Listen Now

EP 10 Passive Income investing during a Crisis by Docofalltradez | Dr. Jeff Anzalone http://traffic.libsyn.com/thephysiciannegotiator/Final20Jeff20No20Leveling.mp3 WHO’S ON THIS EPISODE  Website i Email Getting started with building an emergency fund and passive income- Dr. Jeff Anzalone In this episode, we invite Dr. Jeff Anzalone to talk about his strategies in building an emergency fund, taking advantage of the opportunity in crisis, and investing for passive income generation. Dr. Jeff is a periodontist who eliminated his over $300k worth of student debt after 7 years of practice. He is also an author and an expert in studying successful dental practices, reducing tax burdens, and earning passive income with real estate syndicates. Below are highlights from the conversation we had. The importance of having an emergency fund. It is no secret that we’re in the middle of an inevitable crisis that is the COVID-19. It is therefore imperative to have an emergency fund set up for time like this when even going to work is a risk.  Dr. Jeff came up with a modification of Dave Ramsey’s strategy of building a six months emergency fund to twelve months instead. He shares some actionable tips for setting up an emergency fund: Eliminate the scarcity mindset and adopt an abundant mindset. Have your emergency fund in cash and a money market account for easier access just in case a crisis ever affects how you can access it.  Opportunity in crisis. Dr. Jeff has adopted a quote: “be fearful when others are greedy and be greedy when others are fearful.” It is wise to invest now during the crisis since everything is cheap and affordable before they hike up again.  Most people are now looking for ways to sell the assets that they believe will lose value as the pandemic progresses. Dr. Jeff shares tips on how to seize the opportunity in crisis:  There’s probably never going to be a better time to invest in the market than now.  Do not get out of the market by selling- it will only create a loss and things are going to come back to normal or halfway there once the pandemic is over. This crisis could surpass the great depression with the number of millionaires made. You should engage the entrepreneurial spirit within you to start a business that you would have never started. As a business owner, think about customer care especially if in the healthcare sector. Investing in real estate syndicates. As a doctor, one source income that is highly taxed can be quite restrictive especially for doctors who want to be debt-free. It is therefore wise to find ways to make passive income like investing.  Tips on how to get started with investing: Get a good understanding of what you’re investing in by reading, listening to podcasts and networking. Learn from other people failed invests to look for better investment opportunities. Get a mentor in your field of investment that will lead you. Attend conferences to meet people who know things in your field of interest better than you do.   Why real estate syndicates investments rather than single-family homes: Real estate syndication investment is where an investor invests in large properties than they could ever manage to afford on their own. Their return on investment is 7-8% with a five-year hold and a profit split when they sell. This means that your investment could double in 5-7 years and is tax-free due to real estate depreciation. Dr. Jeff shares tips on what you need to know before investing in real estate:  If you’re not interested in dealing with tenants, then real estate syndication might be the best option for you.  It gives you the choice of not being an active investor. Attend meetings set up specifically for real estate syndication.   https://joefairless.com/ The risk in these types of investments highly depends on the asset class you’re in. Find an experienced real estate accountant to help you with your investments before you jump in. There are no deals negotiation done since you’re going in as a shareholder so no attorneys needed. “As a dentist and physician start building an emergency fund and for those who are at home during the COVID-19 pandemic, look for a way to a passive income once all this is over.”- Dr. Jeff Anzalone Resources: Website: https://www.debtfreedr.com/ Free Guide: https://www.debtfreedr.com/freeguide/ Joe Fairless:  https://joefairless.com/ Book: What They Don’t Teach You in Dental School Final Jeff No Leveling.mp3 transcript powered by Sonix—easily convert your audio to text with Sonix.Final Jeff No Leveling.mp3 was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best audio automated transcription service in 2020. Our automated transcription algorithms works with many of the popular audio file formats. Docofalltradez: Welcome to the Physician Negotiator podcast, where no decision is left to chance with your host doc of all trades.Docofalltradez: All right. Today on the show, I have Dr. Jeff Anzalone. Dr. Anzalone is a Perry or a dentist who started his career with over three hundred thousand dollars of student debt. He was able to eliminate this debt after seven years of practice. He's also an author of a book titled What They Don't Teach You in Dental School. He is now an expert in starting successful dental practices, reducing tax burdens and earning passive income with real estate syndicates. He shares this wisdom on his Web site and his blog called debt-free. Dr. Dot.com, that's debt free. d.r dot com. Dr. Jeff, welcome to the show. But, sir, it's a pleasure to be here. Well, hey, it's a pleasure to have you and you are the perfect guest given the set of circumstances that's going on in this country and the whole wide world right now. We're going through the pandemic of Cauvin 19. And I feel that physicians and surgeons, physicians and dentists, I'm sorry, are feeling the effects of this pandemic. During the last financial crisis, we really weren't impacted. And it seems like this time around we are severely impacted. And you wrote a really nice article on your Web site called Financial Stress during a Crisis Five Lessons Learned and the lessons that are really paramount for professionals. Is it all about debt? And the one thing that you advocated is having a rainy day fund. Now, traditionally, people advocate having a three to six month rainy day fund, but you advocate something a little bit differently. Would you mind explaining that?Jeff: Well, yeah, absolutely. I am a big Dave Ramsey person. I followed him when I first got out of my residency and but I didn't follow his. His baby is seven baby steps to the T. Because he didn't want anybody to do any type of investing while they were getting out of consumer debt. And with me not getting out until I was in my early thirties and I knew I gonna take several years to get out of there. I didn't want to lose those years of compound interest. So I decided to do both, you know, get out and get out of debt quicker. But also at the same time, Max, out of retirement accounts. But and that's where were we? We kind of differ in that aspect. The actually the his first baby step baby step one is to establish an emergency fund. And with with him, he just because you got to think about he's talking to the masses. You know, he's talking to, you know, the just the everyday blue-collar person. Like, you know, I just get a thousand dollars in that account, you know, just just get some because, you know, as you know, most people don't even have an emergency fund. So just getting something in an account. That's what he's recommended. Then after you get out of debt, consumer debt, which is baby step two, you go back to the emergency fund and build it up to three to six months of your expenses.Jeff: Now. What would things have taught me in the past was whenever I was giving out of my residency, I had a supposedly I had a job locked up with with a group here in my hometown in Louisiana. So about 10 to 14 days before I graduated, they basically just pulled the job out from under me. And, you know, I had a two month old. I was married. We'd already bought a house. You know, we were paying an interest only loan on it. I had, you know, almost three hundred thousand dollars of student loan debt, didn't have a clue how to start a practice or anything. And it was just like that. How it change, how things can change. So ever since then, I've I've always been real leery about how things could happen, just like with this crisis, how one day you're sitting here going to work, the next day everything's shut down. So that really changed my mindset about money and kind of fear because I was there for it for a long time. I always had this scarcity mindset. And that's really held me back with with a lot of things not having that bandit mindset.Jeff: You know, I was always like, OK, well, there's only so much money to go around and that's it. Which, as you know, that's that's not true. I mean, look at how they're printing money right now for the country. You know, so. So with with what this crisis has really taught me is that three to six months that he's recommending emergency fund living expenses. Well, when you're going through something like that, that could be like bare bone, minimal living expenses. You know, that could be just to keep the lights on

EP 09: Getting Started with Practice Management by Docofalltradez | Dr. Brent W. Lacey http://traffic.libsyn.com/thephysiciannegotiator/Ep0920Final20Brent20Lacey.mp3 WHO’S ON THIS EPISODE  Website i Email EP 09: Getting Started with Practice Management – Dr. Brent Lacey In this episode, we invite Dr. Brent Lacey to share effective strategies and actionable tips on how physicians can: achieve financial literacy, seek out mentorship, effectively negotiate their contracts and mitigate burnout.   Dr. Lacey is a full-time practicing gastroenterologist and physician blogger. As Founder and CEO of TheScopeofPractice.com, he specializes in personal finance, practice management, and early career strategies.  Highlights and insights from our discussion below. Reversing the trend: The importance of personal finance savviness to mitigate debt. Consider this: Eight out of 10 medical school graduates borrow to earn their degree. Most take on six-figure debt with 18% borrowing $300K or more. The average time taken to repay medical school debt? Thirteen years.1   Despite these astounding figures, nowhere along the pathway to earning a medical degree do educators teach medical students how to manage their personal finances, let alone their private practices or business. Dr. Lacey shares tried and true tips on how to: Seek out a mentor, sponsor or advisor outside of medicine. Understand simple business efficiencies [e.g. how to run a meeting effectively, negotiate diplomatically and more.] Establish your own personal board of directors to provide you with sound guidance when it comes to taxes or accounting, legal matters or estate planning. The art and science of contract negotiation With new graduates coming into the scene and more physicians moving away from independent practice, it’s critical to understand rights and responsibilities before signing a contract with a hospital or large organization. Among many tips offered in this episode, here are a few that standout: Be prepared and do your research ahead of time. Talk to other people in your specialty to get a good comparison point. Don’t just focus on salary. Think holistically about lifestyle, colleague skill sets, peer experience, work-life balance and workplace satisfaction. Don’t just take what’s offered at face value. Most contract items are negotiable so go in with the facts – not emotion. Think ‘mind over matter’ when it comes to physician burnout The U.S. physician shortage is expected to reach between 34,600 and 88,000 in 2025. With high demand for care and short supply of physicians, burnout is a real epidemic. In fact, an online survey of doctors found an overall physician burnout rate of 44%, with 15% saying they experienced colloquial or clinical forms of depression.2   While this is a very real issue and should not be diminished, Dr. Lacey emphasizes the power of a positive mindset and creating boundaries. Some tips include: Don’t take on too many extracurriculars and volunteering activities. Learn to say, “no” or “not now.” Find your outlet to release stress. How can you create balance and seek out what makes you happy [e.g. cooking, fitness, travel, etc.]? Identify your support system. Whether it’s family, friends or coworkers, surround yourself with people who create a positive energy and can give you constructive advice.   Sources: https://nces.ed.gov/programs/digest/d18/tables/dt18_332.45.asp https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056?faf=1#1 Ep09 Final Brent Lacey.mp3 transcript powered by Sonix—the best audio to text transcription serviceEp09 Final Brent Lacey.mp3 was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2020. Welcome to the Physician Negotiator podcast, where no decision is left to chance with your host doc of all trades.Docofalltradez: Hey, welcome back. And today on the show, we have Dr. Brent Lacy. Dr. Brent Lacey is a gastroenterologist and he is the founder of the Scope of Practice Dot.com. Dr. Lacy, welcome to the show. Thanks so much for having me. You know, in a crowded space, you have done an amazing job outlining the steps needed to take to have a very successful launch of a medical career. Your Web site focuses on personal finance, practice management and early career strategies for medical professionals. I've been doing this for about three years or so. I'm familiar with all the physician bloggers. And I got to tell you, your Web site is excellent and it's very, very thorough.Brent Lacey: Well, I appreciate that. Thank you. Yeah. Here's his pen. A lot of work, but it's been it's been a lot of fun, too.Docofalltradez: And, you know, I can tell you personally, I've been the amount of effort and time it takes to build a Web site like yours. I can't even imagine how many how many hours you spent at this. So for that, I commend you. I think your writing is very clear. It's very concise and is very linear. And that's really, really, really hard to find. That's what I struggle with more than anything else, is trying to be a linear thinker. And what I think the biggest challenge that physicians have is financial literacy. And so we hone in on our craft. We we we learn how to practice medicine, but we just struggle with financial literacy. And I think if you look at your what Web site, if you were to go through it from beginning to end, I think you would have a good foundation. So the question is, how did you get such an amazing foundation?Brent Lacey: Well, so my my journey is actually very fortunate. My parents were very good at dealing with money and very savvy, you know, from it, really ever since I was a little kid.Brent Lacey: And so I remember when I was when I was young, you know, doing budgets with my dad when I was really young. And, you know, learn how to do a checkbook, learn how to do mutual fund investing, learn how to build spreadsheets. When I was, you know, in my teens.Brent Lacey: So I was fortunate to grow up with with a lot of education and then, you know, really sort to try to continue that during college and med school and and into clinical training with just reading and reading and reading. I mean, I have a couple of bookshelves worth of business books and personal finance books. And so I've just been reading for over a decade now. And, you know, you know, we were talking a little bit earlier. One of the things we had, you know, I'd mentioned is that, you know, a long time ago, one of my mentors taught me that if you want to be a leader, you've got to be a reader. And I firmly believe that. So, you know, I think that's the number one thing that physicians can do for themselves is, you know, if you're not taught this stuff in medical school, which you know, you're not, unless you're forced to go to one of the five places that has somebody like you or somebody like me teaching this stuff just on their own. You know, you got to go out there and read. You know, there's all kinds of sites out there like yours. Like like the scope of practice, you know, and just books out there that you can get. I mean, you can get an MBA by just going to Barnes and Noble, spending a couple hundred dollars on, you know, on, you know, the top 20 business books and you'll just know so much.Docofalltradez: And based upon your parents teaching you how to how to make a budget, you chose to attend the University of Texas, San Antonio, on a Navy scholarship. What made you decide to do that?Brent Lacey: Well, so that was that was interesting. So Texas is unique in that they have their own match separate from the national. So suffer from like the national match. So I applied to all the different schools in Texas because that's where I grew up. And so I wanted to go to school close to home. And I loved the San Antonio program. I loved the clinical side of things. I loved the people that were there and ended up ranking them. Well, I ended up ranking them second, actually, as a matter of fact. But I vacillated between them and Houston 1A and 1B and then, you know, ended up ranking. And second. But they ranked me. They rank me first. Yes. And I loved it. It was a great place. Now, the one thing that we didn't really get there and I think, you know, you didn't and most people don't. Is the is how to manage a business, how to run your personal finances. And, you know, so that's one of the things that I really wanted to try to do well. And so I spent a lot of time reading and now I spend a lot of time writing about this.Docofalltradez: Fantastic. Now there's the application and there's the acquisition of knowledge, but then there's the application of knowledge. And sometimes it's hard to translate that without a mentor. Now, did you ever have somebody like that in your life to help you apply your knowledge?Brent Lacey: Yeah, it did. And yeah, I'd say my my biggest mentors over the course of my life have really been my parents. I mean, they've they've just I mean, I'm incredibly blessed to have two parents that are just really savvy about this kind of stuff and who are willing to teach me. You know, I was in the Boy Scouts for a very long time. So a 12 or 15 years and very active and says it's kind of a natural leadership laboratory. So I learned a lot about leadership and how to manage

