Today on the podcast, Dr. Darria Long joins Dr. Jim Dahle. Dr. Long is an ER doc, mom of three, author, national TV contributor, educator, entrepreneur, and researcher. She is passionate about helping women have healthier and better lives. Dr. Dahle and Dr. Long discuss a large study she conducted about burnout among women and the fascinating findings from it. They discuss ways to combat burnout, the dangers of social media for children and adults, how to triage your life, and so much more.


 

Building a Career on Television as an ER Doc

Dr. Darria Long, an emergency medicine physician, recounts how her career took an unexpected turn toward television after experiencing the chaos surrounding the swine flu and bird flu epidemics during her residency at Yale. Recognizing the flawed communication of health information in the media, she became involved with the American College of Emergency Physicians and eventually became a national spokesperson. Despite lacking formal training in journalism or television, she embraced opportunities to communicate medical information to the public. Her background in emergency medicine proved useful in translating complex medical concepts into understandable terms for television audiences.

Despite her television work, Long continues to practice medicine part-time, finding fulfillment in patient care and using insights from her clinical work to inform her television appearances. While television initially served as a passion project and outreach effort, Long also leverages her television presence for business opportunities—including paid roles as a medical contributor, collaborations with brands, and in spokesperson roles for various corporations and organizations.

 

Burnout Study Among Women 

Long played a pivotal role in a comprehensive burnout study focusing on women, facilitated through her platform, trueve.com. In collaboration with institutional researchers, media outlets, and corporate sponsors, the study amassed a significant sample size of more than 4,800 women, making it the largest academic endeavor on burnout post-COVID. Notable findings from the study include the striking “do-it-all discrepancy,” where a vast majority of participants feel the pressure to juggle numerous responsibilities but only a small fraction perceive themselves as having the resources to cope with these demands effectively.

The research delves into the multifaceted nature of burnout, exploring the external and internal stressors that contribute. It highlights the pervasive impact of societal expectations—particularly on women—who often face heightened pressures in balancing work, caregiving, and personal life. The study identifies a sense of coherence as a crucial protective factor against burnout, emphasizing the significance of comprehensibility, manageability, and meaningfulness in navigating life's challenges and stressors.

Long said there were huge detrimental effects from social media on mental well-being, particularly among women, who frequently experience feelings of envy and worry when comparing themselves to idealized portrayals. The study underscores the need for people to recognize and mitigate the adverse effects of social media consumption on their mental health, advocating for strategies to promote self-compassion and resilience in the face of societal pressures and unrealistic expectations.

More information here:

Physician Burnout! What Are the Factors and Cures?

 

Combating Burnout 

Long talked more about the pressing issue of burnout among physicians—which has reached alarming rates, with studies showing that up to 60% of doctors exhibit symptoms of burnout. Long emphasized the need for a comprehensive approach to address burnout beyond simple self-care measures, recognizing the systemic factors contributing to the phenomenon. While individual strategies—such as maintaining a support network, disconnecting from social media, and prioritizing health habits—can mitigate burnout, attention must also be given to workplace factors. That includes flexibility and autonomy, particularly crucial for physicians managing demanding schedules.

Long said the disproportionate burden of unpaid corporate responsibilities is often shouldered by women in professional settings, including medicine. She advocates for reevaluation of these expectations and suggests either dropping non-compensated tasks or negotiating for fair compensation for such duties. She stressed the importance of institutions providing support structures, such as childcare assistance or meal services, to alleviate some of the burdens faced by physicians, especially working parents.

In addressing the challenges faced by female physicians, Long underscored the need for formal tracks within institutions to accommodate family responsibilities without penalizing career advancement. She encouraged open dialogue about work-life balance and urged female physicians to advocate for themselves collectively. She also emphasized the importance of delegating tasks, automating processes, and consciously prioritizing obligations to maintain a sense of control and reduce overwhelm.

