Episode 34: Begin With The End In Mind For Career Success In Anesthesiology w. Dr. Jesse Lopez

Feb 4, 2020

This Episode

Interview w/ Dr. Jesse Lopez

You Will Learn

 You will learn:
– How Dr. Lopez manages “burn out”
– The reason why Dr. Lopez started the Physician Negotiator podcast
– Dr. Lopez’ favorite tips for younger listeners

Resources & Links

In this episode, Justin sits down with Dr. Jesse Lopez to talk about how to prepare yourself to avoid many of the strains and stresses that come in the latter years of a physician’s career. They also discuss how to make money work for YOU as a physician.

Justin: 00:54 Welcome to episode 34 of the anesthesia success podcast. I’m your host, Justin Harvey. I’m really excited to be joined today by my friend, Dr. Jesse Lopez. Jesse is an attending anesthesiologist in Columbus, Ohio. He’s also an entrepreneur. He’s a podcaster. He is the proprietor@docofalltrades.com as well as he runs the physician negotiator podcast. So Jesse, thanks a lot for joining us today. Oh, great to be here. Thank you Justin. So we met most recently at the the fin con conference. There’s been a few guests of this show who have met at fin con, so it’s obviously the financial nerd Mecca and there’s a few people in medicine you know, that, that I’ve met there. It’s been an interesting experience.
Dr. Lopez: 01:35 Oh, I, I love fin con. I loved the community and what’s really surprised me this year was how much this community is growing. And I think when I first started there were a few thousand. Now it’s what over 6,000 people in attendance. It’s incredible.
Justin: 01:49 Yeah. And, and I think a lot of the pressures in medicine make, make physicians in this fin con community. It’s a PR, it’s a natural fit because you can really help to insulate yourself from a lot of the issues and problems in healthcare by pursuing financial independence, having a plan and moving towards a desired end intentionally rather than letting life kind of happen to you, would you say?
Dr. Lopez: 02:15 Absolutely. you know, financial illiteracy was something that I was really attracted to and I really got to credit leaf daily from a physician on fire for really getting me involved in that. And if it wasn’t for him, I probably wouldn’t have ever known what fin con was. And the beautiful thing about it during the, the Genesis of discovering myself as a as a blogger and as a podcaster, I was able to then grow a community of other like-minded physicians who had the S who had similar stories and similar goals in mind. So, you know, I can’t think these people enough.
Justin: 02:54 I’d love to hear from you, Jesse. I mean, you’ve, you’ve been practicing anesthesia since the early two thousands and have a good sense for the arc of what anesthesiology has looked like. Talk a little bit about that journey for you and, and how things were for you clinically and from a career standpoint when you first started and how things have evolved over time.
Dr. Lopez: 03:13 Physician is a completely different animal from when I started. I kind of feel like an old man now. I still remember my first day as an attending and that was back in 2005. And I remember being the youngest person there and I had a lot of older attendings that were telling me how it was. And I specifically remember early on in my career that it was sink or swim. They would throw you into the fire as an anesthesiologist. And if you D if you could not survive the clinical pace, if you can survive the onslaught of emotional attacks from older peers cause they’re, they’re challenging you and they’re, and they’re trying to push you then you would make it. It was, it was very, very, very difficult. And you know, I, I’ve been recently watching the opposite again at the U set of lenses.
Dr. Lopez: 03:59 Cause the first time I watched the office, I didn’t think anything of it. I just thought it was funny. Now I’m watching it and I’m kind of going through trauma because now quite frankly, you know, my first five years as an attending as a junior attending was a, it made the office look like nothing because it was very, it was very, it was a very challenging environment. There was no holds barred. Nobody nobody cushioned anything that they said. If, if an attentive, a surgical attending who’s been there for 20 years in like you, they would tell you you’re an idiot to your face. And it was, it was a very, very hostile, you know that being said, I loved anesthesia. I thought anesthesia was amazing. And to me I thought, well, you know, there’s a couple of, you know, rough personalities in medicine. I get that. I, you know, I was in medical school and in residency I experienced the exact same thing. And I realized that if I could just circumvent, not necessarily men, but I could rise above those personalities and you know, perform excellently, then I could rise myself to the top and become an excellent clinician and then possibly even run the department someday.
Justin: 05:06 Yeah. And so can, do you recall any specific stories or instances that would maybe help to embody and give some color to, to those ideas early on?
Dr. Lopez: 05:15 Oh my goodness. I remember the as as a, as an example, onboarding this day and age is very gentle. So if I were to onboard a new CR ne or an anesthesiologist, typically it would give them two or three weeks of being one on one with another anesthesiologist or another CRDA. We would ease them into this call schedule. They probably wouldn’t take call for the first month and we would give them cases to try them. Like, you know, here’s a, here’s a case that would a low hanging fruit. It’s easy, maybe a lap coli, something that to get them familiar with the equipment, with the personalities, with the process. My first week, I am pretty sure I did two ruptured triple A’s, so, and it was like sink or swim and working at a level one trauma center back in the day, we didn’t have a lot of support in the evenings.