EP 08: Starting a ketamine clinic from scratch by Docofalltradez | Dr. Cindy Van Praag http://traffic.libsyn.com/thephysiciannegotiator/2019-04-16-t03-05-09pm-final-mix.mp3 WHO’S ON THIS EPISODE  Website i Email Have you heard of Ketamine or Ketamine Clinics?    Dr. Cindy Van Praag of springcenterofhope.com along with her business partner Tessa Benson, RN decided to open one two years ago without any prior experience.   Now they have a thriving clinic after some trial and error.   Find out why they opened their clinic and why some people would benefit from an infusion of Ketamine.    What are the obstacles, opportunities and investment requirements needed to be successful?  Is starting a ketamine clinic a viable way to transition out of the medical-industrial complex completely?    What are some of the mistakes she made and the advice she has for others?   In the Podcast: Spravato:  https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm632761.htm Cindy Van Praag Podcast.mp3 | Convert audio-to-text with the best AI technology by Sonix.aiDownload the "Cindy Van Praag Podcast.mp3 audio file directly. This mp3 was automatically transcribed by Sonix (https://sonix.ai). Welcome to the physician negotiator podcast where no decision is left to chance with your host Doc of all trades.And welcome to the show. And today I have a special guest Dr. Cindy Van Praag. She is owner and operator of spring of Hope Center. I believe it's a Ketamine Infusion Center clinic in Spring Texas and the website is called I believe it is spring a Center of Hope dot com. Cindy welcome to the show.Cindy Van Praag: Hi. Thank you for having me.Docofalltradez: Well what a you know. So I've been wondering about the ketamine clinics for a long time. And I just you and I just met at the first annual physicians helping physicians conference and it's called the non physician non-clinical career celebration networking and meeting was just this past April 6th and 7th 2009 in Austin. And I had a blast.Docofalltradez: I had a blast meeting you and a funny thing happened during the conference. Tons of people came up to me and asked me what type of careers they could start specifically and the ketamine business. And I was like What a coincidence.I met somebody who's an expert at that too well I guess that's me.Cindy Van Praag: Yes yes.Docofalltradez: So. So you know I thought it was really really neat that I met you. I mean myself I've always had a curiosity about starting Academy clinic. I'm an anesthesiologist and I believe you are as well. Yes. I have numerous friends who are also been interested in starting ketamine clinics. So if you don't mind to introduce yourself tell us a little bit about your background and how did you get into the movie business.Cindy Van Praag: Sure. Well this all started out in Chicago and you know I went to med school and got my M.D. and went to residency in anesthesiology in Chicago well so I spent about nine years in Arizona as a partner of a large anaesthesia group. It was M.D. owned. So it was pretty fantastic but then moved to Houston for family reasons and did about four years of mobile anesthesia where I would be doing office based anesthesia or surgeons in their office which is a whole nother ballgame. About two years ago however I I moved on into the ketamine business so I opened up a business with a business partner who's a nurse and it's spring center of hope and we provide I.V. ketamine infusions for a variety of patients. And I think I have my whole career is kind of built up to this point. I have always been restless. I have always wanted something more. I attended the Sikh conference in Chicago years ago I attended this you know the BHP conference you just mentioned all of these things I think I'm an entrepreneur at heart and I am so fulfilled with this Ketamine Infusion clinic that started about two years ago now now.Docofalltradez: So with your office based practice did you start that business or did you did you get. Did you hire into that business.Cindy Van Praag: No I hired into that business.Cindy Van Praag: And that's that's basically the job that I took when I moved here to Houston and I worked with a great doctor who owns mobile anesthesiologists of Houston and so and together we did a lot of cases in office.Docofalltradez: So did you learn your business acumen through that practice.Cindy Van Praag: I think I honestly just learned it on the job. My husband is not a doctor which is great because he complement me and he is such a business minded fellow that I think I learned a lot from him and he's really supported me this whole time so I just learn on the job and when I say on the job I mean I've been with this spring's center Pope I just jumped right in and I learned this as I went.Docofalltradez: That's amazing. What gave you the courage to take the finals the final leap if you will.Cindy Van Praag: I was done being restless. I was done trying to search for what. What am I gonna do. What is my business going to be. Should I stay open a wellness center should I do this. I do that. And really the opportunity came along when my business partner had a family member. A 15 year old girl suicidalCindy Van Praag: Who I knew personally and multiple multiple attempts almost successful many times and her psychiatrist told her and the mom he pretty much stood up as Hansen said I don't know what else to do for you.Cindy Van Praag: So the mom basically found through online research ketamine as an alternative and so we watch this transition or of this girl who is almost she's just lifeless to now.Cindy Van Praag: She's another person. It was a 180. So that's what really sparked you know my business partner and I saw that and we're like you know what we can do this. Absolutely we can set this up and save people's lives. And so I really have a heart for. Even though I'm in my background as an anesthesiology man.Cindy Van Praag: I have a heart for these mental health people that come in especially the suicidal patients you know and that just gives me chills because I think all of us got into medicine ultimately though to want to help people and I feel like at least in anaesthesia I'm not sure how you feel about this. Me personally sometimes I'm not sure if I'm helping people or not. You know some some days you just kind of go through the whole day and and I feel like I've accomplished nothing but you know it sounds like your work has purpose and meaning and you actually can see your your efforts and the lives that you're changing.Cindy Van Praag: Right. Right. And I used to think anesthesiology was perfect for me because I'm an introvert by nature. And so I thought Oh this is great. You know I interview the patient I talk to them for 10 15 minutes and then I put them to sleep. And so my only interaction has to be with the surgeon and the staff in the operating room but I guess asCindy Van Praag: As time goes on I realize I do want more interaction with my patients and I do want to talk with them and I'm I'm there for each infusion that we do at our clinic and so I am very bald and I talk nonstop now. So we're being an introvert. I am I'm a different person now.Docofalltradez: Yeah. You know I would have never guessed that about you know when I met you in Austin you were very open I felt very comfortable talking to you didn't feel like you were guarded at all.Cindy Van Praag: That's great. Good.Docofalltradez: So you kind of I mean you let into a couple of my questions but let's let's back up a little bit and first you give me a one I want indication for academy clinic but basically again let's let's take a step back. So most of the audience is gonna be physicians there'll be some physicians though aren't really familiar with ketamine. So basically what is ketamine and what is it used for and how does it work right.Cindy Van Praag: So Ketamine has been around for over 60 years. It's I know it well from the operating room. So we use that as an anesthetic as an adjunct to our anaesthesia. It is also used in emergency rooms for. Acute pain control for setting you know let's say just location setting a bone. So E.R. docs are very familiar with it. And also it's been used on the battlefield and I think that's where it started.Cindy Van Praag: It's a drug that doesn't cause respiratory depression it doesn't cause a drop of blood pressure is actually a very safe drug to use in a situation like the battlefield for example when you can't monitor the patient as well. So it's been it has a long history of use in those three areas.Docofalltradez: Now the dose that you use in an anesthetic is much much higher than what you're using in your clinic Correct.Cindy Van Praag: Correct yeah. So I if I use a dose in the operating room I will be pushing or giving a bolus and in the clinic it might be that same dose but it's spread out over an hour. So we give it my eye in my clinic I give it by I.V. And I use that dose over an hour. So yeah but minute by minute it is a much much lower dose.Docofalltradez: And and why why I.V. Infusion versus other mechanisms of uptake.Cindy Van Praag: Well my chip Well it's you can give it in many different routes of administration you can give a nasally and I am an I.V.. The reason I chose I.V. is because it's 100 percent up to you know what you're

EP 06: Exploring Employment Contracts for New Physicians by Docofalltradez | Leigh Ann O'Neill http://traffic.libsyn.com/thephysiciannegotiator/EP07_Leigh_Ann.mp3 WHO’S ON THIS EPISODE  Website i Email You are a trained professional, and you are the best in the business.  You have the best outcomes, have the best patient scores, and have the highest productivity.  Many if not all others envy your skill and respect your success.  In school, you studied harder than everyone else and earned high marks and are one of the top ranked in your class. But there is one problem, you went to Medical School,  NOT Law school and NOT a business school. The problem with modern physicians(myself included) is that we believe our skill, experience, and knowledge translate to any profession outside of Medicine.  Well, remember Julius Irving aka Dr. J only made $230,000 in 1976 and topped off over 1 million in 1950 which by today’s standards are what the benchwarmers make in the off-season.  The problem back then was a lopsided negotiation with a team owner who had appropriate legal and business representation with a player who had the best talent at the time but who lack any understanding of the Business of Basketball.  The same hold true for healthcare professionals,  we understand the delivery of healthcare and are a healer, but we are not Ballers(business minded).  Not only is it unwise to navigate the business of Medicine alone, since there is strength in numbers, it is also unwise to use your precious time to negotiate a contract or even find a job when you should be focusing on things that matter like passing your Boards.  I am still amazed at how much I have learned over the years outside of Medicine and equally surprised how little physicians and other healthcare providers know about the business of medicine and have absolutely no representation. Join me as I explore the concept of the Physician Agent.  I will hopefully have a series of podcasts and blog posts looking at the various aspects of the idea.   The first step was meeting Leigh Ann O’Neill Who as a specialist in physician contracts who understands how disadvantaged physicians are in a complex business environment.  She understands not only contract law but also the market value of physicians.   If physicians do not fully understand all the complexities of contracts, it can lead to a job where you overperform and get underpaid which is a recipe for disaster and ultimately Burnout.   Please leave comments, and if you would like for me to explore anything else in this concept, please leave me some comments! DOWNLOADS EP07_Leigh_Ann.mp3 (transcribed by Sonix) Docofalltradez: Welcome to the physician negotiator podcast where no decision is left to chance with your host Doc of all trades today on our show we have Leann O'Neal Leann is an attorney who received her J.D. from Indiana University.Docofalltradez: Leann has a website and practice called laws O'Neil and she could be found at Lord O'Neill dot com. She specializes in helping physicians find the best possible job and negotiate contracts. She also has invented a concept known as the physician agent a physician agent basically is similar to a sports agent. Your job is to become the best possible physician that you can be. You do not necessarily have the time or the energy to focus on the financial and legal aspects of your job. So you hire an agent to help represent you in those matters thereby freeing you up to be the best clinician. So without further ado I'd like to introduce you to Leon hi Leon. Welcome to the show.Leign Ann : Thank you for having me.Docofalltradez: Oh great. Now currently Leon where do you live.Leign Ann : I live in Indianapolis. OK.Leign Ann : And that's where that's where your main practice is that right. Yeah. Great. OK. Briefly could you tell us a little bit about yourself.Leign Ann : So I finished law school in 2006 and right out of law school started with a medium sized law firm that had a really robust health care group. And so I spent a lot of my time working both for health care providers as well as individual field irons under Medicare and Medicaid rules also and regulations that apply to physicians and hospitals and then also worked a lot of physicians as they looking at their employment agreements.Leign Ann : And so after being with that firm for a while my husband was actually in his surgical residency at that time and once he was finished with that and started looking for a job as a result I was watching as he was sort of struggling with that process and realized that the full job search process and certainly you know doing a legal review of contracts and making sure that everything is as it should be is not something that a physician can do on his or her own. It certainly worked for physicians in the past but decided that I wanted to focus my work to help physicians specifically job search and contract negotiation phase of their careers.Docofalltradez: So when you were in law school did you ever did you automatically one go into health care. Was that kind of when you were in law school itself was that what you're specializing in.Leign Ann : Yes I did. I actually I always say did I get another life a secretly want to be a doctor but don't feel like I probably could pass the requisite chemistry courses. And so Holly kind of was my goal to help health care providers in a meaningful other way. And I couldn't necessarily I didn't feel like that was my path to be one my my stop. So I wanted to get in health care law to support health care providers. And so it kind of took awhile to morph into what it is today but now I have my company law. All physician agency and we exclusively work for physicians and nurse practitioners and physician assistants help them through the job search and contract negotiation process.Docofalltradez: All right. And you do the next best thing. You married a physician so you guys are or a couple physician and oh my wow. Well so you know short of being able to marry a lawyer what's the next best thing a physician can do to kind of get his or her contract off off to the right start from the get go.Leign Ann : Whenever I talk to a group we offer our educational sessions a lot of time we talk to groups of physicians about this process. I always say that it's important to find a lawyer who specializes in this type of work. So of course lots of people have kind of like their uncle or cousin who's a lawyer and dabbles in this or that and can kind of look over their contract. But I really stress that when you are looking for someone to check out your employment contract or a partnership agreement if you're at that stage and with a private group it's important