Episode 37: Privademic Residency, OR Diplomacy, and Entrepreneurship In Financial Coaching w. Dr. Aaron Lewis

Feb 24, 2020

This Episode

Interview w/ Dr. Aaron Lewis

You Will Learn

 You will learn:
– Examples of privademic residency at work in Dr. Lewis’ career
– His experience transitioning to private practice
– Why Dr. Lewis decided to take all 7 CFP modules, and the exam
– What is Money Nerd MD, and who is it for?
– Aaron’s advice for better financial management

Resources & Links

Other show links:

In today’s episode, I talk with my friend Dr. Aaron Lewis. Aaron is an attending anesthesiologist in the Detroit area. He’s in private practice there after many interesting experiences in his career. He is also a CFPⓇ Candidate and is helping others get on track with their financial planning.

Justin (00:04):
Hey, it’s Justin Harvey. Thanks for tuning in to the anesthesia success podcast where we take a close look at important topics pertaining to business practice management, personal finance and careers for anesthesiologists and pain management positions. On this show, I work hard to take your critical questions straight to the experts. Thanks for listening. This week we’re talking with my friend Dr. Aaron Lewis. Aaron and I talk about how his experience doing a residency with the private anesthesia group prepared him for an eventual role in private practice. We also talk about some of the challenges of working with surgeons in the or as well as Aaron’s financial coaching business for physicians. As always, thanks for tuning in. Hello everyone. Welcome to this episode of the anesthesia success

Justin (00:50):
Podcast. I’m your host, Justin Harvey. I have with me today my friend Dr. Aaron Lewis. Aaron is an attending anesthesiologist in the Detroit area and he’s in private practice there and has had some really interesting career experiences as well as some interesting and financial expertise that he’s developed over the years. Really excited to unpack this today with Aaron. Thanks for joining us today. Thanks for having me, Justin. So to get us started off, Aaron, why don’t you just share a little bit about who you are, where you come from and how your training and what was a private practice group in an academic healthcare setting prepared you for an ultimate move into private practice?

Dr. Aaron Lewis (01:29)
Okay, wow. What a question. My training was a obviously in a broader academic institution but the anesthesia group that I worked for was a private practice and so I knew nothing else. During my training I didn’t know how purely academic education would be like we heard that maybe it was a little bit slower. There were more opportunities for research. There were certainly more opportunities for larger cases after I got out. The advantages became apparent, at least for me. And so in a private practice setting, the onus is on doing cases quickly and efficiently and safely above all. And that can sometimes be a challenge, a push and pull on how fast do we do it? Is it safe to do it at all? And so we’re always, my opinion of the private practice world is we’re generally pushing the limits on getting the case done safely, but quickly and, and at all. So we’re, what I mean by that is relative to an academic center there is much less tolerance by surgeons, anesthesia personnel, the culture to cancel a case. So we rarely do that unless we have a good reason.

Justin (02:43):
Okay. So give us a window into the beginnings of your residency experience, maybe as a CA one when you started to get a feel for, okay. Like the surgeon really wants to do this case. Have you, were you in any, can you tell me maybe a story or two about, was there some friction between the anesthesia and the surgeon about whether or not to

Dr. Aaron Lewis (02:59)
Proceed? What was that like? So, yeah, I remember when I first started and until this day that has certainly turned out to be true, that learning the politics and the diplomacy of operating room culture is key for anesthesia personnel. It’s hard to teach, you just have to get in there and learn it. But I suppose a good sort of starting point would be for you to understand as a young anesthesia resident or a more tenured anesthesia attending is that you are like the offensive lineman. You have no glory. You are not important. You are replaceable now. Now, now truthfully you are important and you do have responsibilities that are absolutely critical. But culturally in the eyes of the surgeon, you are replaceable and you don’t get glory. So you’re saying people don’t come to your hospital in order to work with a certain anesthesiologist? Rarely.