Dr. Lopez: 06:05 So I recall my very first night on call and by myself I’ve just been practicing medicine for maybe a month or two and a giant level one trauma comes in for, for the audience who doesn’t know what that is. That’s, you know, eh, you know a very serious case where someone’s life or limb. So, and I remember I’m by myself and my job was to set up the room, call the backup guy, and cover another clinical area at the same time. Wow. You know, and again, there was absolutely 100%, no backup. I was 100% by myself. And if anything else happened in the hospital, that was also my responsibility. Wow. So it was a bit overwhelming. But you know, I feel a little bit honored because I survived. I was able to handle that clinical pressure and other members you know, other friends of mine, they, you know, they were good, but they just didn’t like it.
Dr. Lopez: 07:00 They couldn’t handle the, the emotional pressure of it. So they ended up leaving. So they didn’t, they didn’t survive that practice. And whereas today had I started today, it would be a much, much, much different experience. Hmm. And so what kinds of things are you seeing today? Like how would that have transpired? You know, in 2020 and 20, 20. It’s, it’s a, you know, if there’s a very, very, very challenging case like that, and you, you want to put the right person with the right set of skills to guarantee a person a chance to succeed. Right? So I’m not going to put a brand new attending into a ruptured AAA and give them the chance to fail. I’m not gonna set them up for failure. And so this, this, in this environment, you, you know, I, you know, I put it this way recently, what’s been happening at larger organizations, including my current organization, is that competency is expected.
Dr. Lopez: 07:58 Everybody expects you to be calm, calm competent. If you are a board certified anesthesiologist or board certified surgeon, you know, they expect you to be excellent at what you do. The new paradigm is you actually have to behave at the same time. So you, you can’t act like you’re in a bar, you know, you can say, you know very inappropriate comments to anybody or you risk being fired. And I, I know a couple of people that had been fired recently for, you know, kind of pushing beyond, you know, the, the lot, you know, it’s funny, it’s funny, Michael from the office calls it going over the line. These guys go, they went over the line and they thought they were untouchable and now they’re no longer employed with with, with our organization. And this has happened in multiple organizations in, in with all the other anesthesia groups that I know of. Yeah. So talk a little bit about your, your businesses through both doc of all trades.com and physician negotiator podcast. And by
Justin: 08:56 The way, we’re going to link to these in the show notes. So great. Anesthesia, success.com/ 34 we’ll have links to all of Jesse’s endeavors here that are designed to help physicians really thrive clinically, professionally. Talk a little bit about how you kinda got on this mission to want to contribute in that way.
Dr. Lopez: 09:12 So when I first started my website, I was kind of frustrated. Most anesthesiologists, and I’m sure most physician attendings, whether they’re in academics or private practice, they want to do their best. They want to Excel, they want to succeed, they want to perform clinically, excellently. And in my case, I also wanted to succeed as a leader. I wanted to be, you know, I wanted to prove myself not only in the AOR but outside the or, and I wanted to make an impact in my department and in my community. And so what I did is early in my career I did what everybody else does. And what everybody recommends and I still recommend is I participated in committees. I volunteered for, you know, anything that came up that somebody needed somebody to volunteer to, to help out with the department, to help out with the hospital.
Dr. Lopez: 09:58 I was that person. So countless number of meetings. And as I attended these meetings, I would recognize people as, Hey, thanks for coming to meeting. You know, I know you’re doing it on your own time, et cetera. And slowly that went from me being a person who volunteered to a person who I was actually nominated to be the vice chairman of my department. So I started, you know, having influence. I started getting to know other people in my department. And then outside of the department I started interacting with other members of the medical staff community. And I started to learn with the medical staff community was all about. And in that evolution over the next 10 years, I ended up going from the chairman. I ended up, I’m sorry from the vice chairman to the person who ran the schedule.
Dr. Lopez: 10:42 We have something called a surgeon and governance council. I was a member on that council. And then ultimately I became the medical director of my department now that would, that’s roughly equivalent to being like the president of a group of a private group and, or like kind of like a chairman in an academic department. Okay. Obviously it’s not like when I’m not part of a medical exec, but I was the administrative arm of the hospital in my, in my in my department. So I had a lot of responsibilities. And during that process I think I grew too quickly and I didn’t have enough mentorship. And during that process, as I was running the department, I decided to take on too much. I took on way, way too many tasks and then ultimately one task I took on in particular was had to do with staffing.
Dr. Lopez: 11:31 And perhaps, you know, because my role was really only to run the department of anesthesia, I started to try to run other departments like the department of surgery and the department unit in the operating room operations. And then I overstepped my bounds. And in doing that, I, I would basically was told that I was, my input was not appreciated and consequently thought maybe it was a time for me to try something else. And so I was no longer the medical director. I was asked. I was, I was never stepped. No one ever dismissed me from being the medical director. But I was told that if I wanted to continue being the medical director, I’d have to reapply. And I decided at that point that maybe being a leader wasn’t, wasn’t for me. And so doc of all trades kind of helped me work through that process and it’s continues to help me work through like, what does it mean to be an anesthesiologist today? What are my, what are my values? And cause what it made ultimately did is it made me question my values, what was most important to me. And suddenly I felt like my values were not in alignment with the hospital’s values. And again, it’s not to say their values are bad, it’s just that they were different. And having said that, I needed to kind of realign. And so doc of all trades is the, and the physician negotiative podcast is, was a, was an attempt to do that.