to find someone who specializes in that type of physician employment work because they are very specific provisions in each contract that apply specifically that you own a mess and there market standards and forms of what physicians are offered today and it's to your benefit to have a lawyer working for you. Who knows what those are.Docofalltradez: And you know most physicians I think we feel like if they were to even consider asking an employer and or partnership to look over the contract with a lawyer and to make changes it almost seems like the lawyer the physician would be afraid because they would don't want to offend that potential employer.Leign Ann : Yes and we actually hear that all the time that's a concern that a lot of clients have when they come to us it's kind of they're worried that it might come off badly if they know if their potential employer knows that it engaged a lawyer. And so the thing I always like to talk to clients about though is that especially when you're coming out of training your relationship with your employer up to that point has been very much of a mentor mentee type relationship versus once you're out of training it's more of a traditional employer employee model and the employer is not able to look out for your own best for your best interests as well as their own best interests. And a lawyer drafted that contract for that employer. Right. And that means that they kind of have the upper hand when it at least when it starts off. And so you know they're protecting their best interests and you owe it to yourself family to protect your best interests as well. And so you know actually a lot of employers I think are becoming more sophisticated about this as well and oftentimes we hear you find a provision in a contract that specifies you've been given the opportunity to consult your own legal account. A lot of employers are really interested in entering a relationship that's been very well thought out and considered and they do not want you to move ahead and sign the contract if they don't feel like you've had your fair review with your own legal counsel.Docofalltradez: So that would be kind of a warning sign right. So if you have a group or private practice it comes to says hey well what we voted you got the job so are you to join us. Right. And by the way you've got two days to review the contract and get bachelor's would you say that's a warning sign.Leign Ann : Absolutely and that's another thing we hear a fair amount. Is a client will call us and say well you know how fast can you guys do this because they told me the deadline is Friday and if I don't sign the c

EP 06: Academic Versus Private Practice by Docofalltradez http://traffic.libsyn.com/thephysiciannegotiator/EP06_The_Physician_Philosopher.mp3 WHO’S ON THIS EPISODE  Website    TPP on Facebook  TPP on Twitter   Feeling refreshed coming back from Fincon, the physician-philosopher got his voice back and we hit the ground running with a very nice discussion on the current state of Academic versus Private practice in Anesthesia.   Now since we are only two people working in two different institutions this discussion is far from all being all encompassing.  Despite this were able to cover quite a bit of ground in looking at compensation models, working conditions, common challenges with new graduating residents, Debt, fellowship training dilemmas, generational differences in medical practice and of course lots of PHILOSOPHY.   Which did we decide was the better choice after all the dust had settled?  I guess that decision will be up to you after you listen to the podcast.    RESOURCES & LINKS Academic, Group and Solo Practice White Coat Investor Topic  ACP on Types of Practices Ob/Gyn Practice Patterns AAMC Tool Box for your 1st job Dr. Jonathan Kaplan Post  DOWNLOADS EP06_The_Physician_Philosopher.mp3 (transcribed by Sonix) Download the "EP06_The_Physician_Philosopher.mp3" audio file directly from here. It was automatically transcribed by Sonix.ai below: Docofalltradez: Welcome to the physician negotiator podcast where no decision is left to chance with your host Doc of all trades.Docofalltradez: So today on our show we have the physician philosopher. Hopefully this might be his inaugural podcast but depending on the other podcast. Well I'm just hoping I'm hoping I get to be your first anyway. The physician philosopher on today. He is an expert on wealth and wealth and wealth and wellness and he has a website called The He's done numerous post has an amazing website and he's been featured on websites such as the White Coat Investor and I believe on Physician That is correct. Excellent. Well hey I'm going to call you TPP welcome to the show.Physician Philosopher: Thanks for having me. I appreciate the opportunity to be on here.Docofalltradez: And you know we you and I met at fin con and we had an awesome time. And one thing we both realized early on is we're both anesthesiologists and we have a very similar but different practice models. And so I reached out to you and thought we could discuss that. Now you are a academic anesthesiologist and I'm an employed anesthesiologist so I'd like to kind of just talk about the difference between being an employee in a non not for profit large institution versus an academic institution.Docofalltradez: So let's go and get started. Now how did you go about choosing that you wanted to be an academic because there are numerous choices that you can make as an anesthesiologist. Me personally I chose to go into private practice but you chose group practice. I mean academic practice. How did that choice take place.Physician Philosopher:  Yes it is kind of an interesting journey. I mean I do work at a large academic hospital now and when I was a resident I knew a few things about myself. I knew that I like to teach. I knew that I liked practicing anaesthesia and I really didn't have much of a love for research at the time but fortunately I'm in a group at a hospital that doesn't really force that on you. And so it wasn't demanded for me to do research. And ironically in my third year of residency I stumbled upon a couple of questions clinical questions that I felt like weren't answered adequately and started a couple of randomized controlled trials in my last year of residency that I ended up concluding as my first year in attending so as I started the road not really enjoying research I found that when I was asking a question myself and designing a project to answer it I actually did enjoy it. So it produced a situation where I wanted to be good at all three things that are academics which is clinical work teaching and research and to this day that remains my focus. My main gig is being good at all three of those things and that pushed me towards academics because some of those options are limited in private practice.Docofalltradez: So did you do you even consider going into private practice at any point.Physician Philosopher: I did yeah. There's actually a few groups that I looked at. And you know the big draw of course in anesthesia at least is that you get to maintain the breadth of practice whereas in academics I'm very defined in a specific niche. I did a fellowship in regional anaesthesia but before I did that I did consider going into private practice and the idea of maintaining a very broad scope of skills was appealing to me. In addition to you know the various differences between private practice in academics. But yeah I guess I thought about it.Docofalltradez: Well there's going to be a difference in terms of reimbursement between academics and private practice. Was that ever a consideration in your decision.Physician Philosopher: It was you know just like anyone else I came out with with student loan debt though I had less than the average. So you know money certainly played a part for me it wasn't the substantial part though I you know I really looked at it as what I want to do with my life where I want to see myself in five or 10 or 15 years and made the decision based on that information. Money did play a part in that. You know if there was a massive difference between the two I know I might have been pushed one direction or the other. But nowadays that difference is getting smaller and smaller with each day. And I work at an academic hospital where I'm paid pretty well.Docofalltradez: And you know it's funny I haven't really been looking at the differences lately but when I was coming out of residency that the difference was rather large. And back in 2005 when I graduated they were offering pretty enticing signing bonuses which then really went away. Around 2011 2012 and now they've come back with a vengeance. And there are people in my who are graduating that that I'm currently teaching teaching and mentoring we're offered massive signing bonuses. Do you find that they're giving signing bonuses at academic institutions or have you been enticed with any signing bonuses yourself.Physician Philosopher: There are you know it's just different than ever every hospital and every anesthesiology group whether academic or private practice has a different model and so where I am you can get kind of a signing bonus. They may help you with moving expenses they may help you with the number of shifts that you required to work that year in decreasing that such that. You make more money for less shifts and sometimes they will give you an outright bonus to start. But I would say that that I'd imagine at least in my experience that those numbers are going to be smaller than what they are in private practice.Docofalltradez: Well you know and you also mentioned that you graduated with some student debt and I imagine there are more opportunities to get that student debt forgiven in an academic than versus private practice.Physician Philosopher: Yeah it's actually interesting. You know I I'm doing a study in my academic job where you know we're looking at student loan debt surveys and determining financial literacy is regarding student loan debt management and you know in doing that I discovered that about 75 percent of hospitals you know all comers are 501c3 or governmental hospitals that would qualify for public service loan forgiveness. The implicit assumption there is that you are in fact employed by that hospital though and not working in a private practice group that contracts for the hospital difference there. Right. But if you are employed by the hospital itself then you have a 75 percent chance of going anywhere in the country that your hospital whether academic or not is going to qualify for public service loan forgiveness. Obviously all academic institutions do for the most part. And so that did provide an opportunity there although that's not the route that I'm going personally.Docofalltradez: Well you know I think that would be something really to look into. If 75 percent like you said there's a there's a good chance and then if you could potentially tie that to a signing bonus you could take quite a good dent out of your student loans coming out. Oh sure absolutely. You know a very different choice would be going into solo practice then. Now the problem is if you do have a lot of debt a lot of these private practices will have a b I looked at two different jobs my current job there was no buying but I looked at another job and the buying was you get a reduced reimbursement the first year and that that reduced reimbursement then becomes your buying and it could be upwards. In my case I was gonna be something like one hundred thousand dollars so I imagine for a student who's kind of with debt they'd be more they'd probably less willing to take on that risk. And so of the graduating residents that I'm mentoring right now most of them you mean they have absolutely no desire to take on the risk given their student loans. Are you finding that to be the case with your with your graduating residents.Physician Philosopher: Yeah you know I don't k

EP05: How to find a medical job with disruptive technology using Nomad Health by Docofalltradez | Alexi Nazem http://traffic.libsyn.com/thephysiciannegotiator/EP05_Alexi_Nazem.mp3 WHO’S ON THIS EPISODE  Nomad Health  Twitter  Facebook link  Linkedin  Youtube Channel RESOURCES & LINKS 5 Mistakes in searching for a job EP05:  How to find a medical job with disruptive technology using Nomad Health Searching for a job will be the second most difficult thing we deal with second only to studying and passing our medical boards.  One of the reasons has to do with the antiquated system that requires 3rd parties and massive redundant paperwork for credentialing, onboarding and verifying.  This is busy work and having spent nearly a decade in medical school and residency the last thing we need is more busy work.    Nomad health is trying to change and disrupt the system by streamlining this process with the use of cleaver yet simple technology.    To Err is human and we are no exception.  Dr. Nazem and I discuss the top mistakes physicians make when searching for a job from an industry insider.  Also, we touch on the idea that Medicine is ultimately a business: The medicine is a business and equipping doctors and nurses and other clinicians around the frontline is a smart thing to do because then they can actually lead lead to changes that need to be made instead of people who are non-clinical and don’t really understand the nuances of medicine You don’t need to have an MBA but taking the time to gain business acumen will pay off in dividends in not only in your career but in your entire life.   DOWNLOADS Show Notes EP05_Alexi_Nazem.mp3 (transcribed by Sonix) Download the "EP05_Alexi_Nazem.mp3" audio file directly from here. It was automatically transcribed by Sonix.ai below: Docofalltradez: Welcome to the physician negotiator podcast where no decision is left to chance with your host Doc of all trades.Docofalltradez: Today I would like to introduce Dr. Alexi Nassim. He is the co-founder and CEO of nomad health. Well many health care startups have non-clinical founders Dr. nauseum continues to practice internal medicine at Will Cornell Medical College while building his business. He graduated from Yale Medical School and carries an MBA from Harvard. He feels passionate about fixing the broken health care system and solving the upcoming physician shortage by directly connecting major stakeholders in the delivery of health care namely the employers and medical professionals. His company nomad health accomplishes this by creating an online marketplace for physicians and nurses and skipping the middleman Alexi welcome to the show.Alexi: Thank you so much it's great to be on.Docofalltradez: Excellent. Hey you know Alexi you have an amazing background. I did a little bit of stalking on you. Hope you don't mind. No. I read an article you had written on Kevin M.D. about immigrants making America great. Yeah. And you have quite a legacy in your background your granddad was an anesthesiologist and your dad was a Buckeye graduated from Ohio State which practically makes us related since I'm a Buckeye Anesthesiologist.Alexi: Oh wow okay. Well nice to meet you brother.Docofalltradez: Yeah likewise. And your entire family is filled with medical physicians and pioneers. It's incredible.Alexi: Yes and I'm very lucky to have grown up in that environment.Docofalltradez: And do you feel like that is kind of played a role in your entrepreneurial spirit.Alexi: Oh most absolutely. I had actually interestingly both entrepreneurs in my family and physicians so I guess one could say that I was predestined to go down the path that I'm going down. I grew up in a household where most of my extended family were in some way shape or form involved in the medical profession. And so that originally served as an inspiration for me and as I have actually entered and practiced in the profession. Having all of those family members who are actually colleagues is now served as a support and a push and really sort of like a great set of consultants for me. And then on the entrepreneurial side especially through my dad I was exposed at a very young age to the concept of creating something from nothing making companies that use technology to solve real world problems. And so that brew at home really set me as I said on this pathway and so for sure I'm indebted to my family for what I'm doing today.Docofalltradez: So lucky and you know couldn't come at a better time. Medicine right now is just struggling. I just read an article yesterday on The Wall Street Journal about how health care in general is not now the number one employer of all people living in the United States. And to say that it's not in the best shape is an understatement. And I'd like what you're really doing a nomad health in and trying to help solve those problems. So if you wouldn't mind can you share a little bit of a little bit with us about how nomad health works.Alexi: Sure. So Nomad the problem that we are confronting head on is the challenge with providing enough staff clinical staff to patients in American hospitals clinics and other venues of care. I'm sure you've heard that there are huge shortages of doctors nurses advanced practice providers and many others. And solving that problem is going