Dr. Aaron Lewis (04:01)
Rarely. So the diplomacy plays out in the way that sort of the surgeon who brings the paying customer to the operating room has much more power to influence what happens and when it happens and how it happens. And you must be there when he’s ready to make it happen. So a good example would be this, surgeons routinely show up late. Okay? Routinely, like every day for some of them. Okay. And so we have prepared for a seven, 15 start. Let’s say we get there the same time every day. Maybe it’s six, maybe it’s six 30. And we stand by back straight, waiting for the surgeon to show up. And oftentimes we talk about, just imagine if the surgeon showed up for 7:15 and I wasn’t there yet. Where’s Aaron? Oh no, he’ll roll in. That’d be there anytime you would be terminated on the spot.

Dr. Aaron Lewis (04:53)
So, so it’s very, very different culturally. And so at sometimes you are, when you, if you are doing anesthesia, well you’re, you’re, you’re putting the patient first. You’re taking care of the patient to the best of your ability and you’re sort of giving the surgeon as much. Yes sir. No sir. Or yes ma’am. No, ma’am. That you can afford without challenging safety. So anything that doesn’t matter, it’s, yes sir. No sir. Yes ma’am. No, ma’am. You have to hold your cards. You have to hold the ACE in your hand and cherish it because there will come a time where, and the surgeon is not ready for it. Maybe they’ve never heard you say it, where you stand up and you’re going to say, Nope, and you’re going to stop the whole thing. My cancel the case. He might cancel his procedure, mid procedure and you need to be ready to defend that decision. It could very well lead to a child like tantrum from an adult professional. And so you need to be ready. You are going to have to do it. This is, this is really one of the key responsibilities of an anesthesiologist is to know when to step in and cause a short term mess in the name of patient safety. This is one of your highest callings.

Justin (06:17):
Wow. Interesting. So I’m really curious as far as the stroke, cause this is one of these things that exist in any industry, anywhere where there’s people involved, there’s politics and there’s like factions. And there’s this, you know, this stress and friction between stakeholders, whether it’s the patient and the doctor or between do to doctors or between physicians and insurance or physicians and administration. There’s, these relationships exist in a lot of different places. I’m curious in your organization at the time, how was it, how were the surgeons involved in the hospital administration? Were they their own private group as well? What was their, why? Why was this such a point of friction between you?

Speaker 4 (07:04):

Dr. Aaron Lewis (07:04)
I believe it’s so, my experience is limited to two different institutions. They’re in different States. I believe my experience can be extrapolated to most, and it has to do with the fact I believe that surgeon’s number one, draw a certain personality. It’s what makes them good at it. To be honest with you. They sacrifice more than most. They are spending more time with the patient then anesthesiologists are, they’re sacrificing more of their family time. In my opinion. It’s a harder job to do, but these guys want to be the center of attention. They thrive. They thrive in that environment. They thrive in an operating room, in a, in a, you know, let’s say a 20 foot by 20 foot or 30 foot by 30 foot operating room environment with 10 people in it. They thrive at being number one and so that sort of is one component.

Dr. Aaron Lewis (08:06)
The second component is the financial component. A hospital administrators bend over backwards for surgeons because they want the cases to come to their hospital. If I’m a surgeon, a busy one, I can tell my administration, give me what I want or I’m leaving and I’m taking my patients with me as an anesthesiologist. I don’t bring patients to the hospital. I provide an integral service. But, but I don’t bring pain patients, so I can’t really threaten to leave about administration. We’ll go, okay, see ya and we’ll get another group to come in here. So I think it’s a generalization, the, that the environment that I’m speaking about is a generalization, but these are the things that go into creating this culture.

Justin (08:54):
Okay. Can you tell about a story or two from back in the day when you maybe as you are learning the dynamics of these politics, where did you accidentally step on a landmine and the Orr and a surgeon blew up at you or you had maybe an attending who you witnessed this happened to as, as an anesthesia resident?

Dr. Aaron Lewis (09:11)
Well, yeah. Yeah. I mean I had a classic hardcore old school, Russian chief of the residency program. And he was intelligent, but he was old school and he was tough and he was demanding. And he, I mean we, we had a vote in my third or fourth year about whether he should be terminated because he slapped a resident on the back of the head for doing something stupid. Wow. And that resident reported him and I remember during that vote, I like the guy, by the way. I thought he was good for my education. All his tactics were a little bit rough. I remember the someone who’s leading the votes and we’re going to take a vote on whether this individual should continue as chairman. And don’t worry, the votes going to be anonymous. So vote your conscience. And my first thought was like hell, it’s going to remain anonymous. So I voted for him to remain.

