ve been mulling over in my mind, but you know, there are situations where a financial advisor is not only a good thing, it’s probably, you know, recommended and that’s coming from me who heavily support do it yourself investing. And one of those scenarios is if you know yourself and you know you don’t have the discipline to not worry about the money when the market’s going down, any money that you would be losing to an AUM model or to any other kind of model where a financial advisor says, no, let’s, let’s stay in the market. This is a wise and prudent thing to do. You have reaped the rewards far past any, anything that you’ve ever paid in that model. And so there are situations where a financial advisor is worth their weight in gold and I definitely support that for, for certain people
Justin: 28:33 and it’s my firm conviction that, you know, somebody who is disposed that way will reap benefits, multiples of, of what that fee costs, whatever it is, but it’s not a good fit for everyone. So, and frankly, when I talk to prospective clients, they’re not convinced that the value, I will try to convince them of the value, but I’m not going to try to get them in the door. I want them to be excited and interested to work with me and engaged in the process and convinced of the value or else frankly, it’s going to be a painful union. They may not derive the benefit that I believe that they could and it’s probably going to end early for, for both of us, and no one’s happy in that situation. So I think another nugget to take from this is do your vetting upfront. Make sure you’re excited about an advisor you’re engaging and then dive in with both feet. Yeah, absolutely. So I’m interested you, um, you know, you posted this thing the other day about kinders three questions. So as a financial planner, I love to incorporate the, what we call life planning aspects of financial planning. Obviously it’s more than just the numbers. I’d love to hear a little bit about your perspective on how you think about life planning, how you think about these, three questions which we can discuss a little bit and, and how that’s impacted the way you think about holistic financial wellness.
Physician Philosopher: 29:41 Yeah. So I think that those questions are particularly helpful because they allow you to realize what’s truly important. You know, and, and working in medicine, we see this all the time. Although when you see something all the time it becomes kind of routine no matter how, you know, disturbing or impactful. It might seem to other people. And in end of life scenarios, people almost never talk about, you know, you know, wishing they had more money or that they worked more than that. They published more papers or you know, or any of these things, you know, what they talk about are the experiences they’ve had with loved ones and time they spent together with, with people that care about. And so these questions really particularly in the order in which you read them, help you realize just what parts of life are really truly important and is the life that you’re living right now reflecting that which I think is, is the second part, which is really important.
Physician Philosopher: 30:33 So first of all, realizing what is important and then designing a life that actually reflects that because you know, I’ll be the first to admit that in the last four or five years and you know, living a busy life, you get stuck going through the motions and the routines and you look back and you realize, oh, you know, I, I probably should have spent more time playing with my kids or take him to the park or you know, being intentional with taking my wife out on dates and having conversations and putting my phone down when my kids are around and you know, things of that nature. So I think that’s really important and it really the root of all this is that when you have financial discussions and with as much as we talk about investing in money and advisors and all this, you know, monetary talk, the ultimate commodity is not money, it’s time. We all have only so much on this earth and so we want to do it, uh, you know, with as much intention as we can on the things that really do matter to us.
Justin: 31:24 One hundred percent agree and I would say especially for physicians who are very demanding schedule and other sort of, I would call them, you know, very busy professionals, there can be a tendency to not even take the time to, to think about the most important priorities and values that may characterize your life or your family. And I think one of the temptations is to just never think about it. You’re busy. You figure I’ll make as much money as I can now. And then I’ll figure out how to make it work as we go. And you never stop and think for myself, for my spouse, for my family, what do we want our legacy to be, what do we want to build our lives around? And I think this is actually a great place to have an advisor, a third party sort of, uh, you know, help spouses or family navigate this discussion because even just sitting down and having the conversation of what’s important to you and why are you doing what you’re doing, what’s the end game that can be so, so meaningful. And frankly, a lot of people never slow down enough to be able to ask those types of questions. Would you say?