Justin: 12:50 And, and when did all this transpire Jesse?
Dr. Lopez: 12:53 Oh man, I think this all went down in 2016. I think it’s been awhile. Okay. and so, Oh, sorry. Go ahead. No, but I was going to say, you know what, what it’s taught me though was what you think’s going gonna happen in your professional career when you start out, what you think’s gonna happen may not necessarily be where you end up. So you know, personally I’ve been lucky. I’ve been very, very lucky that things have just kind of worked out for me. I’ve had since I’ve met this larger physician community physician, blogger community, I have felt like I’ve received a lot of excellent advice, a lot of METRANS ship from them. And I’ve since then grown significantly. And the probably the biggest message that I learned, and again, this was just luck, was that, you know, being an anesthesiologist were very well compensated. And one of my mentors early on told me to start saving more than 20% of my gross income back in the day. And just by happenstance, I just did it without really thinking about it. And it turned out really well for me as a consequence.
Justin: 14:02 Yeah. That was back before it was cool, quote unquote. Oh, exactly. And in this, in this weird little corner of the world, that’s one of the things that happens when you start running around in the financial independence community is you forget that there’s like a 99.7% of the rest of the world out there that isn’t already automatically saving 25, 30 plus percent of their, exactly. Well, for anybody who’s listening in, like just, you know Jessie’s talking about this community. So there’s physician on fire who’s been a prior guest on this show and episode nine the physician philosopher and then the, the grandfather of the mall dr Jim Dolly at white coat investor. These, these blogs and these physicians have been really influential in the physician finance community to help doctors like take control of their, their money. And then by virtue of their controlling their money, the hopefully their, their ultimate future and trajectory a as a professional.
Dr. Lopez: 14:52 Exactly. And you know, I gotta give, I gotta add one more to there as Corey faucet. Yes, that’s right. You know, so it’s funny, every time I read one of Cory’s books, he’s written several. I always say to myself, man, that’s the book I wanted to write. But Cory, Cory’s brilliant Daryl because he decided to do to do this whole idea of practice medicine with the end in mind as a medical student. So we’re talking like in the 80s, this guy was, I mean if anyone’s the grandfather, it was Corey is hearing his stories. I will, I just stay, I’ve just didn’t complete. I every time I speak to the guy.
Justin: 15:27 Yeah. And you know, as we’re naming names, I’m starting to get a little self conscious cause I know dr Bonnie Q also done excellent work. She’s actually going to be a guest next week and many others. So if you’re listening to this podcast and you’re one of my friends who has a physician finance blog comes out, I’m sorry if I, if I’m not naming you here, but the point is there’s a growing awareness in the medical community that physician finances is kind of a, it’s like an escape hatch to all of the environmental factors in medicine and healthcare that are eroding physician autonomy and sometimes like work life balance and ultimately fulfillment and joy and happiness. If, if you find all of that going away, one of the ways to combat that and to push back against these forces is to take control of your money so that you’re no longer beholden to an employer who you may not be thrilled with.
Dr. Lopez: 16:12 You know? So on that note what I realized was in, and I think I was burning the candle on both ends. So bear in mind, going back to what I had said earlier, I was still in an a level one trauma center doing open heart surgery with a pretty demanding schedule. And on top of that, I was running, I was the medical director running all the operations. And so, and you know, I’m trying to take care of my family. I had at the time at a very young family, I have a young son who has autism. And so my wife and I mostly my wife had to give her all the credit. We were trying to run an ABA program in our basement with, you know, counselors and teachers in and out of our house 20 hours a week. So, so much was going on.
Dr. Lopez: 17:02 And what, what happened was, and, and this is what I, this is the main advice I give to all physicians. If at any point you feel overwhelmed, you need to basically stop and take a pause. And what I want when I say that, I mean you need to take a sabbatical. Sometimes just an extra week of vacation. I know a lot of my period only take one week of vacation at a time. I took three weeks of vacation. I mean, I needed time off to clear my mind and I would never the amount of, the amount of clarity it gave me, I will never give it up for the world. All the money that I lost as a consequence of not working was totally worth it. And during that process, I realized time was more valuable than money to me at that point specifically because like I said, I had a child with autism and I felt like that was my, my, my professional career was pulling me away from my, my personal life.
Dr. Lopez: 17:55 And I D I didn’t want to sacrifice that. And I’m actually writing an article about this right now as we speak. I haven’t published it yet. Because you know, if you look at the, the generation before generation X, which is what my generation was, they were all about work. Family kind of came second and then the millennials family comes first and work come second. And so right wedged in the middle is gen X where we have to, we have to basically meet the demands of our prior generation, which is works first. And our new peers who says work is second. And so we, we basically try to prioritize them both and end up failing. And so that’s that that was ultimately the real struggle. And the way I combated that is I listened to, I was on call one evening and it was, it was after a very, very long, a long day.