Dr. Aaron Lewis (10:19)
The overwhelming vote was for him to leave. I voted for him to remain the vote. Of course. Got back to him. He remained. And so I had a little bit of good grace know that I voted for him to remain. So, but the reason I tell you about this guy is in describe his personality was because time and time again I would see I would be dealing with a surgeon having a juvenile like temper tantrum. Okay. In the operating room, screaming and throwing instruments and whatever. And the surgeon would for any reason demand that the attending anesthesiologist come in the room fine with me. So I would call this Russian guy in and what would he do? He was a diplomatic superstar and he would sort of bow at the neck, lick you do to her majesty and sort of placate the surgeon in whatever way he needed to do, which of course you would never see him doing something like that, but it was effective. And so this story is sort of describes one of the advantages of working in a private practice, academic hybrid. Now does this go on in academic centers? Probably, but my experience was seeing the business side of, of this guy’s workflow while he was also the residency director.

Justin (11:42):
Interesting. Do you have a sense for in that private group how the compensation was structured for either surgeons or anesthesiologists?

Dr. Aaron Lewis (11:50)
The group that I trained under was a very large group and they had somewhat complex compensation structure where they were on like a point system. So you took call, you got a point, you stayed later, you got a point, you, you, you used points to take vacation, you wanted to take less vacation, you earn more points. And so that’s how I would describe that. There were also penalty points for, you didn’t even give beta blocker, you got penalized. You didn’t do this, you got penalized. The group I’m in now, we don’t, we’re smaller. We have a much, much more simple compensation mechanism where we just, everybody works, everybody eats. It’s just an equal work, equal split. We don’t, we don’t have penalties. We have a simpler structure, but they had a complex structure.

Justin (12:39):
Yeah. It sounds like there’s surgeons. I don’t know. Okay. It sounds like there’s probably some, what we would call it, quality measures and some production mechanisms in, in that

Dr. Aaron Lewis (12:50)
Yes. The quality measures were, were only though unfortunately, where you could be penalized by not following them. Right.

Justin (12:57):
Interesting. Okay. So you mentioned a little bit before we jumped on the call, I’m interested to hear again talk a little bit about how you think that this what I’ve heard called private DEMEC residency uniquely equipped you to transition into the private practice world. Cause that’s one of the challenges obviously coming up through academics. If you want to make the switch, there’s a lot of dynamics that are difficult to get your arms around before you end up taking a job. Right?

Dr. Aaron Lewis (13:22)
Yes. Again, I felt when I left my residency that the most important course that I could have taken, which wasn’t taught, of course I did learn it, but was the diplomacy of dealing with surgeons and how important it is and how you potentially could come into anesthesia residency feeling maybe a little bit big for your britches. It’s possible, right? I’m an anesthesia resident. Hell yeah. You know, I’m gonna swing this and swing that and then that proves to be ineffective. Really. There are anesthesiologists who have, I’m going to just say workplace habits like a surgeon and that does not fly. It’s not, it’s you, you can’t do that. You should have gone into surgery if you wanted to act like that. So again, the diplomacy of knowing your place in the Orr hierarchy, yet understanding that you are the patient’s greatest advocate, not the nurse who is also taking care of the patient and not the surgeon who is there to operate on the patient. You really have these you really have a high standard where you have to be putting the patient first above all yet being the ultimate diplomat for the surgeon. And, and you learned

Justin (14:52):
That every day in my residency. It was very valuable. Do you remember the first time you pulled that Trump card out of your pocket and said, listen, it’s the, it’s this or that or this condition or some circumstances where we were going to hit the red light instead of the green light on this? I don’t remember the first time I remembered the most recent time. Okay.