Physician Philosopher: 32:17 I completely agree. I, you know, I think that what happens to physicians in particular and you know, like you said, other, you know, hiring medical professionals is the following. There is a very specific written, even planned to, you know, achieve becoming a physician or a nurse anesthetist or a PA or nurse practitioner or what have you. And at the end of the day, your job is just to like to go through that path that you know, thousands of have gone through before you and when you look up and, and this is the interesting time that we live in now when, you know, millennials are starting to question a lot of these things, but the hard part is, is like you just, you’re just supposed to do what you’re told and do what others have done before you and put your head down and push the plow just like everyone else has.
Physician Philosopher: 32:57 It’s your turn. And when you do that, you know, five years, seven years later when you’re done with residency, you look up and you say, I don’t even recognize the person that, that I am anymore. Be like, you know, you’ve lost a lot of your passions and your hobbies. And the reason for that is because you get stuck in the muck and mire of the routine of just going to work and doing what you’re told every day. And so I, I agree. Being intentional about the life that you’re living in, whether it’s actually, you know, pursuing the things that really you care about is. It’s really, really challenging in medicine. The job just, it almost actively prevents you from doing that. And so, you know, having these discussions with someone else. I agree. I think I, I think that that would be helpful for many people because, you know, the other thing too is that we all recognize.
Physician Philosopher: 33:39 I can tell him, I tell my kid the same thing, you know, whether it’s about golf or, you know, math problems or reading or really anything. And then the second that someone else comes along that they respect and tells them the same exact thing, even in the same words, uh, oftentimes that is what, you know, makes it click and be like, oh, I get it now. I’m supposed to do it this way. And the same thing happens in marriage. Like you can talk to your spouse until you’re blue in the face about something, but then when you have a third party come in and kind of help you sort through those things together, kind of provide a different perspective. It’s, it’s often really helpful for people.
Justin: 34:08 Yeah, totally agree. And just to give our listeners a flavor, we keep alluding to these three questions. I want to give a brief. You can, you can google this Kinder’s Three questions. That’s K I n d e r George. Kinder is the guy who sort of pioneered or was one of the pioneers of what we call the life planning movement, which is this idea of taking finances and financial planning beyond just the investment account, the brokerage statement, returns and taking it to this deeper level of priority, value and meaning. So these questions that he developed or designed to sort of peel back the onion and the context of, you know, thinking about your own life or your family’s life. And so the first question has to do with, you know, if you’re financially secure today, you have no more financial obligation. How’s your life going to change?
Justin: 34:49 Really think about, you know, what, what am I going to do when I achieve financial independence? So that’s kind of one layer of evaluating priorities. The next layer down has to do with your doctor tells you you have five to 10 years to live. How now are you going to change what you’re building your life around, what you’re putting your time and your money into? And then the last question is your doctor shocks you with this news. You’ve only got one day left to live. What are the things that you’re thinking about that rise to the surface that I wish I had time to finish this. I should’ve done that differently. Things that you know, hypothetically you can still do now, today, and this process, especially when you know, you go through it with a financial coach or a financial planner is designed to help a family or a person evaluate what their priorities are.
Justin: 35:35 Identify them clearly and then say, oh my gosh, if I would do this thing when I’m financially independent, but I can actually do it today. Maybe I should just do it right now or start living differently or these things that I would regret if I died tomorrow. Maybe I should do them next week and, and it can help to bring clarity to these really fundamental questions and I, I’m really excited about this process and excited to walk through it with clients and I encourage everybody whether or not you’re going to do this with an advisor, ask these deep questions, reflect on who you are and what you’re doing, especially in the middle of the dizziness and see if that is going to change the way you align your time. Yeah, and you can even check it out on my website too, on that post. There you go. ThePhysicianPhilosopher.com.