to be critical to the future functioning of the health care system. And so what Nomad is trying to do is to introduce technology solutions to provide more efficient more effective health care staffing myself as a doctor and some of my co-founders also doctors really felt the pain of this problem trying to get recruited into a job or or even just looking for a job yourself is a very inefficient very frustrating process that involves third parties that involves lots of paper and fax machines and phone calls and it's just not a very modern process and in a world where we really need to have the best clinicians at the bedside it's crazy that we're spending so much time energy and money on getting patients the doctors and nurses to the bedside.Alexi: And so the problem that we're trying to solve is actually sort of shortening the distance and the time between the clinician and the bedside and that's what we do know that.Docofalltradez: And so with so how is it different from a traditional recruitment company then yeah.Alexi: So a traditional recruiter is a third party. So there is let's say a hospital and a doctor that want to work with each other well traditionally haven't you. In order for them to find each other and connect they've got to go through a staffing recruiter what Nomad does is eliminate those staffing recruiters and using technology replaces all the functions that those recruiters provide and allows the doctor in the hospital to connect directly and consummate that relationship directly using technology. So instead of having to interview on the phone with a broker and then with a friend with the hospital and the medical director and all that kind of stuff instead of having to mail in paper forms instead of having to sort of look for credentials all over the place we've centralized all of those processes online in a very easy to use technology based platform. So it had that same ease of use to something like air PNB or kayak where you do very high cost complex transactions very easily very quickly online without the intervention of a third party. We're trying to bring that same level of convenience to staffing. And so basically we're cutting out the middleman and allowing the two parties that are interested in working with each other to do that without any outside assistance.Docofalltradez: And that is a fascinating concept because if if you know the modern physician orders looking for a job today and if they have multiple recruiters they may have to go through multiple processes multiple credentialing especially if you're a traveling provider. And so each time you go through the process you have to replicate that paperwork over and over and over again. So is no nomad then creating a database where you would just have to submit it once.Alexi: Exactly. That this company was born out of that very frustration. I I tried to do a locum tenant's job which is that kind of traveling Doctor job that you talked about. And it took me 10 months to organize just three days worth of work and it's because I had to talk to and submit. So I talked to so many brokers and met so many different applications and that just takes a lot of time.Alexi: And so what Nomad does is we essentially have a common app you apply one time to our platform you upload your information and your preferences etc. and then all you need to do is to just point out the job that you like and you don't have to re upload your ACL as current anymore or tell us again about where you went to med school.Alexi: And so that substantially cuts out the sort of hassle of working working with multiple of multiple places. And so ultimately what we want to be is the one stop shop for a doctor the one stop shop for a nurse trying to find a job or leverage the clinical skill set that they have.Docofalltradez: So there are traditional credentialing companies that you can upload all this info

EP04: How To Protect Yourself From Your Group Disability Insurance Policy by Docofalltradez | Christopher Yerington http://traffic.libsyn.com/thephysiciannegotiator/Christopher20Yerington20Final.mp3 WHO’S ON THIS EPISODE  Physicians Income Protection Website  Chris Email  Facebook link  Linkedin RESOURCES & LINKS Kevin MD Article on Disability Articles On Medium Cory Fawcett’s Article EP04: How To Protect Yourself From Your Group Disability Insurance Policy Dr. Chris Yerington is a retired cardiac and trauma anesthesiologist. Chris also attended law and business schools. After his clinical medical career ended due to a disability, Chris used his entire education and experiences to assist start-ups and entrepreneurs in Central Ohio. Chris often volunteers as a spokesperson or consultant for the companies and people he assists. He has a passion for working with professionals and physicians individually to ensure they have the best education and advice about disability insurance. Chris speaks to groups of resident physicians, dentists, and professionals and works diligently to provide income protection. Chris likes to talk about “Why you need great disability insurance” which is usually the last thing a graduating medical student would like to discuss, right up there with flossing and colonoscopies.  But when it comes to protecting your investment of 8 years or more of education the single most important decision you may not even make is private individual disability insurance.   There are very important distinctions between group and individual insurance which may seem trivial to some who has just started their career but It could have devastating consequences if not handled properly early on.    He also teaches finance in the following way.   The foundation of your career has to be financial protection in the form of individual disability insurance since when you first start out, you have no money and/or a negative net worth.   As you save part of your income (hopefully >20+%) over the course of many years you will achieve some level of savings until you reach financial independence.  From this point forward you have successfully navigated your career and then spend the rest of your life continuing to help others.   Without having a solid foundation your entire career could be a house of cards with a disability ending it all.    Approximately 30% of all people ages 35 to 65 will suffer a disability for at least 90 days, and about one in seven can expect to become disabled for five years or more. ( Source: Health Insurance Association of America, The New York Times, February 2000) And as you age the chance of disability increases drastically.   A simple mistake can early in your career could cause havoc if not handled properly.  In Dr. Yearingtons case, although he had great insurance during his career-ending injury, not knowing the nuances of his group disability policy cost him money when he could no longer earn it through practicing Anesthesiology.  Since he has gone through the process of making a claim and having lived through the process he has some amazing insight into how this industry works.  He advocates having the right policy and having it set up correctly will help protect your income.    In this episode Dr. Yerington discusses: Why we need disability insurance? What is the difference between group and individual policies? When is the best time to purchase individual disability insurance? What to do if you are under 40, over 40 and over 60? Why have new graduating physicians elected not to obtain their own DI policy over the past 20 years? A word of warning.  This episode is very long but I assure you it will be worth your time! DOWNLOADS Show Notes EP 04: How To Protect Yourself From Your Group Disability Insurance Policy : Very good. All right. Today on the physician negotiator podcast I have Dr. Christopher you bring in Dr. Christopher Yerington has a website called Physiciansincomeprotection.com. And he was recently did a guest post on CoreyFawcett.com for Financial Prescription Success. I met Dr. Yerington through Corey Fawcett. And I was just so compelled by his content that I had to have him on the show. So Dr. Yearington welcome to the show.: Thank you very much. It's it's great to be here.: Thank you so much. Now I read your article on Corey Fawcett's Website and you said it's really generated a ton of interest since you said you did that guest post.: Yes I I definitely got several hundred new connections electronically and I have been chatting electronically to a lot of stuff online through LinkedIn and Facebook with several several new doctors a lot of them younger attendings and residents.: And you know the one thing that's unique about your Web site physician income protection is that you sell disability insurance but in your previous life you were an anesthesiologist. Is that correct.: Correct I practiced anesthesia from 1998 to 2010 October I'm sorry October 2009 was my last clinical month. And then I was forced to take disability in January of 2010.: And why was that.: In 2009 I began becoming weak and it was more on my left side than my right. And. The I started not being able to even lift an I.V. bag mask ventilation became difficult. I had a lot of shoulder pain. I went ahead and had the shoulder taken care of where every you know everyone thought that was the issue. And then after surgery it turned out I had much more of a neurological component. Eventually I saw three neurologists and a peripheral nerve specialist and I was diagnosed with a left brachial plexopathy stemming from being a high forceps delivery in 1972 and I have the resulting brachial plexopathy from that I was born with an erbs and klumpke's palsy but those had resolved by the time I was a year, year and a half old so completely that you know there there was you know there was no residual. I was a swimmer and in fact my freestyle and backstroke Times were among the top in the United States when I was 19 and 20. And you know you would never think that I had a physical problem and yet my body failed me in my upper 30s and I ended up on disability really out of left field.: Now when start with something with a palsy like that would have it happened anyway or was there something about practicing anesthesia that led to it.: That's interesting. So the way that my peripheral neurologist explained it was that if I had had any more damage at birth than I probably would have retained the palsy for life. Much like the actor Martin Sheen has a policy of his arm and had it recovered very quickly in a month or two then I would have likely still had a problem but it wouldn't have showed up till my eighth or ninth decade of life. And you know when you're when you're 78 years old and you can't put your ketchup up on the top shelf well then that's you know that's a problem you can deal with. But mine was just enough injury that I only made it to about my fifth decade of life and then started having symptoms. So you know do I think that working 80 hours a week hurt me perhaps. But you know I was going to end up with weakness on my left hand side no matter what. You know my career may have contributed to it having earlier in my life than I would have liked. But you know it is it is what it is.: Well I attended an ASA conference several years ago on finance in one of the speakers basically had said that everybody in the audience he said about two in 10 of you would get a disability and the entire audience was shocked. And I think there's a lot of people out there did they don't really understand the odds of them getting disabled in their in their career well I can certainly speak to that.: I. I have spent the last few years becoming somewhat of an expert on physician disability. I like a lot of doctors. I had a policy myself and individual policy and then I also had a group policy and I had two different experiences with those companies and in educating myself over the last few years I found out that the the rate of disability for physicians is approximately three in ten over a 35 year career. And of the 30 percent that get disabled about half of them are disabled for up to a year and then another portion will be disabled between 1 and 7 years and then a smaller portion of that will be permanently disabled from the major duties of their clinical career. Like me nobody wants a one handed anesthesiologist. I mean I can tell you that with 100 percent certainty that if you're left thumb doesn't work in your left hand doesn't grip. You can't be in the operating rooms handling airways. So you know it is a.. The reality is it is a 3 in 10 chance. Well most of those a majority of them are going to be up to that year. Another portion will be one to seven years and then a smaller majority a smaller minority will be permanently disabled from your clinical career. And that that is devastating for somebody who's put so much time and effort into their education and their experience and skills.: Now it happened to you early in your career. Is there any data that would suggest about what time it would occur in their career.: Well obviously disabilities tend to be age related. More of them occur after the age of 55 than before the age of fifty five. And that makes sense from. From what we know practicing medicine is is hard on the body but it's also hard on the mind of those that are procedural lead based tend to get more physical problems than the non procedurally based physicians. But that's not by enough of a percent that you know I think that family doc shouldn't worry about getting carpal tunnel because the reality is that the way we practice medicine has changed dramatically over the last 15 years and the advent of the computer instead of being a occasional interface it's now an every hour interface. So the those cases are slowly climbing up but the one disturbing trend in medical professional disabilities is that the number of mental nervous claims has been climbing every year for approximately 10 years. And that really is a change overall in the nature of disabilities for physicians.: And with respect to that change it sounds like the insurance industry has caught on to that and indeed since then kind of adjusted the way they make their policies on disability correct.: Well for for all group policies you'll find the limitation on mental nervous conditions to be two years and for many individual disability insurance Sharon's policies those would be the private ones that you go out and purchase yourself many of them. The stock option the the the baseline charity option will be two years mental nervous and then you would have to add on an additional premium if you wanted to have mental nervous conditions covered for the life of the policy. And that's so they've they've made it so that they have reduced their risk. But there are options if you want to price in that possibility for yourself.: And in light of the latest data on burnout that may not be a bad option.: Correct. And there are a few of the major carriers that distinguish themselves by offering mental nervous for life but they price it accordingly and they change other aspects of the language in the policy to adjust for that risk premium. So you know it is it's something they've definitely taken notice of. I will tell you that in get team individual disability insurance a lot of the carriers are much more cognizant of asking questions that direct whether or not a person's mental nervous personality or baseline puts them at higher risk of that. So it's not so much in asking you know what your physical problems have been. They they are really attuned to asking Have you ever seen a therapist for any reason ever you know. And they also look at activity. So that's one thing that doctors need to be aware of especially young doctors in residency and medical school. We can all get stressed out in medical school and residency but as soon as you go see a therapist you've eliminated your ability to ever be covered for a mental nervous condition by a disability carrier. Wow. And that really is that is one of the reasons I push interns to get there of their get their individual disability insurance as quickly as they can upon entering residency because that is really as young and healthy as they're ever going to be.: Wow. Well you know with respect to the cost of individual disability insurance it's never been cheaper. Is that right?: It actually has never been cheaper and it is still very expensive and it is worth every dollar if you become disabled you know we'd all like to buy that lottery ticket the night before. It's one point six billion precisely. And just like you'd love to make your first disability premium payment the month before you go on disability. But that's that's not really how insurance works insurance works to pool risk of individuals so that the group itself is safer proceeding through time because there's a known risk you know in this case 30 percent of the pool of physicians will have some sort of disability at some time and because they don't all have disability at the same time and their careers are thirty five years you can price in a structure as an insurance carrier to cover the the the risk. But you know and the more people that participate in it the lower the insurance cost per individual. The problem though