Dr. Aaron Lewis (15:10)
Which was a few months ago. I was working with a surgeon who I would just say I don’t have a warm fuzzy relationship with, which is fine. Right? And he wanted to do a procedure on a patient who was not optimized because he was leaving town the next day. That’s the only reason. And it was electric procedure and it was high risk. And the people around the people, the support staff, I’ll say, so the nursing staff and the charge nurse and the resident, I could see that they were a little bit uncomfortable, but they don’t have the card, the same card that the anesthesiologist would strictly because me and the surgeon are the only MDs in the room or taking care of the patient. And so I approached him gently, are you sure you want to do this? Why you want to do this? And he hummed and hawed and said, of course he wants to do it.

Dr. Aaron Lewis (16:09)
But you could see it didn’t have the most compelling reason to do the case. And I said, started most diplomatically. I think we should rethink this to which he exploded because what right do I have to suggest? Whether we rethink a certain dedication, not to which I said, this board is on an ethical and you’re not doing it because I’m not doing it to which he yielded. And the patient did not have the procedure because he was leaving town and got it the next day to which there was extensive fallout right now, he still won’t look me in the eyes and we’re not warm and fuzzy, but, but again, that’s the job. Yeah. So that’s just the job. See, I think it’s, it’s key to understand this in a residency. That, and I, and I will tell you, a lot of people have trouble with it. They don’t want to be placating themselves to a surgeon. They don’t want to have to fight with them. They don’t want to have to have this sort of responsibility that requires this level of diplomacy. And so that was the most recent.

Justin (17:17):
Yeah. And you know, you’re this, we’re not talking about like some random person, especially if you’re in like a smaller hospital or setting, these are people you’re going to work with, not infrequently and, right. So you, right, exactly. So you have to be comfortable. You’re going to see this guy in the cafeteria. Yeah. He’s going to be talking about you to his colleagues. Yeah. He’s going to, you’re going to be operating

Dr. Aaron Lewis (17:35)
With him the next day. You’re going to have to ask him a legitimate question about another patient. I mean so you have to be ready for that app. But from that, in my opinion comes the greatest reward, which is you re you really get to put your foot publicly in the best interest of the patient. Yeah.

Justin (17:55):
Awesome. That sounds super stressful. I’m glad I don’t have to deal with that. Okay. So talk to us about, you know, making the transition from residency into that first attending role, coming up through the private DEMEC track. What kind of job offers were you looking at? How did you kick the tires on potential practice opportunities and did you feel well prepared going into those, those interviews and understanding the practice model and things like that.

Dr. Aaron Lewis (18:20)
So I’ll start off by saying, what many of your listeners may be feeling? Well of course it’s normal for a final year resident and that’s just being terrified, right? You are terrified that you are going to become the attending where the, where, where the buck stops. And as a resident you always have someone to call for help. And as an attending you have colleagues to call for help, but you ultimately have to make these decisions and be the guy. Right. So it’s, it’s very nerve wracking and you know, without sounding belittling, really the thing that helped me most was I looked ahead in my class a year or two to people who had already left. And I just thought some of them were, were, were, were not very good and I thought they’re doing it right if that guy, and then I can do it. And that got me through my first few months. Yeah, it’s helpful.

Justin (19:14):
Okay. So as we’re, you, you know, describe like the different options that you were considering as you looked at that first bit of employment. Were you, did you stay in the same practice that you did residency in?

Dr. Aaron Lewis (19:25)
I did not. My situation was a little bit unique because at that time I was a Canadian citizen doing my residency training on a visa. I’m proud to be an American citizen now. So I needed a job that would sponsor me for a green card. Okay. So I looked for rural jobs. I also had student loans, so I appreciated the increased salary and that signing bonus and stuff like that. So I went from my institution which was very large to a smaller 250 bed hospital level two trauma center, which is the same as where I work now. And I was looking there because it fit my immigration needs. I mean, I, I couldn’t just go anywhere. I really had to go somewhere that would sponsor green cards. So that kind of focused my application. Got it.

Justin (20:17):
Okay. And how was that transition for you

Dr. Aaron Lewis (20:20)
Into that private practice place? Yeah. My memory of it was fond. I, I had good colleagues. I went into a group of about seven. I got into it and I said, of course I wasn’t really nervous, but I, I felt as I got into it that I was well prepared. Both academically, you know, I had a hone skill set and also like we talked about most of this conversation is the diplomatic side of all of those dynamics. I was well-skilled, I was not sort of an amateur in the private practice world or I didn’t feel like I really knew how to push and pull and when to do it and what was important and what I had to let go. So I was walking forward. Well prepared.