Justin: 36:16 Everybody go there to check it out. So, you know, we talked about the types of advisors to find. So I, you know, full disclosure, I am a financial planner fee only. Um, I, I don’t use the AUM model, but I do have a similar calculation that’s sort of beyond the scope of this discussion. I don’t want to get into the weeds there, but if somebody comes to you in one of your residency and says, how do I find it? An advisor, how are you going to counsel them? What were you going to tell them to go to look to find one of these types of advisors who you think might be a good resource?
Physician Philosopher: 36:42 Yeah. You know, that’s actually one of the more challenging questions that I get because I certainly know specific people and specific advisors that I think are just fantastic and worth and worth looking into. And so depending on what the person wants, you know, whether they want an in person advisor or they’re okay with someone else’s, you know, remote. I might give them specific names to consider it and I always give them more than one because I don’t want to feel like there’s a conflict there. But, uh, there are things I tell them they can go look on a, a NAPFA and see if, uh, you know, see if they’re listed there is a fee only advisor or if they, you know, take part in x, y planning network. I also encouraged them to look up anybody they would consider using on the a FINRA broker check, see who employs that person, you know, because if it’s an insurance company then they’re not a fee only advisor.
Physician Philosopher: 37:27 Um, you know, and, and you can also learn a lot about, you know, kind of their background perspective and if they’re, if they’re a particularly interested person that really wants to get into the weeds, I’ll even tell them, you know, there’s this thing called the adv brochure and you can go read about specifically, you know, how these people, you know, align their models and, and, and that has to be factually correct because it’s, you know, what the, what they’re required by law to submit and so, you know, and they’re helpful posts on how to read through an atv if you don’t know how to do that. But yeah, so it really just depends on what the person’s looking for. Um, but just like you, I tried to minimize my conflicts and so, and, and most of my residents don’t know about my website because it is anonymous and so, you know, I really want to do the right thing and do it the right way. And so I try to try to do that.
Justin: 38:10 Yeah, I’m a big believer in, uh, the exact same thing as if somebody asked me that question, I’d say NAPA, that’s the National Association of Personal Financial Advisors, which is a fee only organization, meaning every advisor who participates on that platform is not legally allowed to earn a commission. So all the advice they’re getting is totally divorced from any commission possibility. Same with x, y planning network and other feelingly and, uh, association. That’s definitely great place to start. Uh, and, and I think it’s important to just, you know, look at a few, as you said, look at a few different advisors, interview them, find out how they tick it, if they’re going to personally resonate, if you’re going to resonate with their investment philosophy, they’re planning the experience, make sure that they’ve worked with some other doctors. Those are definitely all really important things to think about.
Physician Philosopher: 38:54 Absolutely, and I guess I should’ve mentioned those four criteria from earlier that we talked about, but yeah, I think that experience is a huge thing because people don’t realize is that if physicians, financial situation is very unique and very specific, and Justin, you may have an example, but I can’t think of another field where you go from making basically the average salary to making, you know, the top one to five percent. All the while you have had all this debt you can even pay the interest on during training. And so it’s um, it’s a very unique situation. So if you don’t have somebody that’s, that’s honestly got a lot of experience with sorting through student loans and whether to invest or pay down debt and help you figure out based on your personality and your desires, then you know, it can really hurt you honestly.
Justin: 39:34 Absolutely. And I would, I would go a step further and say, if you have a lot of student debt and your advisor doesn’t have extensive experience with student debt, I’ll tell you as a CFP a handful of years ago, I didn’t even know what I didn’t know. And I had a physician friend come to me and say, Hey, what do I do with these loans? I was like, well, you know, sort of in descending order of interest rate and start at the top and work your way down. And actually that’s terrible advice potentially. And by the way, none of this is specific advice for your situation. We’re going to put a disclaimer at the beginning and end of this episode. But, uh, the point is get somebody who knows student loans because if you are in the federal loan system and if you’re a physician working through residency, looking at a potential career in an academic center, there’s so much opportunity for tax free forgiveness through PSLF and other forgiveness programs.