is it's it's expensive because of the what it does pay out for somebody in my my case if you get injured 11 years into your career they're going to be paying for twenty to twenty three years. And so it can add up to like millions of dollars and it can it can add up to millions of dollars but it still would not be the same. Millions and millions of dollars I would have earned as a physician. But the the idea that you would trust the 30 percent chance that you get disabled to a group policy that was priced out by executives for the cheapest amount of dollars is not a real smart way to conduct yourself as a physician Exactly.: Now the question with respect to cost. OK. So sure. As a rule of thumb you said I think at one point that you get pay for all those every ten thousand dollars of coverage is correct.: Right. So the real range is closer to three hundred to five hundred dollars for quality individual disability insurance per ten thousand dollars of coverage. And I'm pricing that ad in the middle so that's not like if you're an absolute premium person never had a health problem. Never done anything to see a doctor except forget your vaccines. You know your pricing is gonna be better if you were let's say you were an athlete but you suffered a bunch of injuries playing in the NCAA Division One sport you may not get the premium pricing and there may even be some limitation language in your policy concerning those injuries that you got in athletics and that would of course push your price up. There is some differential also between the sexes. Males tend to not males tend to be less expensive as a as a as a risk category than females overall. And so some of the carriers charge females more than males. However there are still a few states that require what's known as unisex pricing. So they basically average out the men and the women and the price you pay is in the middle. So if you're a man in a state with unisex pricing you can end up paying more for your policy. But if you're a female you'll end up paying less for your policy.: So explain to me how that works then with respect to the price. So if you or you're going to get ten thousand dollars worth of coverage right. Is that over the course of the year?: No. So that benefits benefits are all priced in in dollars per month. So OK ten thousand dollar benefit level would mean that you get paid ten thousand dollars each month.: So it's gonna be roughly three to five hundred times twelve then you can multiply the number of months in a year.: Correct. So you get a ten thousand dollar benefit would be one hundred and twenty thousand dollars a year. You can purchase depending on the carrier up to between 60 and 75 percent of your salary if you purchase your disability insurance with pre-tax dollars. In other words it's some sort of benefit that your group offers and you pay with pre-tax dollars you'll actually receive your ten thousand dollar benefit as pre-tax money which means you'll owe taxes on it. So you'll take home ten thousand bucks you'll pay 30 percent in taxes. And so that will be seven thousand other policies you pay with post-tax dollars and then you'll receive them in post-tax dollars. So that's that also will change the pricing because it's whether or not the company is taking you know that tax equation into into part of the the pricing of the premiums. So there's there's actually a lot of things that go into the pricing but it isn't in so far as your listeners need to understand. You purchase individual disability insurance with post-tax dollars from your own checking account so that you receive those benefits as post-tax dollars and they do not show up as income if your group allows you to buy a group benefit with post-tax dollars. You definitely want to take advantage of that that benefit within your group or hospital.: Is there ever a situation where you want to do the pretext paper with pre-tax dollars.: Oh absolutely. If you are. Well let's say that you went into medicine because you have medical problems yourself and a lot of the great carriers are not going to offer you good policies. You may want to look specifically for groups or hospitals to work for that offer a great group benefit. As far as disability insurance goes and you may not have a choice about it being paid with pre-tax dollars but you could have a choice with how much you maximize it or whether there is a supplemental policy that you can purchase on top of that a lot of times those supplemental purchases must be made in pre-tax dollars because that's how they're priced. So you know with each specific physician depending on their own history medical history they there are different policies from different carriers that work better for their situation.: And with respect to So So let's say you have. I mean obviously you want to be. You want to purchase your your disability policy is early as possible. And if you're as healthy as possible. Yes. So let's say let's say you start. You recommend doing it when you're an intern. What if you wait until you're 10 years into your practice and now you've I'm assuming even if you've aged 10 years and nothing's changed in your medical health it's still going to be more expensive rather than had you purchased it when you were an intern.: It is. And that's actually a really easy way to understand that if you start paying for disability insurance when you're an intern your premiums are priced based on you paying for thirty five years into the system I get wrecked. If you start at 10 years later your premium is based on you paying in for only twenty five years. And it's the same amount though. It's no matter what exactly because you as an individual have a specific risk and that's pooled with everybody else's risk. So that's one of the reasons disability pricing goes up as we age and it also goes up depending on our own medical conditions. So because that premium has to be asked to be priced in their.: OK so in your situation you had a group and an individual.: Yes. So I I started residency and we had a financial lecture. And part of that was to steer us towards purchasing individual disability insurance which I did. I've always been a big believer in savings and insurance. I don't know whether I learned that from my family or where I learned that exactly. But I I've always thought that that's what everybody did. Everybody saves 20 percent and everybody maximally insures everything because that's the best way to be safe and secure financially. So I went ahead and bought that individual disability insurance policy as an intern and then about six months before I graduated I I took my employment contract as an attending and went ahead and raised the premium to coincide with the additional income I made as an attending and then I also that hospital that I initially worked for offered me an additional 5000 on top of that as a group benefit. So you know for my income at the time I was very well protected when I. Then several years later entered private practice. There was a group policy offered with the private practice contract and I had the choice of either purchasing it with pre-tax or post-tax dollars and I opt for the post tax dollars. At the time because that just made sense to me I didn't want to deal with the taxes because I had no idea what the tax code was going to look like for the next 30 years. So that's the situation I was in when I got disabled was I had one individual disability insurance policy and one group Disability insurance policy.: Well you know what you said was very interesting was that you assumed everybody else did it but that's not the case. Very few people or there's a I would say the majority of people still don't produce it isn't.: Yeah it's actually declining participation over the last 10 years has been noted by every carrier. The truth is back in nineteen ninety to ninety five actually two thirds to 75 percent of all physicians had some sort of individual disability insurance. And there are some programs here in Ohio that are now graduating residents and less than 40 percent of them have an individual disability insurance policy the day they graduate from residency or fellowship and they don't understand what an amazing amount of harm they are potentially doing to their lives by by not having secured this while they were in in residency well.Correction, Interns make money. Just not very much. Hierarchy of "Financial" Needs: And you wrote a really nice article about this. You talked about Maslow's hierarchy of needs and put a little spin on it. And you showed the hierarchy of needs with respect to finance the bottom level being financial protection. Correct. And as an intern you have absolutely no income in fact you probably have negative income because you're paying off your student loans but your ability to grow a nest egg is going to take a long time. And so in your hierarchy of needs you have financial protection at the bottom and then financial savings as the next level. And that's where you mentioned your 20 percent and then financial independence which which is not really the focus of this topic but that's the goal is to get to the point where your passive income exceeds your current income which then can lead to your own personal legacy which would then hopefully give you enough money not only to take care of yourself but all of your loved ones as well.: Yeah I mean my my career focus as my second career in life is to work with as many physicians as possible to make sure that they're financially protected and that they have a financial savings plan that puts them on the path to financial independence. Too many financial representatives, And this is from many companies, they focus on the doctors that are financially independent that have excess income every month and they want to invest it for them and there is not enough time or patience to work with somebody who is six hundred thousand dollars in the hole and is just graduating and they have really no income or they haven't done any of the prerequisites.: And so unfortunately the financial representatives that they do meet really are biding their time for when those physicians quote unquote get their act together and then in today's world it doesn't happen because the financial underpinnings underpinnings that they're taught are are not really in alignment with with with what a resident faces today. Our average resident entering residency as an intern is two hundred and five thousand dollars in the hole from educational loans. They are then swamped with in the first three months probably the equivalent of an average person's first two years at a job any job other than medicine. They are swamped with that amount of data about how to do their job.: It's not only the hospital EMR cars and human resources and all the other things that have to do with having a real job and income but they they have a they have a focus that is on learning their career not on learning how to manage their life. And in fact they they they are rewarded for managing their career and dealing with patients and working inside the system. In the hierarchy of residences of residents and if they go to spend time on themselves you know often and I don't know why we do this still as physicians but we kind of we discourage our fellow residents from taking the time on themselves when all of them should be. And maybe it's human nature. You know we feel better in misery we don't want to leave this one person taking time to eat right and sleep right and to exercise every day and then they they save 20 percent and they drive you know a three year old Toyota Camry or Honda Accord and they're doing everything they can to protect themselves and to save for their future selves.: And I think sometimes that that is that's that's another stress on residences. You know I'm barely hanging on dealing with my patient load and my 80 hours a week and I don't have time for all this other stuff. And so when I work with doctors I I actually address both problems. I do a lot of life coaching on work life balance because part of the problem with with modern medicine is there's there is a tremendous amount of stress. It's leading to burnout and you know if anybody who's read any of the articles even the rates of Physician suicide have slowly been climbing over the last 20 years. And in fact the American physician as a profession we have the highest suicide rate in the world of any profession in any country. And that is that is really a statement as to how stressful it is to enter medicine in in the 20 20 years here.: And what I've done is I've taken my disability and my experience and education of being a physician I'm married to a physician my younger brother's a physician. I've really had this front row seat to watch medicine change over the last eight years and I've also experienced the entire system as a patient which really opened my eyes to a lot of things that are wrong with the health care system and how I chose to address it was well the basic problem I see is doctors get in way over their heads eight to 10 years out of medical school and residency and they've dug this huge hole and it would be better to not have ever dug the hole in the first place. But that means they need to be taught as an intern or as a medical student. And so that's why I'm putting a lot of the materials that I put out in order to help educate that younger physician so that their career is is really supported underneath by a really strong financial life and financial understanding of keeping themselves healthy both financially and personally.: Well you know this Physician suicide is officially at an epidemic level. The most recent story was out of Stanford where they had one of their graduating resident surgical resident who went out to practice and within six months of practice committed suicide. And you know that the entire city and community mourn for this person because he was very well liked and so Stanford reactively started their wellness program which every other medical school now is modeling. Now part of the problem with that program in my opinion this is 100 percent my opinion is that they're looking at they're looking at ways to promote resilience amongst these these residents and you know they're promoting health in that sort of thing but they're really I think they're failing to see the underlying cause. And I think I applaud what you're doing you want to start early on their journey to to not let them get them into that position where they get overwhelmed. So even you know at other institutions that I've been to they're focusing on you know eating well and being part of the community. But it seems to me there's more that needs to be done with respect to the infrastructure that's leading these people to be burnt out and to commit suicide in the first place.: And you know that that leads to the why would you not be including basic financial literacy and financial health in a wellness program. And I'll tell you that. Next to sex itself finances are about the most taboo subject to discuss between one human and another in American society and I was going to say especially in medicine because it is there is this assumption leftover from the 80s and 90s that physicians make a tremendous amount of money I have several friends in non-medical Fields who way out earn any of my doctor relatives or doctor friends. And it is there is a growing parity now between medical and nonmedical careers."But publicly there is this perception that if you're a doctor you're automatically financially successful.": And so it's just not true anymore. But publicly there is this perception that if you're a doctor you're automatically financially successful. That perception leads to an expectation in doctors themselves that expectation leads to stress and residents and interns measuring themselves against this mythical perspective that physicians are financially successful and they look at themselves and say well how is that possible. I'm foreigner and fifty thousand dollars in the hole making forty eight thousand dollars a year. And I am I am I. I don't. There's no there's no light at the end of my tunnel because I'm in a cave.: Oh my God. So there's there's a basically disconnect between perception and reality. Absolutely. Society hold you to a certain high level of expectation which you yourself will never live up to. And so it leads to more stress more."you will hold yourself up to that same high level of expectation right. It's a public image and it is very difficult for a doctor to remove themselves from the public doctor image": But you will hold yourself up to that same high level of expectation right. It's a public image and it is very difficult for a doctor to remove themselves from the public doctor image. This is you know there is some obviously some psychology and sociology that I am not an expert on going on. And so you know I only have a few hundred physician friends and I only have talked to several hundred other physicians. And so my perspective is that it's the same story over and over again. It's the same stresses and mismatch between perception and expectation and reality. And so you know again the way to