Justin (21:02):
Was that, was it a case where you were doing your own cases or were you supervising or what was the care model like?

Dr. Aaron Lewis (21:08)
In my first job, yeah, I was supervising, we did have, I remember a month or two where we would do a day of our own cases, but that was very brief. So I was mostly supervising. To this day I mostly supervise, I 100% supervise. Okay.

Justin (21:22):
And then eventually you transitioned to the practice in which you now operate. Talk to us about what precipitated that decision and what made you want to make a switch.

Dr. Aaron Lewis (21:31)
Sure. So interestingly, many of your listeners would be, well behooved to know that 80% of anesthesia residents leave their first job within five years. Hmm. And I was that statistic statistic also. I left in year five and so what happened was me and my wife went from Metro Detroit to a cold and blustery North Dakota. Wow. Shocker. She did not love it. We had our first daughter there and as we started to look at, we also, so because we were there, we didn’t have help from family and yeah, we had to find a place where we would all be happy and where we want to raise our kids. So I began a job search in year three or four. I was professionally very happy there. I had a lot of good friends there. I was actually raising the praise in Canada. So I was kind of used to that lifestyle. So it was just sort of a broader family dynamic issue that caused us to move back here. But most importantly is because I got a great opportunity. I wasn’t going to take anything that was somewhat stressful. I really thought, Oh boy, I’m eventually gonna have to settle for something I don’t really love. Luckily I got a great job, great partners as I took the job that I’m in now. I said, and I still believe, I hope it’s the last job I ever have. Hmm.

Justin (22:50):
Did you know that when you took it, you thought this is like the best thing ever and I feel really lucky. Or is it something you grew in a way as time?

Dr. Aaron Lewis (22:57)
Good idea. I had a pretty good idea. I knew one of the partners that was asking me to consider it was my residency classmate. Okay. So I knew him on a personal level and so we were able to, I could just tell that this is likely where I would be happy and it happened to be the same size hospitals, same type of cases, same case volume, case load as North Dakota. So it was very easy for me to imagine what the work life would be.

Justin (23:25):
Okay. And what is it that characterized for you? Like how did you know, what were the factors where you said this, this thing and this thing about this job is what? I think it makes it a home run.

Dr. Aaron Lewis (23:39)
Okay. So there are a bunch of things but I’m going to just say it. What was the most important thing to me to start before I would then filter through other issues and that was money. I don’t, I don’t know how acceptable that is actually, but I think it’s sort of culturally accepted that maybe we shouldn’t say that, but for me that was the true thing. I, I wanted to know what I would be paid for, what I, how hard I worked and I’m not looking to get rich. I just wanted a, a fair salary and, and a fair reimbursement for the work that I was going to do. So once that box was checked, I moved on to who am I working with? Do I like the other anesthesiologists? Is it a toxic work environment? How long is the commute? How long am I going to last? There is the practice going to last. So there was a there was a list of things that I looked at and actually I localized for them for a week. I volunteered that to them. I said, I’ll work for you for a week and you, you can size me up and, and I’ll get to size you up also and we can see whether we fit. And so that was, that worked out well. I liked, I liked it and they liked me and so I took the job.

Justin (24:49):
Interesting. So did you find that your locums experience was reflective of what you ultimately found to be the case or was that, was it like the first day or everyone’s on their best behavior? No, no, no, no. It was, it was legit. Okay. He was legit. And how’s your current practice? If you don’t mind talking about like how the practice is structured, how many docs and like you know, in the private practice world obviously there’s like what I would call like the big private group, which is essentially W2 you know, you’re just an honestly just an employee, but there’s no equity interest, meaning you’re not making business decisions, you’re not getting a piece of the business net income versus smaller private practices, which some people say are kind of disappearing where the physicians who are partners own a piece of the business and get a piece of the bottom line. Sure. My