Dr. Lopez: 18:46 I think I’d been working 20 hours straight and level one trauma came in and I remember taking care of this person and you know, they were, they, they were fine. And when my peers gave me a break and I decided to walk out, it’s like two or three in the morning walking out of the operating room and I leave a trail of blood with my shoes and I look back and I’m like, I’m like that. If that, if that isn’t symbolic, I don’t know what is. Yeah. And I sat down on a chair. I was just exhausted. And why I did this is beyond me. I started looking at my phone and I started just kinda, you know, trying to get my mind off of what was going on. And I ran into an article about a physician that retired or was about to retire at age 4,142.
Dr. Lopez: 19:28 I can’t remember what, and I said to myself, that’s a thing. Like this is, this is possible. Cause for me at that point, I’d never even considered it. I never thought retirement at an early age was even an option. And that’s when I first found out about physician on fire and the fire community and et cetera, et cetera. And so at that point, I kinda got it in my head that I wanted to back off of my clinical practice and give myself that time that I’m, that I’m telling you about to kind of figure out what I want out of my life and to spend more time with my family. And so probably it’s been about a little over a year and a half now. I did just that. Now I’m a part time anesthesiologist. Wow. Awesome. So I didn’t realize that you had officially made the transition to talk a little bit about how that unfolded for you.
Dr. Lopez: 20:16 So it was a part of the reason why I started the physician negotiator podcast was because as the medical director, I was privy to all the meetings. I knew exactly. I was being mentored by other physicians who would then go negotiate their own the groups contracts. And so I kind of started to understand how the inner workings of of hospital hospitals worked in my first two contracts. I successively negotiated. And the way I did that was with the help of, of, of my peers who had done it before me. And I started investigating MGMA data. I started learning about, you know physician salary surveys. Yeah. And in that process, you know, I got really savvy about making spreadsheets, you know, learning how to figure out what my market value was, how to look, look, you know, how to investigate.
Dr. Lopez: 21:10 It’s kind of like real estate, right? You have to, you figure out your comps, et cetera. In that process though I became pretty good at negotiating. And so when it came to, to to do, to transition to part time, no one had ever done it in my practice before. So I proposed it in the way I did it is I basically went to a bunch of my peers were older than me and I asked him questions. I’m like, well, what do you think about going part time? What do you think it would look like and how do you feel about that? And so I did it as I was able to get some buy in with many of my peers. And then once I got buy-in, I constructed a a business model and then I proposed it to the hospital and the hospital loved the business model.
Dr. Lopez: 21:48 They thought the business model made sense to them. It created an extra cushion of anesthesiologists that could potentially work in times when we were busy and when times weren’t as busy, it saved the money. So it was kind of a win win situation. Everybody was happy. But the funny thing was trying to get all the pieces in alignment. Sometimes is difficult. And I struggled to get all the players to, to all the cogs to move at the same time. And anytime you work in a large organization, I don’t care how big, you know, what organization it is, especially healthcare, they move incredibly slow. And so first, you know, I thought I would get this deal done within a month. One month turned into three pre months, turned into six, six months turned into two year. And then at that point I just became very frustrated.
Dr. Lopez: 22:36 And I had attended another, I believe at that point I attended another fin con and other, all these other people were doing these amazing things. And what they did was they said, you know, here’s the deal. If you want something bad enough, you will find the resources to make it happen and you have to take massive action. Hmm. So I it’s funny, I was cleaning out my cabinet today. I found my resignation letter in my in my, in my cabinet. And it was very simple. I asked, I, I told everybody in the group and I told the hospital that I did not want to threaten him. I didn’t want to resort to, you know, anything that would be considered hostile. I said, but at the same time, if my needs aren’t met, I’m going to have to go someplace where they are met. And they said, well, you have to do what you gotta do. And so I did. I re I resigned. And you know, the funny thing about that was it said, you know, people thought I was bluffing and I know literally I wasn’t ever, it wasn’t even poker. I just really wanted to put what I wanted into, into play. And my fam, I had the total support of my family. And, and then I did it and it was still, despite that, everybody was shocked when I did.
Justin: 23:45 Were you nervous? Was that something where you were like a little jittery as you were going to allow them to quote unquote, I mean, you weren’t bluffing, so you’re just like, I’m done. I’m done. As that unfolded you, how did you feel?
Dr. Lopez: 23:58 So I had attended another conference and there was, this guy’s name is Mike Mandel, and he talks about this concept of threshold and threshold is a point where there’s gotta be a change. It’s gotta be now and it’s gotta be me. Right? And so I knew the change wasn’t going to become from without, it had to come from within. And so then I had to basically muster the, the, you know, the, the, the courage to do this. And and that’s what I did. Now having said that, going back to the, talking about having the end in mind, I’d been saving tons of money that whole time. I didn’t go nuts with an extravagant lifestyle. And so I had enough of a cushion that if it did not work out, I would have been fine. And having said that, as a professional, as a, as a professional anesthesiologist, as a professional physician, you know, if you have a good standing in your group, you’ll also have a good standing in the community. And, you know I feel like I have a very good reputation in my community. And I knew for a fact that if I couldn’t get employment elsewhere, I could easily just do locum tenens. There’s jobs everywhere. I live in the mid Midwest and literally there’s, there’s unlimited options. And so I figured I had the option of having enough, a financial cushion and I had the option that I can get another job elsewhere. And I had the support of my family. So I had the trifecta.