Justin: 40:17 You don’t want to flush that down the toilet without knowing all of the different options. And so it’s really important. Either get a specific loan analysis done or work with a planner who is very familiar with that system because it can literally be a six figure, a big six figure number six figure decision. Just last week I was doing a loan analysis or somebody and it was $130,000 differential and another advisor told them to refinance. They were going to qualify for PSLF and the forgiveness was like 160 k at the end of the line that they were going to qualify for. So there’s so much misinformation out there that’s a really important area to make sure that your advisor is savvy on if you’re going to be engaging them for that.
Physician Philosopher:40:54 Yeah. I think that’s the toughest part honestly, because unlike designation for investing or financial planning, there’s not really a test or exam or qualification or designation. You can get to be called an expert in student loans. I mean, you, you can read about it. Um, but, you know, I can say that having experienced lots of conversations with residents and you know, reading through this, you know, the AMC WMC, student loan debt manager and, and all these other resources that it’s amazing what residents don’t know. And honestly, it’s amazing. It’s amazing what some, some advisors don’t know, just like you said, because I had a resident that was two years into a residency and wasn’t in repay and she was a single, a single physician. And uh, I told her about repay and she, um, you know, saved like five or $10,000 in the last couple of years by switching to that, you know, and it’s like, but she missed that the first two years because no one ever had that conversation. And so, and that honestly is what prompted my blog is that despite all of the other wonderful things that other physician bloggers and podcasters and people out there doing, there’s still this massive void that needs to be filled.
Justin: 41:56 I’m really grateful for you and Jim Dolly over at white coat and others who are spending a lot of time investing in educating the community. And frankly, the purpose of this podcast is equipping a anesthesia and pain docs to have the information they need to fill this gap so that I, you know, I can’t help everyone as a client, but having helpful information like this publicly accessible is going to be hopefully a real asset to the community. So in closing, I want to ask you is sort of a two part question here, which I ask all my practitioner guests and since you have this dual identity of, you know, attending anesthesiologist as well as physician finance, wellness blogger. Yeah. Maybe you can answer this in each context is you obviously spend a lot of time and effort pursuing these vocations. I’d love to hear a brief anecdote or story about in each of these, a proud moment where you said, you know what, it’s all worth it because I was able to help one person or save one person or do have a real meaningful impact in this way.
Physician Philosopher: 42:52 Yeah. So I think that as you know, as an attending physician at, at my main Gig, the times when this comes up the most, or when you were helping take care of a patient who’s in the toughest times in their life, usually involving an airway of some kind and you come in and help somebody successfully save a patient. And after the experience you kind of look back and you think, wow, I’m probably one of only a couple of people in the entire hospital that could have done that, you know. And so in anesthesia we have such a unique training experience that pretty self sufficient in our abilities. And so, you know, I’ve had that happen several times. I’ve had it happen recently. Um, and, you know, I guess the one story that I tell you know the most because it’s just kind of interesting is I was at the beach with my family and uh, I was reading the lion, the witch and the wardrobe to my two oldest kids.
Physician Philosopher: 43:37 And when I was reading that book, we heard a helicopter and you know, my son at the time was like, you know, four. And so he’s of course, you know, just enamored by anything that is a truck or helicopter or anything like that. And so he’s like, you know, helicopter Daddy. And so we, we know step outside and, and um, and I see, um, I see this ambulance parked over to the side of the field and a helicopter landing behind it and this, this patient in the back of the trucks clearly being airlifted and we stand there for a few minutes and like nothing’s happening, you know, I looked down there and nothing’s going on. And so I’m like, there’s gotta be something wrong in the back of the truck. And so I walked downstairs and I put my loafers on and I’m wearing like, you know, baseball shorts, like athletic shorts and a white tee shirt.