combat that is to say hey yes you're in a pile of debt. The average is two hundred and five thousand but you can get out of it OK."That's and that's why on my pyramid as you pointed out my base is this big financial protection because if you don't do that psychologically you're really undervaluing yourself.": This is how you build a triangle to be successful. You've got to protect what you've done because you did something that only a very very few number of people in the United States did and that's attend medical school. Then you survived into residency and you are headed towards being a doctor. Why would you not protect your next thirty five years as your first and foremost move to tell yourself I am valuable I'm valuable to me now and I'm valuable to all the mes. Five years 10 years 20 years 30 years from now. So why would you not. That's and that's why on my pyramid as you pointed out my base is this big financial protection because if you don't do that psychologically you're really undervaluing yourself. And if you psychologically undervalue yourself it leads to a lot of other stresses.: Well and on that note you do write about financial safety and physician suicide and burnout. Now with respect to what had happened to you with your group disability policy that led to a tremendous amount of stress as well."you out there in the audience who think you're totally protected because your hospital or your medical system has given you a group disability plan ,you are not" "Let me tell you stressful is going for making you know twenty thousand dollars a month to making three because you only have a five thousand dollar group benefit that is pre-tax so you lose the taxes and then it disappears two years later.": Yeah. So in my particular case in this you'll find this happens with group carriers all the time so those of you out there in the audience who think you're totally protected because your hospital or your medical system has given you a group disability plan you are not most of your plans are they will sell it to you as an own occupation. And if you look at the language you'll find that the own occupation period is mostly two years in group plans. There are a few out there that are about four years but that's it. You have you have a small period where it's own occupation and after that the language will shift to any occupation and they do mean any if you can physically be driven to a toll booth and hand out tickets on a highway. That's a job if you can answer phones. That's a job. If you have your medical knowledge intact and you can review insurance cases that's a job. And so whether or not you do those jobs is irrelevant the fact that you have the potential to do any occupation means that your claim will terminate. So a lot of people that think they have disability insurance if they're disabled at 40 they will get two years of benefits as a doctor and then that's it they're done. They've been learning to flip burgers very quickly. Right. And so if you think you are stressed out in medicine right now because your hospital changed you know electronic medical records three times in the last five years. Let me tell you stressful is going for making you know twenty thousand dollars a month to making three because you only have a five thousand dollar group benefit that is pre-tax so you lose the taxes and then it disappears two years later."The group carriers have been collapsing through mergers and acquisitions pretty steadily over the last 30 years. There used to be over one hundred carriers and now it's down to just a couple dozen for the individual side.": That's stressful. That is true. But it doesn't have to be that way for my my own. What happened in my case was really kind of unique. So. The group carriers have been collapsing through mergers and acquisitions pretty steadily over the last 30 years. There used to be over one hundred carriers and now it's down to just a couple dozen for the individual side. There were about 70 or 80 carriers in the 90s and now there are 12 carriers left and it might be down to 10 because there are some other mergers going on and there's really only five or six really superior individual disability insurance carriers that you would want a policy issued from in 2018 the group carriers themselves. What happened was 19 days before my last day of work the carrier got bought out and or sold their book of business would be the industry term in insurance and I was part of that book of business and so I got sold and a new policy got issued but my policy was misconstrued. It was it was mis written it had errors in it it had sections missing it had sections that were left blank that in big capital words said use custom wording here. Unfortunately when you go on claim your policy is frozen in time. So for all my colleagues a year later all those policy errors got fixed and they got issued a new policy and that's the other thing about group policies with doctors."Your policy is only as good as this year. As soon as it reaches the anniversary date they issue a new policy with new language.": Your policy is only as good as this year. As soon as it reaches the anniversary date they issue a new policy with new language. Could that language stay the same. Yes but on a whim they could change it and most of us meaning ninety nine percent of us will never read the new anniversary edition of our disability insurance product through our hospital or medical group. So with my misconstrued. There was a it was very difficult to determine what would happen to my benefit should I ever even earn a single dollar and I finally got so frustrated in five or six years later from not doing gainfully employable work that I took them to federal court and I learned painfully under (The Employee Retirement Income Security Act of 1974) ERISA law which is what insurance companies function under at the federal level. My carrier actually didn't have to answer any of my questions they didn't have to tell me what happened and that that put so much stress on me that I became very very very depressed and in fact I started having images of my life without me. So my wife moving on my kids older but I was never in the picture anymore and I had to I had to seek psychological help and I'm not afraid to say this but I. It took me a long time to come to terms with the phrase suicidal ideation but I was I was suicidal whether I wanted to admit it at the time or not and I needed help and I got help.: I ended up being a very good patient. I went through a wonderful program. I continued for an entire year with therapy after that and part of that led to my passion of preventing other doctors from going through what I went through. So you know really there's two parts of my story. I did a lot of things really fundamentally right in my financial life that allowed me to take a huge hit through disability. Eleven years into my career and I want to teach that but at the same time I also want to teach people if you really protect yourself properly then you will be able to focus on your health and getting back to your what your life and not spend six years fighting a hundred and seventy billion dollar company that really doesn't care about you.: So as a fun thought experiment I sent you my group disability policy and the funny thing about that was as I went into my own H.R. website I couldn't find it anywhere. After making about 10 phone calls that actually is that actually is absolutely the modus operandi because they don't want you to know well it's not that they don't want you to know you can do it as long as you follow all the steps which you did. The reason they don't do it is because it changes every single year so they can't exactly put a static PD f up because that PD F will change the next year.: What was incredible is how little knowledge H.R. had about it I had to know. People didn't even understand that physicians actually operated under a different policy than the the non physicians yes."So the insurance carrier might start off with all these things on a platter but in order to maintain the pricing through the years they'll take a few things off the menu each year on that anniversary date": And so. So at large hospitals that's actually right. So the way disability insurance works is that depending on your occupation you're broken into different classes that have different premium structures to them. So for example and this also has to do with income. So you know non physicians who are not medical professionals are in kind of one class and then there'll be another class of medical professionals at at hospitals or groups that sometimes includes docs and sometimes doesn't. And then normally physicians are their own class. And then in really large groups you'll usually even have an executive class above that because they have a completely different salary and compensation structure so. The policy for all of the non medical professional people will be a baseline to year policy. It will often be I hate to use the word cheapest but what they do is they control the premium by adjusting the benefits downward in order to maintain the contract with the hospital system. So the insurance carrier might start off with all these things on a platter but in order to maintain the pricing through the years they'll take a few things off the menu each year on that anniversary date. Physicians it's the same thing when you get a lot of physicians together they'll create a physician group Disability product like they have it for your organization and the they will take off things on the platter or if they have to keep them on they'll raise the price."And the reason H.R. doesn't really care about it is because if you go on claim you don't deal with H.R. you are put into a completely separate organization where you have a disability claims manager that has nothing to do with your other organization and you are strictly dealing with the insurance company.": And that's that's why it's not there because it's a moving target. And the reason they don't teach H.R. about it is it's a moving target. And the reason H.R. doesn't really care about it is because if you go on claim you don't deal with H.R. you are put into a completely separate organization where you have a disability claims manager that has nothing to do with your other organization and you are strictly dealing with the insurance company. And so you are and you're even separated from you know let's say that there is a representative that talks to all the docs when they're on board and at your hospital and says you have this group policy and it's from my company and it's wonderful and it's own occupation and all this that Representative can't talk to you if you go on claim they're not allowed to. The industry forces all claimants into one bucket of communication with an insurance company and all sales into another one.: And is that because of a contractual obligation that they signed when they work for the organization.It actually actually has to do with liability. So if the sales person has said something that's not true but then they're saying it to the claims person. You could get the carrier could be an a liability mess because the salesperson is a representative of the carrier. So what they do is they separate the humans so that the humans that are on the sales side don't talk to the humans that are on the claim side so that the carrier can broadly teach the claimants side to only say these things whereas the salespeople often have more latitude to sell a policy": It actually actually has to do with liability. So if the sales person has said something that's not true but then they're saying it to the claims person. You could get the carrier could be an a liability mess because the salesperson is a representative of the carrier. So what they do is they separate the humans so that the humans that are on the sales side don't talk to the humans that are on the claim side so that the carrier can broadly teach the claimants side to only say these things whereas the salespeople often have more latitude to sell a policy. And. I could even use your group policy as an example when you were onboard and they likely told you it was an own occupation product which sounds fantastic right because all dogs one own occupation.: Well as of today I had a it was a mildly heated discussion as to whether from with other members of my department as to whether or not we had on OK and certain members were convinced this was a great policy in and all is well in the world and I said Well I'm not sure that's the case. And so and that's when I went ahead and reached out to you."But I'll tell you with your policy you don't have to worry about it anyway because your own occupation period is only 48 months after 48 months this policy switches to an any occupation definition and it is very very loose definition of any occupation.": Well I mean your policy and you know this. We could've pulled this from 60 different systems across the United States. Your your policy is a it's good in some some regard. Let me tell you the good things the good things are. It offers fifteen thousand dollars post-tax per month as a benefit as a maximum. And that would be up to 60 percent of your salary. So if you were making you know if you're making five hundred thousand dollars a year 60 percent would be three hundred thousand. And since fifteen thousand times twelve is one hundred and eighty thousand that's below three hundred thousand you would get paid fifteen thousand dollars a month because you're well below that 60 percent max. But if you were only making two hundred thousand dollars a year then 60 percent of that is one hundred and twenty thousand your benefit would be reduced to ten thousand dollars a month. OK. Now because that money is post-tax you don't have to really worry about the tax code through time. If you are able to hand out tickets at a toll booth on a highway that will count as any occupation if you can flip burgers one handed that will count as any occupation if you can review a chart."There'll be lots of jobs available to you so your insurance company at in that forty ninth month will take a determination from all the doctors you've seen. They will tell you which occupations you can do and because you can do them. They will then terminate your claim.": There'll be lots of jobs available to you so your insurance company at in that forty ninth month will take a determination from all the doctors you've seen. They will tell you which occupations you can do and because you can do them. They will then terminate your claim. So this is not a this is not a policy designed for anybody who experiences a disability that is short of a total catastrophic disability. So if you were a doctor and had a stroke. This policy would be great because it would literally pay you 60 percent up to fifteen thousand a month post-tax through the entire occupation period of age sixty five and that's great if you have a total catastrophic disability for your family to be able to take care of you. But if you have anything short of that of loss of limb or the loss of use of your mind you really are boxed in to a 48 month benefit period and that's it. You're gonna be off claim at the end of that they are going to terminate it and and the the sad part about a generous product like this one meaning that it goes up to fifteen thousand is it removes the possibility of a doctor like yourself saying hey I don't like being only covered for four years I'm going to go out and look at a great carrier and I'm going to get an independent disability insurance product for myself. And what you're gonna find out is that unless you make substantially over three hundred thousand dollars all of your benefit has already been taken up by your group product so you can't even purchase individual disability insurance."So that's one of the reasons that it's so critically important to get your individual disability insurance while you are in residency.": That's the real the real rub in these group policies and that's where I see a lot of young attendings there. They're making one hundred and eighty thousand they're making two hundred and they've got this great ten thousand dollar a month group benefit that only lasts for two years. But they can't physically apply and and acquire individual disability insurance because they already are covered 60 percent or 70 percent of their income. So that's one of the reasons that it's so critically important to get your individual disability insurance while you are in residency. I wrote a short article about you know I think was called P.G. y one and done. But the point was that if you want to get your individual disability insurance your intern year and you want to make sure that you maximize that contract with the ability for the future increase options so that you can go up to 17 or twenty thousand dollars depending on the carrier and for 75 percent of docs out there that is the only policy they will ever need for their entire career. They got it at the lowest price they got it from a great carrier. They they they have it available for their entire career and they can have it increase or decrease with the years."So