Justin: 25:20 Yeah. And I think anesthesiology is one of those specialties that lends itself quite nicely to locums work. And we interviewed Kyle Hadley in episode 17 talking about how do you use locums to accelerate your journey to financial independence. Even for physicians who are full time employed, are pointing back, Lloyd, you can use it to supplement around the edges and that can be really a really a really useful tool in the toolbox. But you said something that I want to circle back on. So begin with the end in mind. I think this is such a valuable concept and probably many spheres of life, but one of them is, you know, career and finances and the intersection of those things. So talk a little bit about this concept and what it means to you and, and also, you know, there was this article that you wrote on your blog that I want to refer to. We’ll drop it in the show notes. So anesthesia, success.com/ 34 I want to link to this article where we’re talking about physicians who either have or have not begun their career, their finances, and he’s talking about the idea of retirement planning. I don’t even really like that phrase as much as like financial independence and moving towards full financial autonomy, but talk about how does this unfold in the context of somebody who does it right and what have you seen.
Dr. Lopez: 26:28 So I think with respect to financial literacy, there is still a giant gap in what people understand and what they need to do. So what would I like to, the way I like to teach is I like to teach, especially younger attendings and CRNs that you need to think about your 30 years. You think about your 40 year old self, your 50 year old self and your 60 year old self. What’s current. Like I’ll for example, I’ll get a brand new CNA or brand new anesthesiologist and they think everything is shiny. They’re like, this is amazing. Anesthesia is amazing. This is so much fun. And I, and I tell them, I’m like, it is a lot of fun and it’s a very rewarding career, but what you feel the way you feel now may change over the course of time. So why don’t you approach it the way you would approach medical school or the way you approach residency when you approach medical school.
Dr. Lopez: 27:21 You know in four years you’re going to be you. You started at point a and you’re going to end up at point B. Same thing with residency. There’s a beginning, a middle and an end. You got to approach your career the exact same way. The question is what? What is the beginning, middle, and end. Traditionally, most people would say the beginning is when you start in the end is when you stop working and you die. And I wrote an article about that because that’s what happens to most people. Whereas I’m of the, I’m of the belief system and I agree with you 100%. If you can seek out financial independence that earlier you achieve it. And I’m not talking about being super frugal, but the sooner you achieve it, the more options that you’ll have. So for example, let’s say 10 years down the road, something fundamentally changes in anesthesia that I don’t like.
Dr. Lopez: 28:09 I could basically make a ship, I could do something else. I can you know, I can go become a Walmart greeter. It makes no difference. That being said, I also believe that if you’re doing that, you have to measure it. And so me personally, what I do I D I’ve just turbaned what my spending is. I determine how much money I’m going to have to save in order to support that spending. And then I measure how much I’m going to have to put away every single month based upon the growth, how much, what it’s going to look like in five, 10, 15, and 20 years. And I literally keep track of it every single month and I have a spreadsheet so that I know if I’m off for a ma, if I’m off or if I’m doing better than what I, my projections are great, but at least I’m measuring it and it’s always at the top of my mind. Hmm.
Justin: 28:57 So as far as having a physician charting a path to financial independence in the context of like wanting to insulate themselves from all the the forces of healthcare that may not be working in their best interest, how do you recommend somebody like sit down and start this process? Cause you just use some financial terms there that may be somebody who’s like, Oh my gosh, he’s talking about future income and retirement spending and these things, or that’s utterly intimidating. And maybe speaking Greek, what kind of resources might you recommend or how would you break it down? For somebody who says, I love the idea of being financially independent, but I don’t even know where to begin.
Dr. Lopez: 29:29 Well, first of all, I would have them go to anesthesia, success.com and after that you know, so, so I get this question a lot actually. So I get a lot of brand new CRNs and even even a brand new physician attendings and their attitude is, well, you know what, I have worked so hard. I have scraped so hard to make it here. I want to enjoy myself. Now I want to, I want to enjoy the, the, the, the, the, the the joy. What does it, what I’m trying to say, the, the the pleasures of being an attending and making you know, multiples of what I’m used to living off of. And I tell them, that’s fine and good, but only after you, only after you’ve saved 20, 30%. So far I’ve convinced a lot of my friends to stop, not to buy a house.
Dr. Lopez: 30:15 If you’re just starting out, there’s absolutely no reason to buy a house. One of my, one of my CRNs was a, she’s single, she lives with her parents and she was about to buy a house. And I’m like, is it a nice house that you’re living in right now with your parents? She says, yes. I’m like, why on earth would you move out of that house, save the money? So again, I don’t think that’s an extreme point of view. You could still have fun. You could still go on vacations. Even Corey faucet talks about this in your book. My God, if, if, if you were used to making $70,000 a year and now you’re making half a million, go spend $100,000 go nuts. But still save about 200. I mean, there’s no reason not to save money, you know? And so obviously you want to maximize a max out all your IRAs maximize your 401ks whatever your, your on your job works.
Dr. Lopez: 30:57 It’s free money. I personally, I like to do [inaudible]. So I maximize my HSA. I maximize what else do I do after I have everything maxed out? Then I look at me personally, what I did was I looked at my debt and then I did basically a snowball of my debt. B being an anesthesiologist or being any physician for that matter. Yes, yes. We are burdened with massive student loans. My me, myself, I actually inherited my wife’s student loans on top of that. But you know, you’re young even if you’re not young, if you’re diligent, you could snowball it and get an eliminate that date, that debt at the same time, saving for retirement. And then once that debt is paid off, then you could really start accelerating that saving.