Long suggested using the strategies of triage, automation, and deletion. This process offers practical approaches to task management and stress reduction. Drawing from emergency medicine, triage involves prioritizing tasks based on importance and urgency, allowing people to focus on what matters most and prevent overwhelm. Automation streamlines repetitive tasks through technology, freeing up time and mental energy for more meaningful activities. Deletion entails removing non-essential commitments or obligations, enabling people to declutter their schedules and prioritize tasks aligned with their goals and well-being. Together, these strategies empower people to manage their workload more effectively, reduce stress, and achieve a healthier work-life balance.

If you want to find Dr. Long online, you can go to her Instagram @drdarria where her content is mainly about making it easy for women to keep their families safe and healthy. You can also find her personal website at drdarria.com and her business website trueve.com.

More information here:

My Solution to Overcoming Burnout: Diversify My Income

 

If you want to read more from the fascinating discussion with Dr. Long and Dr. Dahle, check out the WCI podcast transcript below. 

 

Milestones to Millionaire Podcast

#158 — Hospitalist Pays Off Student Loans in Just Over 2 Years

This hospitalist paid off $235,000 only two years out of residency. She has always been very debt-averse and knew she wanted to get rid of it as quickly as possible. Nearly half of her income went to paying off her loans. She said paying off the debt was easier than she thought it would be largely because she is comfortable living like a resident. Her next goal is to buy a new car with cash. She plans to save for a house eventually but currently wants to pour money into her retirement accounts. She said paying off her loans has given her a huge sense of freedom.

 

Finance 101: Emergency Funds 

An emergency fund is a designated pool of money set aside to cover unexpected expenses or financial crises without resorting to borrowing. Typically consisting of cash, it can be stored in various accessible forms, such as a checking account, high-yield savings account, or money market fund. This fund acts as a safety net for situations like sudden travel needs, appliance breakdowns, or vehicle repairs, allowing you to handle these expenses without relying on loans or credit.

The size of an emergency fund is often recommended to be equivalent to three to six months' worth of living expenses, not income. It's tailored to individual spending habits rather than earnings, so someone spending $5,000 monthly would aim for a fund of $15,000, regardless of their $10,000 monthly income. The stability of your financial situation also influences the necessary size of the fund; those with less financial stability may require a larger cushion.

The best options for storing emergency funds include accounts with a balance of liquidity and interest accrual, such as high-yield savings accounts or reputable money market funds. Having a portion of the fund in a local institution for immediate access and some cash at home is recommended for added security. While there may come a point, such as retirement, where the need for a separate emergency fund diminishes, it is super important for people in the early stages of their careers. As you progress in your financial journey, you might integrate emergency funds into your broader investment portfolio strategy.

 

To learn more about emergency funds, read the Milestones to Millionaire transcript below.

 


Sponsor: WCI Courses

 

Today’s episode is brought to us by SoFi, the folks who help you get your money right. They’ve got exclusive rates and offers to help medical professionals like you when it comes to refinancing your student loans—and that could end up saving you thousands of dollars. Still in residency? SoFi offers competitive rates and the ability to whittle down your payments to just $100 a month* while you’re still in residency. Already out of residency? SoFi’s got you covered there too, with great rates that could help you save money and get on the road to financial freedom. Check out their payment plans and interest rates at sofi.com/whitecoatinvestor. SoFi Student Loans are originated by SoFi Bank, N.A. Member FDIC. Additional terms and conditions may apply. NMLS 696891.

 

WCI Podcast Transcript

Transcription – WCI – 355

INTRODUCTION

This is the White Coat Investor podcast where we help those who wear the white coat get a fair shake on Wall Street. We've been helping doctors and other high-income professionals stop doing dumb things with their money since 2011.

Dr. Jim Dahle:
This is White Coat Investor podcast number 355.