Dr. Aaron Lewis (25:35)
Practice now is a seven member privately owned PC that’s a professional corporation. I obviously worked for the group for two years before he came partner. Our most recent hire has now finished his two year associates ship and his now partner. So all seven of us are now equal partners. We own the group, we are responsible for all of it, the administrative side. And we like it that way. You are correct that these jobs are disappearing. And so an example of that is our group, which will eventually need to hire, will, may or may not offer partnership anymore. Hmm. We are sensing that the graduates now rightfully are curious about how long we’re going to last. And they don’t want two years of associateship. They want to get their money now, which is fair enough. We don’t mind that. But there’s a trade off, right? They will never be owners. So with ownership comes risk and reward. And our feeling is that that’s what we wanted when we were coming up. We wanted the risk and the reward of ownership. We have that now the responsibility of ownership and the reward of ownership. But we’re not sure whether there’s further appetite for that or whether we have appetite to offer anymore of that. So that’s how we sort of reflect the broader market.

Justin (27:06):
Yeah. And that seems to be consistent with the things that I’m hearing and seeing. You know, you go to the national conferences and hear the anecdotes from the smaller groups that are, you know, challenged to compete in different ways and the administer, growing administrative and compliance burden. And all of that. And that’s something that we’ve, a topic we’ve explored at greater length in other episodes on this podcast and we’ll continue to do so because that’s a really, I think important thing to be aware of. I want to pivot a little bit here. So during this journey that you’ve been making on a career, on the career front, you’ve had a bit of a, like a, I’ll call it a personal enrichment story as it relates to personal finance. So the way that you and I first connected Aaron was you or doing the CFP curriculum certified financial planner, which for those that don’t know out there is a financial designation that’s essentially the gold standard of financial planning.

Justin (27:56):
A certification, sort of like the MD of the financial planning except the way, way, way less difficult. And to be clear, I’m not comparing myself to someone who graduated from med school, but I don’t know, I told Aaron before we jumped on this call. I’m not aware of anyone, any other board of anesthesiologists who have gone to the trouble of taking all seven CFP modules and then sitting for the comprehensive exam, which you have done, which is a very impressive achievement. While you’re a full time position. So talk about why did you do this? What were the factors, motivations as a physician or you said, I want to carve out some real time in my life to read these textbooks and understand personal finance to a level and degree that most of my peers will never even understand. Sure.

Dr. Aaron Lewis (28:38)
Yeah. So my journey began where some of your third and fourth year residents are now, which is, I had zero financial literacy and I went to a finance for beginners lecture in my institution and a couple of things stood out from that lecture. Number one, I remember being really impressed by the reams and reams of statistical data they had. Similar to my experience with Madison is like real studies and numbers and they could extrapolate this, that and the other. But also I realize I really knew nothing. And so I realized that I wouldn’t be able to even speak to a financial professional without understanding the terms. I wouldn’t know what, what I needed. And I felt like I would, could be roadkill for a dishonest adviser. So I, I didn’t have any mentors in that field. And so ice, I realized I had to start reading.

Dr. Aaron Lewis (29:31)
And before that moment, I really thought that finance was the most boring subject in the world. I had no desire to learn. But, but fear drove me to start reading. And lo and behold, I kind of liked it. So I read and I read and I read and I read and I, I read really something financial every day. So skip to a couple of years ago, here I am giving financial advice essentially, but then at the end, qualifying at with, but I’m not an expert. You need to go on your own. And so I realized one day, why don’t I, why don’t I try and get a real financial credential? And what is that? How would I get it? Could I get it? And I started researching and found the CFE, which I view as the highest standard in the land and I’m understood that I could take the courses and then pass the exam.

Dr. Aaron Lewis (30:25)
And so I was excited by that and I thought talking to my wife and the apartment doing this is going to take sun hours outside of work and there’ll be a big exam, don’t need to study for. And she said, go for it. So I went for it and let me tell you, it’s a damn good thing that I paid tuition before I got into my first two couple of courses because I would not have done it. It was much more work than I thought. Although I enjoyed it. It was a lot of work. And that was before the exam. Taking the exam. I want your MD listeners to understand that it is, in my opinion, just like a U S MLE, the volume of material is similar. The hours needed for three to four months is similar. The poor metric center is the same. The amount of time for the exam is the same. The amount of time per question is the same. The breadth of knowledge is the same. And so if you are an MD and you are listening and you are proud of yourself for studying for and passing step one, which you should be, you need to give that same respect to anyone who has passed the CFP exam. So I passed it and that was the summer. And then I started lecturing and created money nerd MD and try to help.