Justin: 31:44 Yeah. I have a rule, not a rule, but a thing that I like to share as far as how do we celebrate becoming an attending without doing something. We’re going to regret, regret. And it’s so you can spend as much money as you want, as long as you spend at once and it’s not a recurring payment. If you’re celebrating by doing something that requires a recurring payment, you’re probably not doing it right and you’re going to, you’re going to shackle yourself to your job longer than perhaps you’re going to want to be shackled. I totally agree. So, and let’s talk just briefly about financial planning, financial advising. Cause you know, we just talked about IRAs and HSS and maxing things out. And this still might be, I mean, anybody listening right now who has a medical degree definitely is smart enough to be able to understand these concepts, but maybe they just don’t have the time or inclination and they’re just thinking, I literally want to outsource this the way I outsource somebody cutting my grass and I want to partner with somebody that I know I can trust going forward to be able to have these wealth building debt repayment mechanisms happening
Dr. Lopez: 32:40 For me. How would you, you know, do you have any advice or thoughts as it relates to that? Yeah, actually I do. I, I, I do think it is incumbent upon an intelligent person to become you need to become financially literate. It’s absolutely, positively necessary. And, and here’s why. It’s a value. Money is a value of now they say the root, the root of all evil is money. But that’s not true. It’s the love of money is the root of all evil. That’s the actual term is so, but money itself is a tool and it’s one of, it’s probably like my second highest value. And the reason why it’s my second highest value is because I have a huge family to support. Not only am I supporting my, my primary family, I’m supporting other, you know, my my extended family as well.
Dr. Lopez: 33:31 And as I age, I suspect I’m going to be supporting them even further. So for it not to be a value would be reckless on my end as far as I’m concerned. So that being said, I, I really highly recommend that you read a series of books. Now they’re on my website. You can go to the book club and start reading them. But if, if, if you still need help by, by all means, you know, they, they say that if you want to learn how to swim, you can go read a book about it. You go watch a YouTube video about it, but you really want to learn how to swim. You gotta jump in the pool or jump in the ocean and then be with a good instructor. I still feel very strongly about that. I personally had a very good instructor when I first started my financial journey and I feel my advisor gave me very, very good counsel.
Dr. Lopez: 34:15 I feel like if you don’t know anything, you, you actually, you do need an advisor. You need, you need a team of people including an attorney, including an accountant. You need what, I can’t remember what Brent called it, Brent from scope of practice. You need your board of directors, your personal board of directors, and one of them should be a financial advisor. Now the controversy is, should you have assets under management or should you be playing fat feet? A flat fees? Mmm. That again, that’s controversial. Yeah, we can do a whole another podcast on compensation mechanisms. Exactly. But clearly like you for example, you are trained, this is, this is your, this, this is what you study every single day. You’ve been educated about this. So for me to, to not take advice from you would be silly. Right? It would be unwise.
Dr. Lopez: 35:06 So I, I definitely think everybody needs a team to help them with these decisions early on. As you get better, as you, you know, get more literacy with respect to these different topics. Yeah. Maybe you can start managing your own portfolio, which is what I do. So me personally, I manage my own portfolio. I’m very comfortable doing that. I’ve read thousands of pages. I’ve actually, you know I’ve jumped into the, into the swimming pool and I’ve made I’ve studied it, you know, I had spreadsheets about it. I very, very, very close track of my, of, of how I’m performing with respect to the S and P 500 index. So my, my job, my goal is not to beat it. I just want to keep up with it. And so that’s my personal philosophy and it’s been serving me very well up until this point. But I personally think of, you know, absolutely nothing about I’m sorry about that. If you know absolutely nothing about investing, especially with respect to the stock market yeah, you definitely need an advisor. And if you want to invest in real estate, then you need another advisor who is an expert in real estate. So
Justin: 36:10 Yeah, yeah. And I’m obviously biased in this department, but having a fee only advisor, meaning somebody who doesn’t earn any commissions, who has a transparent fee model, meaning I know exactly how much I’m paying my advisor every month, every quarter, every year. And in exchange for that payment, I’m getting good counsel, I’m getting a financial plan, I’m getting investment management and I’m getting somebody to both educate and do the work. The actual tasks of financial planning, financial management, that pays for itself in spades, nine times out of 10 for physicians. So I’m a, I’m a big proponent, big believer in that, obviously.
Dr. Lopez: 36:44 Well, you know, and, and just like I read the financial news every single day, and unless you’re willing to do that there’s so much going on. Like regulation changes all the time. Laws change all the time. And so if you’re not abreast of that, you absolutely need somebody to help you with that. So I, for that, I 100% totally agree.
Justin: 37:03 Yup. So let’s, let’s pivot back to, you know, the, the article we’re talking about before. So beginning with the end in mind, try to talk a little bit about some of the people in your life who, who you’ve seen walked down this path one way or the other, either being really well regimented and planning appropriately, or maybe taking the, the path that you wouldn’t necessarily recommend and how do those things play out?