Today’s episode is brought to us by SoFi, the folks who help you get your money right. They’ve got exclusive rates and offers to help medical professionals like you when it comes to refinancing your student loans—and that could end up saving you thousands of dollars. Still in residency? SoFi offers competitive rates and the ability to whittle down your payments to just $100 a month* while you’re still in residency. Already out of residency? SoFi’s got you covered there too, with great rates that could help you save money and get on the road to financial freedom. Check out their payment plans and interest rates at sofi.com/whitecoatinvestor. SoFi Student Loans are originated by SoFi Bank, N.A. Member FDIC. Additional terms and conditions may apply. NMLS 696891.

 

QUOTE OF THE DAY

Our quote of the day today comes from Robert G. Allen, who says, “How many millionaires do you know who have become wealthy by investing in savings accounts? I rest my case.” It's true. You got to put some money at risk. You can't just put it all into CDs and savings accounts and money market funds. You got to put some money into stocks and real estate and let your money do some of the heavy lifting for you.

Thanks so much for those of you out there who are practicing medicine, doing dentistry, law, all these high income professions. They're not easy. And if you're listening to this while you're working out or walking the dog or on your way to work or coming home after a bad day, just know that we appreciate what you're doing.

Katie and I both had colonoscopies recently. And it's interesting to interact with the system as a patient and to get that view from the patient's side. And I just become so much more grateful for what everybody's doing out there every time I or one of my family members has an interaction with the healthcare system in particular but just about any high income profession.

All right, for those of you who aren't aware, we have a free 12 week email course called Financial Bootcamp. And if you're like most doctors, nobody tell you anything about managing money or investing. Financial Bootcamp is the financial education you need to convert your high income to wealth. It's only 12 emails, one a week for 12 weeks, but could be worth millions of dollars over your lifetime. Sign up for that at whitecoatinvestor.com/financialbootcamp.

All right, we've got a great guest today, I learned about not that long ago, who actually shares a specialty with me, but also shares a love of working part-time in that specialty and doing some other cool stuff with their life. A lot of which has an impact not only on your patients, but also on your own burnout. So, let's get Dr. Darria Long on the line, and we're going to talk about burnout as well as a whole bunch of other interesting topics and what she's doing with her life right now.

 

INTERVIEW WITH DR. DARRIA LONG

Our guest today on the White Coat Investor podcast is Dr. Darria Long. She's an emergency physician who's been dabbling in a lot of other things in her life. She actually has had a really fascinating career, but I'll bet there's a fair number of our listeners that don't know you and would like to know you a little bit better. So, why don't we start, Darria, with you telling us about your upbringing and education?

Dr. Darria Long:
All right. We're going back, we're rewinding a lot there. It's such a pleasure to be here. Thank you. And hello to all of your listeners. I grew up in Tennessee and I live in Atlanta. I’m a girl from the south, but I ended up going up north for college. It was kind of interesting since we're talking about career paths. I was accepted to medical school out of high school.

Dr. Jim Dahle:
Wow.

Dr. Darria Long:
It was a joint program. It was at the University of Rochester. And so, essentially you had to graduate and you didn't have to take the MCATs. You can major in whatever you wanted. You didn't have to do any application, which was wonderful. And I studied abroad three times, and I studied classical piano performance at the Eastman School of Music and did a lot of other things.

And then went to medical school at the University of Rochester, and then got into medical school and was there, and having kind of a culture shock, having been a political science major and classical piano performance. I saw a lot of physicians very frustrated by the changing dynamics of healthcare, by the changing dynamics of how they were practicing and how they were being told to practice. And I didn't know what I specifically wanted to do, but I felt that I wanted to have some role beyond clinical medicine.

I ended up going to Harvard Business School, got my MBA there, and planned to come back and do healthcare finance, to do healthcare investing, maybe some private equity, maybe be involved with some operation stuff was always the plan.

And after medical school, I was at Yale for emergency medicine residency and was watching TV, and Jim, you probably remember it was the swine flu and the bird flu epidemics. And you'd watch the local news and they would say “Stay tuned for the 10:00 PM for the death flu, for the swine flu.” And everybody was terrified. Our Yale ER waiting room length of stay was eight hours to see a doctor. This was before we did that early triage up front or any of that, but still, it was packed. And by the time I saw somebody, the typical response was, “Yes, you have this, but you are 32 and you are totally healthy, and I'm sorry you were scared and you probably caught it in our waiting room if you didn't already have it. And you're fine, you're going to be fine.”