Justin (31:38):
Yeah. So tell us about, I was, I want to talk about your business. So I think this is a really awesome model. Money nerd MD. I want to hear more about what that is.

Dr. Aaron Lewis (31:48)
Money nerd MD essentially bridges the gap between physicians and the financial world that maybe they’ve never interacted with that they may be intimidated by or that they don’t speak. The language of. This sort of was me when I was finishing residency. In other words, money nerd, MD advocates for the physician who maybe doesn’t understand the financial services industry and is worried about being taken advantage of.

Justin (32:11):
And so how have you found it to be received? I know you’ve, you’ve engaged with your first few physicians recently to help get them put in the right direction. What kinds of things are you doing for people?

Dr. Aaron Lewis (32:22)
In essence, I think the, the value of the interaction is probably similar to what you experienced, which is these physicians have so much worry built up and they don’t know who to talk to, what to use in financial parlance. And they’re, they’re a little bit embarrassed and they’re scared of sounding dumb or uneducated and they’re scared of being taken advantage of. So the real value aside from the technical aspect of the consult and the questions and the advice isn’t just listening. Physicians feel relieved in letting their anxieties out. To me, because I’m a physician too, I’m a full time practicing physician like them. And so I’m a safe place to hear this. And, and then that’s even before the advice and that’s before the connections, the, the, the value of where they can find what they need for best value. That’s all before. So the real inherent value is in just listening, active listening. And I know good CFEs do that. I think you do that. That’s the most important quality, I think. Not the technical expertise of the planner, but the ability to have empathy for your client.

Justin (33:38):
Yeah, really important. And so the reason I really like your business model is I think it serves as a bridge between what I do, which is like full-blown, right? We’re going to pay thousands of dollars a year to have somebody do all the work for us, manage our investments, and do all the financial planning and look at everything. That’s for some people that’s a lot to commit to and they may not be ready for all of that. And they may not know even how much the, the model of my firm compares to others out there. Right. And I think that money nerd MD, and this is why I’m really excited, Erin, about what you’re building is, is a perfect intermediate step where it’s a, and I’d love to hear more about the model, but you’re not managing money. You’re not, it’s not protracted drawn out engagement. It’s, it’s very high impact.

Justin (34:20):
It’s very distilled and it gets physicians oriented to important questions that they need to ask. So tell us a little bit about, if I came to you and I said, Aaron, I don’t even know what I need to know, but I, I recognize you’re a physician and you’re smart enough to pass the CFP so you know your stuff. And I just need somebody to tell me if I’m missing something really big and maybe recommend, do I need to talk to a financial planner or am I good as a do it yourselfer what kinds of things might they experience in talking to you?

Dr. Aaron Lewis (34:48)
So if you came to me and said that, I would say, you are the perfect person to come speak with me. So I’m one who just really doesn’t know the first step to take. That is who this services for. And so I ask you some very basic questions about your financial life. You know, your student loan that your goals for the future. What do you know about investing? How do you feel about investing? Basic stuff. How much money do you save? How much money do you want to save? And then what I’ll do is go through your answers to those questions and prepare in language that you will understand that the answers to those questions. Some of those questions include just what would you like to know more about or are you nervous reaching out to financial planners and why? So we’ll address all that in a video conference where we’ll speak face to face and I can answer any question that you have.

Dr. Aaron Lewis (35:40)
So we’ll also eventually cover, it’s important I think the compensation models for financial advice and financial management. And so that’s relevant to what I do because it is important that the person who is listening to my advice understand that I am essentially fee only also. So, so people may not understand what that means, but in, in, in an interaction with me, we will cover it. Feel only essentially boils down to the fact that if I recommend something to you like you need a student on console or you should get disability insurance and the best person is this person, it’s [inaudible] imperative to understand that I do not get kickbacks. If you purchase disability insurance from the person who recommend you to or if you go get a certain student loan service from the place I recommend you to, and again, that’s part of the broader education of becoming a smart financial services consumer, but that also happens to be my model and I think that if you are going to reach out to me, you should know that upfront and understand that or else it would hard. It will be hard for you as a customer to be open to what I’m going to tell you because this is the broader opinion of most physicians when they interact with, let’s say you Justin [inaudible] is, I don’t even know what fee only is. I don’t know whether you, what you’re telling me is true. You’re saying I need it, but I don’t even know if I actually need it. You’re saying what it costs, but I don’t know if it’s a fair price. So we cover compensation mechanisms and anything else that someone may want to know.