Dr. Lopez: 37:25 So the, the, the main article I had written is I think it was like w you remember the name of the article?
Justin: 37:31 It is why doctors need a retirement plan before starting their practice.
Dr. Lopez: 37:37 Excellent. So in this, the premise of this particular article is a story of two physicians. Okay. They’re both friends. They both went to medical school residency together and then they both ended up starting practice together and they made this pact. And the pact was if I ever appear or if I ever lack the skill to take care of my patients because I’m like slowing down or if something happens to me where I’m, I’m no longer capable of knowing when to quit, they, they made a pack with each other to help the other person to quit medicine and not quit in a bad way, but to say, you know what, maybe it’s time you stepped down. And so I, I kinda talk about the whole story and how w w w w the way I found out about this story is I would eat lunch with, with a peer.
Dr. Lopez: 38:27 And he was in a much older peer than me and he always gave really Sage advice. But one day, you know, I was sitting there with him and he looked a little tired and said, Hey when are you going to retire? He said, well, you know, maybe next year. I said, really? I said, well, how old are you now? He’s like, well, I’m 73. I still, you know, I have stuff to do. You know, I got, I have all these patients to see and I have this procedure to do. And, and he would always make these excuses why he didn’t want to retire. Meanwhile, his kids don’t ever live in the city. They live outside of the city. He has all these grandkids he wants to spend time with. And I said, well, what’s your dream if you could retire today will be your dream.
Dr. Lopez: 39:04 It’s like, I wanna spend time with my grandkids, you know, go to the beach, go sailing with them, et cetera. I said, well, what are you waiting for you? I said, you just should do it. He’s like, well, maybe next year. I said, okay. Oh, this kept on playing out year after year. And I think actually when it first started, it was around 66. So this played out over four or five years with finally one day, you know I find out that he got really sick. Okay. And once, once I, before, before you realize that we realized he had some, he had terminal cancer. Okay. Wow. And he didn’t, he basically made it six months and I don’t want to go into details of the story. I don’t want to, you know, because I’m sure members of the community stuff my community know who he is.
Dr. Lopez: 39:47 But he basically passed away and I remember running into his friend and I said, Hey, you know, that’s really sad. What happened to your friend there? He said, yeah, he pushed it a little bit too far. And I said, yes, sometimes people do that. Well, what about you? I said, you’re, you’re, you’re, you’re kind of right there with them. What, what’s, what’s your plaid? He’s like don’t worry about me. He tells me, I know when I know when I’m, when I need to quit. I got all kinds of plans. I’m going to go golfing, I’m going to go, you know, I’m going to go traveling and I have all these plans. And I’m like, okay, great. Well, when are you going to do them? He’s like, probably next year. Yeah. So long story share it Mike. My goodness. And he said, I’m nothing like him.
Dr. Lopez: 40:28 I said, he’s like, I told him not to do it. I told them not to do it and yet he went and he did it and didn’t listen to me. So I did not tell us in the article, but like literally a year later, I’m sorry, two years later, exact same thing happens to him. Hmm. You know, and now he has terminal cancer. He never retired and he never lived out the, the dream that he wanted to post retirement. And for me, that to me it’s sad. I, and I think it’s a generational thing because I know a lot of gen gen baby boomers who are totally okay with that, they want to work till they die. Me personally, I just don’t think that was a very good executed plan. Whereas like take somebody like Cory faucet, the day he turned, I can’t remember what it was, 56 or 57.
Dr. Lopez: 41:16 I can’t remember. He was done. He told his partners, I’m sorry, this was the plan from since day one in medical school. I started with, with the ended mind and now I’m done. And I have all of these plans that I’d like to execute, but I can’t if I continue to practice medicine. So me personally, that resonates with me and sort of what when I mentor or coach somebody, I always basically I try to help them pin down a date. And for young people, it’s really interesting. They think they’re gonna go till they’re 65 when you start talking to a 40 year olds, they say, Oh, I’ll go till 50. And then when you tart start talk to 50 year olds, they say like, well, I think I’ll be done in five years. And so yeah, you, you know, if you know that number early on, it’s an option.
Dr. Lopez: 42:03 You don’t have to do it. So let’s say you become financially independent at age 50. Great. Now you basically have options. So if you don’t like the institution that you’re working at because of the insurance, maybe you can go start a concierge practice. You know, maybe you can go start a, you know, anesthesia on the traveling on the road practice. There’s a group in Columbus called smile MD. They basically have a group of anesthesiologist who go from dentist office to dentist office and they work on a cash basis. They, they, they love their work. So you have unlimited options once you achieve financial independence.
Justin: 42:37 Yeah. And I think the key takeaway here is not quit your job as soon as possible, as much as live intentionally. Figure out what the things are that are really important to you and if you want to work until you’re 70 because it’s so enriching for you and you enjoy working with patients and making a different in an intimate way that you can’t do in any other way than great. Do it. And beef be free from the stresses and the strains of being financially encumbered in that context. And you may find that if you’re living intentionally, I want to build X number of hours per week in my schedule with my wife or with my kids, or do these other things or take this trip. You may be able to do that and have the vocational pursuit that you want. If you start today, if you intentionally reflect and you know, like what you said before, like when there needs to be a change.