And that was the first time that I thought how we talk about healthcare in television, how we talk about healthcare in the news to the lay person is broken. So, I started outreaching to some local news outlets to ACEP, working with ACEP, which is the American College of Emergency Physicians for any of your listeners who aren't familiar with ACEP. And I ended up becoming a spokesperson to that with them and ended up becoming a national spokesperson with them as I started doing more and more television.

And TV was never my plan. I never thought I would build a career doing television. That was never. Maybe I was in a couple of plays and musicals and shows, but beyond that, no, I had no preparation for journalism or television. I remember I went back to John MacArthur, and I'll stop here and let you kind of go from there. He was one of the deans of Harvard Business School, and he became a dear friend and a mentor.

And I remember saying “I have these TV shows reach out to me and they want me to do stuff. I have no TV training. I'm not skilled in this. Why would I be able to do it?” And he said, “Darria why not you? Why not?” And I was like, “Oh, okay. You're right.” And hence, I started really building my career doing television and really communicating mainly to the lay person, important things they need to know when it comes to their health.

Dr. Jim Dahle:
Wow. What an unusual career path. And lots of emergency physicians, other shift-based specialties, too, anesthesia, etc, can have their career take a serious left turn and do something like this. But it seems pretty common in emergency medicine. Did you feel like your training in emergency medicine really prepared you to do new things that maybe you didn't have any training in doing?

Dr. Darria Long:
That's a great question. I think any specialty you can see in your own specialty opportunities, I think emergency medicine specifically for television was very handy. The CNN network, NBC, any of them knew that they could call me with pretty much anything that was happening. And as an ER doctor, I'm like, “Yeah, I can talk about that. I saw that last week. That's fine.” And so, it became very useful as I built my career, which is really mainly how I built it, was doing national news.

So yes, ER, being able to think on your toes, talk to a whole bunch of different people and translate really complex medical things into very understandable and manageable terms is, yeah, I think something that we're taught and do all the time in ER.

Dr. Jim Dahle:
Now you talk like you're not doing anything clinically anymore, like you're spending all your time on TV, but you're still practicing, aren't you?

Dr. Darria Long:
Yes, I'll practice as long as they let me, until they pry my stethoscope from my cold, dead hands. I love it. Yes, I practice far fewer shifts a month. When we got out of residency, what was it? 15 was our full-time shift a month? I can't remember.

I practice far fewer shifts per month now, but I still do. One is, I love it. I work at University of Tennessee. I live in Atlanta, but commute up. I grew up there. We have a farm up there, and so it's very easy to go up. We have residents there, so it's really fun. It's a level one trauma. And when you are in residency, you're constantly teaching. And so, I truly enjoy it, and I think I learn a lot from my patients there, which I then end up putting into an Instagram reel or something else because you really hear the boots on the ground, like, “Oh, this is what people are seeing and talking about?” This is where they need to have answers.

Dr. Jim Dahle:
As a business, when I think of people inviting me on television, like you have, you've been on CNN and Fox News and CNBC and these sorts of stations. I don't think of those as paid opportunities. Is that a business for you or is this kind of a passion project and outreach for you?

Dr. Darria Long:
That's a great question. And if you are not careful, I talked to a couple of friends of mine who do television. Television could just become a really expensive hobby for you. So you have to be very deliberate. When people say, “We want to be a doctor on TV”, I have to say, “Well, why? Let's look at the end goal.”