Justin (37:12):
Awesome. Have you found this to be something that you found more interest among like residents and fellows? Or is this like attendings who have been reaching out to you or some of both?

Dr. Aaron Lewis (37:21)
These have been both and I think that the people most drawn to it are late tenured residents, early attendings. But in my opinion, the largest impact in dollars would be to a mid to late career attending physician. Because for example, if you, we’re 45 years old or 50 years old and you have a nest egg of $1 million or more and you were paying a large active management fee of percent or higher, and you had a consult with me and our, our conversation led you to be confident in moving to an index portfolio, you would save tens of thousands of dollars per year. Right? Yeah. And so the dollar impact is larger for a higher net worth individual. Right. but the psychological impact I think, or the help that is really needed seems to be with younger physicians. Right.

Justin (38:27):
And to be clear, you’re not a registered investment advisor so you’re not giving specific investment advice, but what you’re doing is it’s essentially like a financial coaching model, providing context, providing resources and providing specific feedback in some areas that doesn’t, you know, transgressed the line of what you need to be registered for, which is what I do. But to be able to point people in the right direction and say like, here’s something that’s a screaming emergency, you need to think about it and potentially talk to a professional who, who is registered to be able to give you that type of advice.

Dr. Aaron Lewis (38:58)
Correct. Correct. I realized when I finished the exam, you know, what was I going to do to offer some sort of help? I realized right away that I don’t want to do financial planning soup to nuts like you do. There’s no need for me to do it and I can’t do it to the level you’re doing it. But what I can do is guide people to best in class advisors or a trusted insurance salesman who, who is not gonna sell them what they don’t need. And so I can sort of be a conduit and a guide as it isn’t, like you said, it’s exactly financial coaching. It is not financial planning. I’m not certified to do financial planning. It is financial coaching.

Justin (39:37):
Cool. So in closing here, Aaron, thank you very much for your time today. Any any advice or any kind of pearls of wisdom that you might want to leave us with as far as, you know, there’s people out there listening who think, you know, I’ve been, this has been a nagging thing. I feel like I ought to be doing better with my finances or maybe there’s a career decision or something. There’s, there’s things looming that are sort of causing anxiety for people. What types of, you know, insight might you have to offer for somebody out there like that?

Dr. Aaron Lewis (40:04)
So I think anxiety inducing financial subjects are common among later and residents and attendings. And I would just say that if you have anxiety about something, please somehow find somebody that you trust. You can read a little bit on your own. Actually I would, I would, I would advise that. Read a little bit on your own so you just understand the basic terminology, but then sit down with someone you trust. I guess it’s up to you to find out who that person is, but spend a little bit of time with them and really try to get down with, really try to get down to the details of what do you actually need there. So there’s two questions you’d ask. What do you need versus what do you not need and for the things you need, how do you get it for the best value? How do you get it where your goals are best served? And so the, this is where a trusted financial advisor or helper or guide or whatever you want to use is invaluable and proper financial advice really addresses, in essence someone’s money anxiety and a yacht not to have a life lived with compounded financial anxiety. It’s really worth dealing with checking the box and focus on being happy and enjoying the fruits of your hard labor as a physician.

Justin (41:22):
Absolutely. Awesome. Well, we’ll close with that. Dr. Aaron Lewis, thank you very much for joining us today on the anesthesia success podcast.

Justin (41:29):
Thanks for having me, Justin. If you liked what you heard this week, pet on over to anesthesia, success.com where you can find more content and free resources to help you build a successful career in anesthesiology and pain management. If you want to leave her review in iTunes, I would also really appreciate it. Thanks for using some of your valuable time to join me today on the anesthesia success podcast.