Justin: 43:27 I can’t remember the gentleman who you said had this paradigm. I was like, something’s gotta change. It’s gotta be now and it’s gotta be me. Once you sort of internalize that it can, it’s like the whole world opens up to you. And that’s one of the things that I love about being a financial planner is sitting down with my clients at times and saying, Hey, like, let’s draw your dream life right now. What does it look like? And what we often find is we don’t need to be 67 with $7 million in the bank in order to live three quarters of that dream life. We can actually get a lot of the way there today by just being a little bit more intentional.
Dr. Lopez: 44:00 You know, and the, and a funny thing happened now that I’m part time and now that I living an intentional life and I, and and I, I feel financially comfortable. I feel like I enjoy medicine again. It’s the weirdest thing. And having said that, I feel like since if somebody comes with a new regulation in healthcare, like there’s a new EMR update or if there’s a new policy that’s going to impact my, my, my, the way I practice medicine. Perfect example, I was just told last week I can’t use Dez flooring anymore. Right? That’s right. Right. And so you would be surprised. I mean, maybe you’re not surprised. Everybody was infuriated. Like how dare they say I can’t use desk Lorraine, you know, and you know, what kind of environment are they talking about? All those studies are blah, blah, blah. And so like th they’re, they’re giving away so much energy net and they’re putting out all this negative energy.
Dr. Lopez: 44:55 They’re making themselves miserable over something that, you know, is it going to change my practice a little bit? Yeah. Kind of a little bit. Is it gonna is it gonna? Is it gonna change? My opinion of myself as going to change my happiness is going to change the way I practice medicine? Not at all. In fact, you know, I, I tell, I tell people who say that I’m like, it’s not really worth, you know, the, the cortisol. It’s not worth the stress to get upset about something like that. And if you want to fight the good fight, by all means do it. But don’t let it control your life. Cause at the end of the day, what really matters is, you know, you, your health, your family the job is, you know, taking care of your patient matters. But the job itself doesn’t matter so much, you know?
Justin: 45:38 Yeah. Yeah. It’s funny. I think it was maybe episode 13, I interviewed a dr Timmer Roselle CEL, who is the head of the the green anesthesia, a special interest group of asthma. And he was telling me about Dez Lorraine and how I think he said, the stat that sticks in my mind is doing a, you know, a day’s worth of procedures with desk Lorraine is the equivalent of driving a car from like Cape town to Oslo, Norway or something like that. It’s like a, from an environmental impact standpoint. And I know that that’s been something that’s I guess been on the radar in the anesthesia community. So
Dr. Lopez: 46:08 What’s, what’s fascinating about that though, is if you, if you look what, what really makes people unhappy is the sense of loss, right? Yeah. If you have loss in your life, if you had something and then it’s taken away, that results in unhappiness, right? But if you look at something like desk flooring as an example, you, if you never, if you never had it in the first place, there would be no loss. But the fact that somebody gave it to you and then they took it away, you feel a sense of loss. But the reality is there are plenty of good alternatives. So it would be different if somebody said, Hey, you can’t do a practice anesthesia with volts full anesthetics anymore. That would be okay, fine. I mean, I’m out to do TV everyday. Oh my God, I like that. I get but even then it still fundamentally would not impact me. It’s not going to emotionally have anything to do with my life. And I feel like a lot of anesthesiologists basically they live for finding the next thing that the hospital’s going to take away from them so they can just kind of complain to the world about it. And that’s just no way to live a life if in my humble opinion.
Justin: 47:08 Sure. And I think that’s human nature and it’s not, it’s not unique to the specialty by any stretch. Exactly. awesome. Well, I want to wrap it up here. Jesse, I really thank you for your time today. In closing, you know, are there any other, like, either words of wisdom or resources to what you would want to point us or, you know, key considerations that you want to leave us with as far as

Speaker 1: 47:30 Developing a life of, you know, contentment today so that we’re insulated from some of the challenging environmental factors in the practice of medicine?
Dr. Lopez: 47:39 Absolutely. so for me, my website is all about kind of finding my way and in that process I hope other people will find their way as well. So the best quote I can give for you is work on yourself more than you work on your job. Okay? So if you can be a better version of yourself than you were yesterday and you have growth every day, that is the key to happiness. If you feel like you’re receding, Kay, if you feel like the world’s impacting you, that if you feel like everything that, that determines your happiness is from without, then you’re not going to be very happy. Whereas if you realize that all your happiness is right within you, you’re going to be a very, very happy person. That’s, that’s, that’s about it. So me personally, I feel transformed. I used to be, I used to have tremendous burnout.
Dr. Lopez: 48:31 I don’t have burnout anymore. I feel like even the loss of my medical directorship that was lost. Okay. I was paid to be the medical director. I had a title. I felt like I had prestige, I was in charge. All of that was taken away. And I’m telling you right now, for me, that was a blessing. It was the biggest blessing in disguise because now I can focus on things that really matter to me. And so I don’t see it as loss anymore. I see it as a gift. And so one more thing, if you’re going to blame somebody for how bad your life is, make sure you blame him for how good you like this as well. Hmm.

Speaker 1: 49:07 Wise words. Dr. Jesse Lopez, thank you very much for joining us today on the anesthesia success podcast.