Yes, at first when I was doing local television and some national, you're just trying to get your name out there. Once it became more of a medical contributor, and in working as that, then that becomes more of a paid role. But also for me, and for everybody it depends when somebody says, “I want to do television.” What is your end goal? Say, I have a girlfriend who's a plastic surgeon. Her goal is to drive people to come to her business where she does plastic surgery. My goal on the other hand, is not to drive people to come see me in the emergency department. I do not need to stimulate any ER demand. But as a result from kind of a business model, for lack of better, if you think of how I structure it, yes, sometimes it's being paid by a television show, a TV programming. I'm working on a number of different pilots now on a variety of different TV shows. You get paid for those.

But also once you build a name and a brand, which comes from doing television, doing it regularly, producers know you can do that, then you figure out, “Well, who's going to be the person paying you?” Is it the consumers? Are you doing courses or things like that? Are you having brands pay you for ads or for what I tend to do in my biggest revenue drivers are a lot of collaborations and spokesperson roles with different brands. Large corporations are hired to speak also by large corporations. For me, I deal with Mucinex or Bayer or Tylenol McNeil, Pfizer, the CDC. All of these are groups that I work with, and they hire me to function as a spokesperson. I'll go do a lot of TV shows, TV appearances and things on their behalf.

Dr. Jim Dahle:
Oh, very cool. I've done a lot of things with ACEP. We're actually going to have a big part in the scientific assembly this year. We're doing a day-long financial workshop the day before the assembly starts this year.

Dr. Darria Long:
Amazing.

Dr. Jim Dahle:
But are you the spokesperson for ACEP? Are you one of multiple spokespersons? How does that work?

Dr. Darria Long:
No, I'm one of many and some really great, brilliant minds. There's the ACEP Communications Committee, and often that works on what are the messages that we're getting out. And then within that, there are people who kind of become spokespeople for ACEP. But that's not paid, that is just because it's an important mission. And I think it's really important that we tell the story of the emergency physician from our perspective and wear that white hat as emergency physicians and have people see us as that.

Dr. Jim Dahle:
Yeah, there's certainly a lot of volunteering going on at ACEP. That happens a lot with ACEP.

Dr. Darria Long:
Yes.

Dr. Jim Dahle:
You look at the dues you pay and you're like, surely there must be more money than this. But yeah, there's a lot of people who have done a lot for their professional societies, basically pro bono.

All right. Well, some of the work you've done has been super interesting to me. You helped run a burnout study on women. Not women doctors, but women. Can we talk about the key findings of that study?

Dr. Darria Long:
Yes, absolutely. That was the burnout study in women. One of the things I was doing was creating a platform which we called trueve.com. And the goal is to be, kind of my mission when I speak to, to lay public and to general and social media and different things, is making it easy for women to keep themselves and their families safe and prevent accidents, prevent illness, and to know what to do, kind of that first step to do if something does happen, and give them peace of mind around all of that.

Because especially as women, as moms, you are trying to take care of everybody's health, you're overwhelmed by all the health information you're seeing, you're feeling stressed, you're feeling burnout.

As a part of that, I had wanted to do an article on burnout for Trueve and was trying to look through the data and really try to cull through things. And I realized that there wasn't a lot of data when it came to all the different hats that we as women wear. And there's a lot of thoughts on, here's workplace burnout, which is how the WHO defines burnout. I thought, “Well, what about all the other stuff we do?” And why can I take two women who might look very similar, but one is losing her mind with stress and one is, “Okay, what's going on there?” I was super curious about that.

Another part of the business model, what I do is the creation of True Lab, which is where we partner, where we find and kind of match make really exceptional researchers with media outlets with corporate funding to fund all of this. The burnout study on women was the very first one that we did.

I found some brilliant institutional researchers at the University of Tennessee who have done a ton on burnout. The three of us were co-PIs, brought Good Housekeeping on board as our media outlet to be featuring us in their big conference and in magazines and digital, and print a number of things for that.

And then as a result, I was able to bring on a couple of corporations. Clif Bar, Luna Bar, another foundation. We were able to come on and they were able to sponsor this research to create this new thing where we can get research done. Essentially from ideation to our very first publication was a year. And I was like, “You can't do that with the NIH.” But when you have really great institutions and you can partner with corporate funds, and still with them, we had an IRB, we kept Chinese wall, none of them had no impact on the data. We were very clear for that.