you'll stack to individual policies on top of each other and that'll get you up to an industry maximum depending on the carriers for disability insurance. ": So then let's say you are in a specialty where you go on from residency to a fellowship and you go on from that fellowship to another fellowship and you are looking at an income that might exceed six hundred thousand dollars coming out because that's the specialty you're in. Well then what you want to do is in that six month will that last year of training you will want to look at your disability insurance and you may want to actually purchase a second individual disability insurance policy. And that in the industry is known as stacking. So you'll stack to individual policies on top of each other and that'll get you up to an industry maximum depending on the carriers for disability insurance. Then you go join a group. In that group insurance product will stack on top of those. And that's really how you maximally cover yourself. So.: So it has to do with timing then really more than anything else."And so and even a doctor that's coming onto your organization within those first 90 days that they become a doctor they can actually get an individual disability insurance products without the group Disability insurance product interfering with their benefit amount.": Yes. And so and even a doctor that's coming onto your organization within those first 90 days that they become a doctor they can actually get an individual disability insurance products without the group Disability insurance product interfering with their benefit amount. So it's critical but I'm sure you weren't told that when you were onboard it I'm sure when you join. They didn't say hey this is a group Disability product but it's really good if you're totally disabled if you stroke out if your heart doesn't work or your spine fails. But if anything less than that happens to you and it will to 30 percent of you we're going to pay you for four years and then you're on your own extra.: Well you know goes back to what we were talking about earlier though they changed every year. Yes. And if you go if you go based upon which recommended by your peers without really getting you know getting the document which you later have access to and then getting you know a third party to give you an actual appraisal you wouldn't even know."That is a huge struggle through hospital administration and anybody who works for a hospital certainly understands how difficult it is to do things in their departments': That's right. You would not even know. And that's and that is the sad part because they're not teaching this to interns and residents anymore. And then trying to get in to teach residents and interns. That is a huge struggle through hospital administration and anybody who works for a hospital certainly understands how difficult it is to do things in their departments so for instance when you want to go speak to a resident group you have to get your entire talking points and everything through. Normally the Graduate Medical Education Office everything has to be approved and then if you're doing any sort of solicitation in there that all has to be removed and so you know I'm kind of in a unique position in that I have been able to talk with residents and some medical students without those restrictions because I teach one to one physician to physician not as a financial representative although I have the ability to sell insurance. I really do what I do more for the education component than I do for the insurance sales component.: And you know I can see way that you know the Graduate Medical Education Committees would want to protect their residents but at the same time they're kind of hurting them."Well when when that system folded in on itself because they found that physicians were biased towards using those products they collapsed all of the external activities and they've tried to internalize those in large bureaucratic systems. ": Well they are and it's you know I would blame them. But when you talk to program directors over the last 20 years and my understanding is you came into medicine right around 2000 so you probably saw the very tail end of the pharmaceutical reps coming in and bringing lunches and giving out pens and did notes. Well when when that system folded in on itself because they found that physicians were biased towards using those products they collapsed all of the external activities and they've tried to internalize those in large bureaucratic systems. And it's not working very well. I know that I'm working with the hospital system right now where they are struggling to create a professional development didactic and curriculum for their graduating residents because they have seen over the last five years they're graduating residents are not doing as well as the ones from five years before that. And it's because they simply are not exposed to the other parts of being a human being who also happens to be a physician. And the other thing is obviously the debts have increased substantially over the last five 10 years."And so you know when you are a compassionate intelligent dedicated tenacious personality that self selected to go into medicine and then work your tail off to get educated far beyond what most people are to then run into a situation where you don't know what the right answer is it is profoundly disappointing to you.": So those those two components together is you know you've got a debt servitude type component to a graduating resident. At the same time a complete lack of education. And so you know when you are a compassionate intelligent dedicated tenacious personality that self selected to go into medicine and then work your tail off to get educated far beyond what most people are to then run into a situation where you don't know what the right answer is it is profoundly disappointing to you. So when somebody says hey you should be you should have an individual disability insurance products. Right. And you don't know anything about that because you've not been taught anything and then this you know happy salesperson tells you that hey if you join Hospital X we have a group Disability product and you're covered. Well you don't know anything about it so are you going to start asking questions that you believe might make you look stupid in front of other people.: And you mentioned that the previous generations of people who actually had that business acumen are now fading away. So it's not like human access to a generation of people to to mentor you."They tell me they say Chris I don't know what medicine looks like five years from now so I don't have any business telling this young doctor what they should do or shouldn't do"Right. And so that is another dynamic to physician stresses that are older physicians and I'll say for those fifty three and older if you're listening. One of the things that you guys have done is with the invention of the electronic medical record your personal satisfaction and has gone down and your stress has gone up. Practicing medicine and in in part of that frustration. There is less confidence about mentoring the younger generation those under fifty three and especially those under 40 in mentoring them because a lot of them. And you know these are my contemporaries now in their upper 40s and lower 50s. They tell me they say Chris I don't know what medicine looks like five years from now so I don't have any business telling this young doctor what they should do or shouldn't do and instead of just applying to medical knowledge and the practice of medicine and the infrastructure of health care it's gone global into this bucket of. I don't teach anything because I don't want to be wrong for these young kids.: Which then further adds to their stress.: Yes. And that is that is the the domino effect of what's happening and know technology is wonderful but the adoption of any new medium by by humans takes a little bit of time. And some are early adopters some get it and then there's public acceptance. But those often take a generation or two generations to really become part of the culture and in what you've seen in medicine and a half a generation we have really advanced on on communications and documentation.: But then taking a giant step back with respect to personal development.: And well we've taken a giant step back on the quality of that communication and Doc right. So it is. And I'll use an example. I have a little bit of law school under my belt and a little bit of business school and one of the things I did when I was practicing was I was an expert witness for surgery ICU Anastasia and even pain management which I practiced for about a year. I I found that when I would look at a case in two thousand three four or five that often I was looking at anywhere between three and five hundred pages of material for an entire week or 10 days hospitalization."I reviewed a case from 2013 the same six day hospitalization had fourteen thousand pages from the EMR" "So there's all those challenges that are going on right now with technology and in the administration and practice of medicine. And at the same time we've removed this kind of doctor to doctor mentoring about your own life.": That as recently as 2012 2013 I reviewed a case from 2013 the same six day hospitalization had fourteen thousand pages from the EMR. I can't even tell you how overwhelming that was to see that in one decade 20 times as much information is produced. And so you know that case I actually took some time and looked at it and you know ninety nine percent of it is duplicated. So it it will say the same thing over and over and over and over again and I can see doctors filling out three filled out notes just hitting return return return return return return and they don't realize that it's generating this massive massive amount of material that is it's it's impossible to navigate after the fact. I can't imagine what it's like to navigate trying to practice medicine. So there's all those challenges that are going on right now with technology and in the administration and practice of medicine. And at the same time we've removed this kind of doctor to doctor mentoring about your own life.: And I think that I think that that's why I have found I think that's why I'm I'm moved to do what I do and to work with the doctors the way I do is because it it's a huge deficit. I have experience and and expertise and I love to teach. I love to teach medicine. I love the teaching Anastasia residents that those were that was the highlight of my career was when I got to teach both the SRO and A's and and medical students and residents. I just absolutely love teaching. And so now I found a new thing to teach for and and I'm I find that I'm just as just as emboldened with trying to get everybody to learn everything as I used to be.: Great. We know Chris and I don't see this this medical system getting any better. I'm sure the manner of bureaucracy will even increase in physicians frustrations will continue to evolve. So I really I really loved your message of financial protection and and you know there's two I think we have two audiences here right now. I think we have an audience of young people who we can give them fair warning on on what steps they need to take to protect themselves for the duration of their career and also bear in mind their career may not be 35 years it might be just 10 years or 15 years. And so you really want to take the steps to make sure that you're protected and then the second thing I want to talk about is you know you're you have a couple of mid career people like myself for example you just reviewed my group policy and what I've done is I've done the reverse stacking so I have my group policy and then I have a private policy stacked on top of it right. So what advice would you. And that's that's pretty much the majority of people that I know who have the situation. So what advice would you get.Advice for physicians under 40. : So let's let's let's break those into two groups. Let's break it into the the under 40 crowd which will be your young attendings and residents right now you know if you're in residency get yourself to an independent insurance broker and get yourself individual disability insurance from a quality carrier get a quality product make sure that it has all the future increase options on it so that it will cover a majority of your career. So you get that in place. The if you're an attending and you're within a system and you're only under a group product then you need to do a couple of things you need to one find out if it's possible that you can get an individual policy for the people who are under your contract who are making less than two hundred fifty thousand dollars. They would be basically boxed out from getting anything but there are other policies out there that only go up to five thousand if that's the case then they can qualify for five or six thousand dollars. Now they can put future increase options on it and they can they can get that gap sealed.Over 40 advice. : Once you hit 40 you start to acquire medical conditions. Maybe you've been burnt out in the system. Maybe you've gone to therapy all the sudden getting insurance and I don't know in your particular case whether that was a problem you're you're pretty healthy from what I know of you. So for you it was just simply Hey I make this much money I've got this coverage. How much more can I get. And hopefully when you got your individual disability insurance product you had some future increase options on there because if you were ever to leave your current job and I don't know your family decides to move to Florida you go get a job down there.What happens if you change jobs. "Well when you change jobs before you're under the new group policy you would exercise all of your future increase so that you're covered on your individual policy maximally. And then the new group policy would stack on top of that.": Well when you change jobs before you're under the new group policy you would exercise all of your future increase so that you're covered on your individual policy maximally. And then the new group policy would stack on top of that. So what's really important for midlife doctors those that are 40 to 50 three is if you you're going to change jobs if that's part of the plan in the next couple of years. Then you need to look at positioning yourself even if you just buy a very small policy like fifteen hundred dollars a month but you have the future increase options so that during the transition from one job to the other job you can exercise those those options. That is that is kind of the only way to get that in that midlife which is you know it's a little bit more of a difficult especially if you're like a career guy and a system. You know I don't suggest quitting your job and going to another job for a year and then coming back. But there are docs who have taken sabbaticals to do locums work for six to 12 months and then they come back and they have their individual policy completely maxed out which then puts their group on top of it and they're good for the remainder of their career. Say from fifty three onto 65 to 70 which is

EP 03: Leverage in Negotiations with Financial Independence by Leif Dahleen | The Physician Negotiator http://traffic.libsyn.com/thephysiciannegotiator/Ep03_Physician_On_Fire.mp3 WHO’S ON THIS EPISODE  POF Website  Pof@physicianonfire.com  POF on Facebook  POF on Twitter  POF on Pintrest EP 03: Leverage in Negotiations with Financial Independence Although there are many negotiation tools and strategies, the single most important lever is confidence from having a Best Alternative to a Negotiated Agreement (BATNA).   Which is the best of the best according to Physician On Fire?   Financial Independence of course.  Have financial security to not have to give into consensions during a contract negotiation will give you the most confidence over any other trick.    So what is financial independence and can it solve other problems plaguing healthcare?  This podcast is intended for new graduates who are just starting out and have questions about student loan debt, signing bonuses, how to keep a low tax burden and geographic arbitrage.  Having Financial Independence doesn’t mean you have to quit your job, it just means that your job needs you more than you need them. Tanya Foster This then gives negotiating room to ask for a part-time job or transition out of medicine entirely.  Some people call medicine a calling and even though he has been criticized for wanting to retire early, at the end of the day Medicine is a business and we as physicians have free will.  POF used to help only one patient at a time.  Now that he has a blog with thousands of page views amazing advice he can help many more than practicing medicine.   His final advice on the recent and ongoing stock market correction;  Stay the course, recognize that this will be a buying opportunity which will help you get ahead.       DOWNLOADS Show Notes   ← Previous Podcast Next Podcast → The post EP 03: Leverage in Negotiations with Financial Independence appeared first on The Physician Negotiator.