Physician Philosopher: 44:17 I look like an absolute bum. You didn’t bring your white coat to the. No, exactly. And no stethoscope. Yes. Right. And so I walk, I walked down and you know, there’s a road in between the field and where our, where our beach houses and I talked to the guy who’s conducting traffic and I say, hey know I’m, I’m sure that you don’t need my help, but uh, you know, if you do, I just wanted to mention that I’m a physician and I’m happy to help you if you need it. And uh, he looks at me, he says, well, you know, they’re having a really tough time putting the breathing tube in, on the back of the truck. And I said, that’s interesting. So I’m an anesthesiologist. And he’s like, Oh yeah, yeah, yeah. We would love for you to help. I walked to the back of the truck, which is, which is actually surprising because, you know, there are lots of stories about people that, you know, our physicians in plain clothes that asked to help and are denied.
Physician Philosopher: 44:56 I actually have a friend who got put in handcuffs because of that situation he got, he got sent to jail for a couple of hours because I’m. So they proved that he was a physician. He was very upset about a situation that was happening. Of course, everything ended up being fine. But uh, so I walked to the back of the truck and, and, and I got the response that I initially expected, which was, you know, young EMT and he’s like, no, no, we’re good. We don’t need your help. I look in the back of the truck and there’s this guy with gray hair, lots of experience probably in his sixties, fifties, and he is just, he’s having a hard time. And so I look at him, I make eye contact with them and say, Hey, I’m an anesthesiologist, I’m happy to help you. This guy here saying you don’t need my help, I’m happy to walk away if you don’t need it.
Physician Philosopher: 45:31 And he looked at me and he said, please come save me. And so I got in the back of the truck and you know, started asking about what was going on and you have to Kinda took control of the situation and you know, ask for Miller too and a Bougie and asked where the equipment was that I was going to need. Ended up intubating this, this person on the back of a truck while I was at the beach on vacation. It was really interesting though, because, you know, had I not been there in that situation that they were not gonna be able to intubate this person and uh, you know, we got them on the helicopter and he got transported. But kind of moments like that where you know, you realize all this training that you’ve gone through, it really has taught you a lot because a lot of times, particularly in anesthesia practice in a silo and you don’t really see other people.
Physician Philosopher: 46:09 And so that was one of the, you know, affirming situations. And I guess at work, probably my favorite situation, this is just a generic example. I won’t give any specifics just for anonymity, but when I see a young learners lights turn on that they finally understand a concept, whether it’s, you know, about intubations or you know, cardiac physiology or an epidural or even personal finance. Like I love those moments and it’s the reason that I went into academia is to teach. And so in the same thing happens on the website when someone emails me and say, Hey, you know, this is post really, really resonated with me. I really appreciate you talking about that. And uh, and introducing it to me, I, you know, I learned a lot like those, those are the things that really make everything impactful and worth it.
Justin: 46:45 Yeah, that’s excellent. I, as a financial person, that’s that level of intimate impact is something I obviously can’t relate to, but always deeply respect and appreciate and uh, it’s, it’s an amazing thing to be able to do that kind of work everyday. So I’m grateful for people like you and like my wife and, and others in the medical community. Thank you. The physician, Philosopher. Thank you very much for joining us today on the anesthesia success podcast. Absolutely. Thanks for having me. I really enjoyed it. Hey Justin here. This may shock you to learn, but I am actually not a fulltime podcaster. I also run a financial planning company called quantify planning, where I work closely with anesthesia and pain docs to build and implement customized financial plans. If you’re interested in working with a financial planner who knows many of the ins and outs of your profession, shoot me an email or head on over to quantify planning.com. For more information, if you’re a resident or fellow, I can also offer you a free student loan analysis if you’re interested, but there might be a waiting list, so check out the link over there to see if you’re interested in learning more about the topics we discussed today. Head over to anesthesia success.com to join our community residents and attendings and others to ask a question or get more free resources. If and only if you liked this episode, please leave us a review and subscribe. Thank you very much for listening to the anesthesia success podcast.
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Dan Gummel & Justin Harvey
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Great Scott: Don’t Hold Back
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