You can really get great things done. We kind of created that model, which wasn't even part of my initial plan, but really was an exciting evolution. We created the burnout study in women and it ended up being the largest academic full scale IRB study on burnout post COVID. It had over 4,800 women complete a 30 to 45 minute survey and got really fabulous findings from that.

We published our first paper, we have a poster up on it, a conference presentation, and we're in the process. I was just reading our second paper manuscript before this call. That's the background of it. You had a specific question, Jim, though. Did you ask me about one of the findings or did I answer it?

Dr. Jim Dahle:
Yeah, yeah. It's fascinating to do research, but I'm a community emergency physician. I'm very interested in the bottom line. What did you find when you did this study on women?

Dr. Darria Long:
A lot of different things. And a lot of these things will go for women, for men as well. We had men. We did not exclude men from the study, you all were allowed, we just focused on women. A couple of things, and then I'll go into a couple different frameworks because we have also ended up… This has created some follow on research. We've done some qualitative research in executive women, as well to really find out, and speaking with some physicians as well.

When we think about burnout and what's happening, a couple of top things that came up is we found that 87% of people felt that they needed to be able to do everything and do-it-all. And in terms of all the expectations that they had for themselves, 87% of that, feel like they need to be able to “do-it-all.” 7% felt that they actually had the resources to be able to do all of the demands for which they thought they needed to be able to do it. 87% of them think they need it and only 7% think they do.

So, there is this discrepancy, and when you look at models in psychology and burnout, it is balance between your demands, the things you need to do, and your resources, which are your abilities to handle all of them. That's the case, whether it's burnout at work or anything else.

And so, we found that my demands, my resources might differ from another woman's or another man's, but it is that discrepancy between your demands and your resources. That discrepancy is going to directly predict your burnout. We call that the “do-it-all discrepancy.”

Now we have this framework that is universal across people. We could say, “Well, your demands might be different, but we know we can lower your demands or raise your resources.” Okay, now we have a way directly to handle burnout. That was kind of a framework that we created.

Another thing, a couple of interesting findings, we wanted to say “Take this beyond workplace burnout”, because that's how the WHO defines it. We said, “What about parenting? What about personal life? What about caregiving? Can all of those contribute to burnout?” And we found that yes, in fact, as we would expect to the degree, they all contribute to burnout. They all kind of have their individual places of burnout. And there's spillover. The more employee based work burnout you have, the more likely you are to have parental and personal burnout and vice versa. There's an inter-role spillover there.

Dr. Jim Dahle:
Interesting.

Dr. Darria Long:
And these are all kinds of background. It's like, okay, now even more reason, let's target these things. Because yes, as you know, when you're feeling burned out at work, you are going to bring it home. But sometimes you need data to be able to find actionable solutions for it.

One other thing for all the working moms who are your listeners, we had a hypothesis that being a working mom would be more burnout, Jim. Would you believe that what we found that working mothers had less parental burnout than non-working mothers?

Dr. Jim Dahle:
Interesting.

Dr. Darria Long:
Right. This is going to be a place that we are going to have to dive in more. But we are just hypothesizing at this point. We were so surprised. The people who had the least burnout were part-time working mothers, at the least parental and personal burnout. Then full-time working mothers, and then the non-working mothers had the most personal and parental burnout.

Dr. Jim Dahle:
Wow, that's fascinating.

Dr. Darria Long:
Yeah. Isn't that?

Dr. Jim Dahle:
This framework you use about having resources and increasing resources. Tell us what you mean by resources. Time is a resource, money is a resource. What else are you thinking about when you use that framework?

Dr. Darria Long:
You asked about resources. Can I start on the demands, if that's okay? I’m going to but your demands. You have your internal or external demands. Your external demands, having to go to work, that's obviously a demand. You have children, you have to keep fed and alive. That's looked bad and frowned upon if you don't do that. You have a roof you have to keep over your head. Those are kind of things that have always been there.