Ep. 02 Networking for busy physicians and job seekers by Docofalltradez | Dr. Michelle Mudge-Riley http://traffic.libsyn.com/thephysiciannegotiator/EP02_Michelle_Mudge-Riley.mp3 DOWNLOADS Show Notes Ep. 02: Networking for busy physicians and job seekers Dr. Michelle Mudge-Riley trained as a physician but realized early in her career that wanted to transition into non-clinical medicine.  In doing so learned lessons that are not usually taught to physicians.  In the process has become a successful serial entrepreneur her current company, Physicians Helping Physicians serves physicians who are interested in figuring out how to make their career work for them. The community is unique because it’s not a “cookie cutter” approach to career transition or strategy. Every doctor is different and is coming from a different place. Some are 1-2 years or more out of residency and others have been in private practice for 10 years or more before finding this community. It’s been our experience that 80-90% of the time, physicians who work with this community will have a clear focus and career direction within 6-8 months. Most doctors have been struggling with this on their own for years, if not decades. In this episode, Michelle teaches us the importance of networking for career advancement.    Also, We are announcing the Physicians Helping Physicians Celebration Conference.  From Michelle:  In April 2019, I will hold the first Physicians Helping Physicians celebration meeting.  I’ve been coaching for over 10 years and I have only met a fraction of the people I’ve worked with.  Most, if not all our work has been via phone or Skype.  For those of you I haven’t yet worked with, this is an opportunity to get your non-clinical career or side-gig started – or grow it.   On April 6-7th, 2019, I’m having a meeting/conference to celebrate you, meet you, and to talk about non-clinical careers and side gigs.  I’m springing for food and drinks (over $10K!) and have negotiated a block of discount hotel rooms with an airport shuttle in Austin, Texas.     In keeping with the theme of non-traditional careers, this will be a non-traditional meeting.  I’ve already had 15 people who have successfully transitioned to a non-clinical career commit to coming to help mentor you.  There will be sessions, workshops, networking, and plenty of fun!  I will personally guarantee you an updated resume, elevator pitch, and action plan.  I’m hoping for media training, expert witness training and companies with actual jobs who will be available to talk with you.   The best part?  The registration fee is up to you!  Yep, I’m keeping with the non-traditional theme.  I only ask that you consider a donation of $200-$500 to help with the costs.  IF there is money left over, it will go towards next year’s celebration to make it even bigger and better! Learn more about the conference! . WHO’S ON THIS EPISODE  Physicians Helping Physicians  Dr. Michelle Mudge-Riley  Dr. Michelle Mudge-Riley  Dr. Michelle Mudge-Riley Ep. 02: Networking for busy physicians and job seeker [3:49]  Dr. Mudge-Riley Discusses transitioning out of medicine early in her career. [5:12] Networking is not a skill learned by doctors.  It helped her transition out of medicine.   [7;21] – Recommend working while in school to learn skills about the world and people.  Networking is not about selling, it is about adding value to people’s lives.  And in turn, that motivates them to want to help you. [10:05] – as doctors, we are always fearful of selling and being sold to, and just that mindset, and that’s what a lot of people think about when they think about networking [12:19] – And you may not even get another conversation with this person, because they’re going to not want to talk to you. And they’ll think that you’re going to be asking them for a job. So by really focusing on what’s the other person interested in?  [14:19] – And you may not even get another conversation with this person, because they’re going to not want to talk to you. And they’ll think that you’re going to be asking them for a job. So by really focusing on what’s the other person interested in?  [16;32]  So networking is a little bit harder. It’s not just an easy, call a recruiter, have them feed you jobs, take the job, they give you boom, you’re done. [23;11] –  networking was probably twice as hard for me, because I’m an introvert, and it’s scary for me to reach out to other people. [24;49] – But if you think about a big room, most of those people are either afraid or introverted or don’t want to be there or just are unsure [26;03 – Today, social media is an interesting beast, it is very overwhelming… But the great part about social media is that it can introduce you to people that you never would have otherwise met. [29;08] – First, I would do a little bit of research is easy for us doctors… So once you identify what your options are, then you can start to see if there’s anyone there at any of those clinics or hospitals or organizations that you may know…find someone that is an alumnus of your medical school, or your residency or college or that your brother’s sister knows, or somehow you have a connection with this person…reach out to them and and just let them know that you’re considering moving to that area? And do they have any advice? Or how do they like it, you would not ask for a job at that point. [31;32] – Here’s the really beautiful part about it, you may find out something that you would never have found out about. [32:31] – So if you don’t have those coaching, those mentors that help that upward trajectory, all of those things, then all of the the burnout, the exhaustion, the extra administrative stuff, that extra hours, all that is just going to become intolerable, and you’re going to end up leaving. [33;51] – (about coaching and Dr. Atul Gawande’s acceptance of coaching) But I think it kind of goes back to the culture of medicine and the inability to ask for help, or to be seen as weak or to be seen as not knowing it all. [36:32] – Physician Helping Physicians Celebration Conference… we’re going to be mentoring like crazy. There are going to be some workshops and sessions because I want people to get value out of this. And I will personally guarantee that everyone who comes has an updated resume an elevator pitch when they leave.  Now the really cool thing about this is the way that I am structuring the registration for it’s going to be a donation.   RESOURCES & LINKS Fireside Podcast Episode Docs outside the Box Podcast Never Eat Alone- Keith Ferrazzi Atul Gawande Ted Talk PHP Celebration and Networking Conference  ← Previous Podcast Next Podcast → YOU MAY ALSO LIKE No Results Found The page you requested could not be found. Try refining your search, or use the navigation above to locate the post. The post EP 02: Networking for busy physicians and job seekers appeared first on The Physician Negotiator.

EP 01: Location, Money or Lifestyle. The Rule of Three. by Cory Fawceit | The Physician Negotiator http://traffic.libsyn.com/thephysiciannegotiator/EP0120Cory20Fawcett.mp3 DOWNLOADS Show Notes EP 01: Location, Money or Lifestyle. The Rule of Three Dr. Fawcett is a man on a mission; to teach doctors how they can live healthy, happy, and debt-free lives–to regain control of their practice, their time, and their finances. He is making an effort to improve the lives of his colleagues. This episode explores the physician job market and looks at strategies to start your career on the right foot. Dr. Fawcett is an award-winning author, speaker, entrepreneur, personal coach, and repurposed general surgeon. He completed his bachelor’s degree in biology at Stanford University, his doctor of medicine at Oregon Health Sciences University and his general surgery residency at Kern Medical Center. After completing his training, he returned to southern Oregon to practice for twenty years in a single specialty, private practice group in Grants Pass. Since 1988 he has shared his home with his lovely bride Carolyn. They have two boys: Brian, who graduated from the University of Oregon with a degree in economics, and Keith, who graduated from Full Sail University with a degree in mobile development. In this podcast, we explore the “rule of three” for finding a job as a physician.  When I started my first career a wise older attending told me that I could not have it all.   I was told that I had to choose two out of three major aspects of a job.  They are: Money Location Lifestyle This was back in early 2000s and the healthcare job market has changed considerably since then.  Likewise many of the choices to understand the job market did not exist.  Today many companies survey physicians to better understand the job market.  Salary, demographics, location, job type, length of each job, student loan debt burden, life-style choices and other data.  This data primarily helps serve the industry looking to hire physicians but since it is made public can also provide valuable insights to the job seeker.  What this data has started to unfold is a changing and dynamic medical employment picture which looks somewhat different from only just 10 years ago.   I have attached several of the documents that Dr. Fawcett and I used in our discussion.    Key Points: Take Lots of vacation Figure out what you want in very great detail before looking for a job Don’t get burned out but if you do make sure have options like a financial cushion Take time off in between residency and your first job You can have it all.  Money, Location and Lifestyle Don’t forget about the work environment including culture and conditions Changing jobs after only working for two years may not be the best strategy for long-term financial success and well-being Location still matters and consider the pros and cons of living a larger versus smaller community.   Don’t forget how time and money can be lost if living in a larger city. Beware of larger than average salaries and bonuses, it could be for a reason. Find a mentor as soon as you start your job to help understand the culture and roles that are expected from you.  Modern society has shifted from buying things that last to a “throw-away society.”   Don’t practice medicine like a throw-away society.  Find the right job, significant other, home the first time and try not look at these commitments on the way to the next best thing.       WHO’S ON THIS EPISODE  Prescription for Financial Success    Dr. Cory Fawcett    Cory on Facebook    Cory On Twitter    Youtube Videos   EP 01: Location, Money or Lifestyle. The Rule of Three Dr. Cory : (02:11)  Yes, I did 3 years of locums work and it was a way for me to taper my practice. Dr. Cory : (03:06)  Yes, we took somewhere between 8 or 12 weeks of vacation every year throughout my career.  Dr. Cory : (04:48) Dr. Fawcett give tips for taking time off in between residency and post-residency. Dr. Cory : (08:03) He gives advice on planning out your entire life starting with residency. Dr. Cory : (10:12) Gives advice on burnout and options.  Dr. Cory : (12:00) Discusses that today’s doctor can really have it all. Dr. Cory : (13:03)  Work environment matters too.  Dr. Cory : (16:09) The first job and figuring out what you want is key. “Start your practice right” Dr. Cory : (18:09) Changing jobs has consequences for many and may not be a good thing.  Docofalltradez : (20:00) Don’t forget about significant others with making career decisions.  Dr. Cory : (21:05) Time off versus location.  Choosing the right location will impact the time spent on and off the job..   Dr. Cory : (24:55) Rural medicine life versus living in a big city.  Dr. Cory : (28:10) Outrages salaries and bonuses beware.  Dr. Cory : (30:13) Should you use a recruiter and how to use a recruiter. Dr. Cory : (34:29) Millennial doctors and what they bring to healthcare. Dr. Cory : (36:36) Advice for millennial doctors, do be part of the “throw away society.“ Dr. Cory : (39:25) How a Mentor changed his life. Dr. Cory : (43:14)  Negotiate a balance with your peers to divide the work. RESOURCES & LINKS 2017 MHA Resident Survey ← Previous Podcast Next Podcast → YOU MAY ALSO LIKE No Results Found The page you requested could not be found. Try refining your search, or use the navigation above to locate the post. The post EP 01: Location, Money or Lifestyle? The rule of three appeared first on The Physician Negotiator.