But those things have become more complex. And again, if we looked at the burnout study, about 84% of people felt that those demands have become more complex significantly than our parents' generation. Work is no longer 09:00 to 05:00, it is 24/7, responding to emails and slacks and all the different things at all times.

Childcare is no longer just keeping them fed and clothed. Is your child in a travel soccer team by the time they're three? Have you signed them up by the time they're 18 months? Am I ready for this Valentine's Day party that I'm chairing? Apparently chairing a Valentine's Day party that I'm chairing for his party next week for my first grader?

All of the things that have become more complicated in our kind of external demands. And then on top of that are internal demands that we phrase, that we put on ourselves. And some of these are idealized. “Do I look as good and does my home look as good as my neighbor does on social media? When I do that Valentine's Day party, am I taking angel food cake that I baked myself using wheat that I threshed in my backyard because it needs to be organic and not part of the dirty dozen? And while I'm doing that, does my hair look Ombre beautiful like everybody else does on reality TV and again on Instagram?

There are these demands, and these have just increased in caliber and complexity and just sheer volume. And then there's your resources. Your resources of course are income. Yes, we know that to a certain extent having more income is predictive and protective against burnout. Having a supportive partner. That's also a resource that is protective against burnout. Incidentally, age. The older we get, the less burnout we experience. We can probably discuss that for a while, but it was negatively protective.

Those resources. What is your support system? What are your finances? What do you have for that? What time do you have? What degree of autonomy do you have? What degree of flexibility do you have? And then there's some internal resources. The world can go on around us, but what to you, what do you have that is protective? And one of the things that we found is something called a sense of coherence. And Jim, I'm sure you're aware, in the 2000s people talk about resilience and they talk about grit and these things being so important. They talk about optimism, happiness.

We found actually something, a factor called sense of coherence, which is something that doesn't get talked about that much. It was actually more protective than a lot of the things, than even optimism. And in fact, we weighted coherence versus optimism, having a strong sense of coherence was more protective against burnout than just being optimistic.

A sense of coherence was something that was kind of coined by a gentleman, Aaron Antonovsky in 1979. It's not even new. But he looked at, he was trying to theorize why some people become ill under stress and others stay healthy. And he found three factors that factor into coherence, a sense of coherence. One is comprehensibility. And that is the sense that you're able to make of the world around you, the stories you tell of what's happened in your life.

Number two is manageability or agency. Degree to which you think you can control things. And the third one is meaningfulness. The meaning that you take from it. If anybody has read Viktor Frankl's “Man's Search for Meaning”, they know about this. He specifically looked at what helped, and he was a Holocaust survivor, if anyone is unfamiliar at it.

He wanted to look at what enabled some people to survive the Holocaust and these concentration camps when some didn't. And he found very much that it was very similar to this sense of coherence. He didn't use that exact word, but this very much along those lines, that sense of meaning that they found in the experience, the ability to make sense of it or make a storyline out of it and find some roles of agency that actually were more predictive than people who were hopeful about being rescued.

That's why I think a sense of coherence is something that's really exciting. Because it is something that we know is directly tied and protective against burnout. And it is also something that, yes, we're all born with an intrinsic sense of coherence, but it is something that we can grow, which is why I like it. Because okay, now we can get actionable and help grow that sense of coherence in individuals.

Dr. Jim Dahle:
Yeah. Now obviously this is the White Coat Investor podcast. We spend lots of time talking about finances. And so, I want to take just a minute to explore something you said earlier, that higher income is actually correlated with reduced burnout. Are you telling me that getting a raise will decrease my burnout?

Dr. Darria Long:
No. And interestingly, it's more nuanced than that. In a paper upcoming, I can't tell all the details on, there are various factors where if you look differently across personal burnout, parental burnout than workplace burnout, higher income is not universally. Actually, the higher income, the better off it is for burnout.

To caveat that, when you look at Maslow's hierarchy of needs, yes, you have to have a certain degree of finances to be able to feed and meet at least your basic demands. Yes, a certain income is protective up to a certain point. Beyond that though, however, income can have some various and some variable effects on burnout.

Dr. Jim Dahle:
Your study didn't look at what that point is, did you? I've looked at happiness studies, income and happiness. It starts to level off at $70,000 or $100,000 a year and pretty much doesn't climb after half a million dollars a year.

Dr. Darria Long:
Yes.

Dr. Jim Dahle:
But certainly more income leads to more happiness. I suspect that that's about where you see it plateauing for burnout too. But I don't know that anybody's ever really looked at that.

Dr. Darria Long:
Right. We didn't quantify it by point of dollar. But yes, it gets to at what point are you able to meet those basic demands that you have a shirt on your back, a roof over your head, and you know you're going to be able to feed your family. Below that, you have worse burnout, concern, lower happiness. But above that, income, as you said, it does not improve your happiness per se. And depending on how you are pursuing it and the workplace environment in which you are pursuing it, that higher income can worsen your burnout too.

Dr. Jim Dahle:
All right. You've alluded to this difficulty with social media, that people look at their Instagram feed, and of course, that's the highlight reel of people's lives. We compare ourselves to that. Can you talk a little bit about why social media is bad for us and what we should do about it?

Dr. Darria Long:
Absolutely. And as a mom, I have three kids. My oldest is a 9-year-old girl. I think about social media a lot for her life. But this study was actually very eye-opening to see that how much it impacts us as adults as well. One of the things, we looked at a variety of factors for social media as impact on burnout. And one of the things was we found the top two emotions that women feel after being on social media are envy and worry.

Dr. Jim Dahle:
That's terrible. That's terrible.

Dr. Darria Long:
Yeah. It sounds great and far outpaced any feelings we had of optimism, happiness, or pride. So, why? What's going on? Well, one is it's this self-comparison. It is me versus this idealized diversion. We saw in the burnout study, over 64% of women said they compare themselves against a woman who they perceive as doing it all. And they're never enough. They are never going to be. We talked about those demands, that top half, which is those idealized version because you can always add more demand. The world is happy to take your time, energy and your focus and make you think that you're not doing enough. And so, it is that self-comparison that was directly tied to burnout, triggered by that envy and worry from social media.

Dr. Jim Dahle:
Yeah, I think this is particularly concerning for younger people. I remember an experience we had with our oldest daughter who's now a very well-adjusted young adult. In junior high, it was time for her to have a phone. We had an older iPhone or something that we weren't using. We'll just give her this instead of getting a new phone. And after a few months we realized the damage that social media was doing to her. She was realizing every time she was left out of anything at the school. And so, after a few months, we took the phone away, got her a dumb phone, and she did a little bit of therapy even. And I realized, “Wow, this is really dangerous.”

I think here in Utah, our government is actually passing laws against social media use by minors. And some families are actually suing the government because they feel like they're being censored. But I think there's a pretty good consensus that it's bad for young people, that it is really doing damage. Did you get any sense of that from the burnout study?

Dr. Darria Long:
Yes. And I'm on the board of a couple different organizations regarding social media. One is the organization for social media safety, and they're specifically putting laws in place to help protect young people. I was speaking at a conference a while back and I was talking to one of the original, probably number five, at one of the social media platforms that will go unnamed. And he said, “I realized what was going on when we had more behavioral scientists working at our app than we had programmers.”

Dr. Jim Dahle:
Wow.

Dr. Darria Long:
I realized where they were going with this very early on before any of the rest of us knew. What we found also is that it is the mere presence of social media. We found that those negative feelings, that self-comparison was even more important of a factor than time spent. Sometimes people will say, “Your teenagers, just let them spend 10 minutes on the phone, five minutes.” In fact, if you get on the phone and your first post you see causes you to feel less than, it doesn't matter, the damage is already done. We'd never seen that before. This is such an important factor. It's more important than the amount of time that you actually spend on it.

I created a term, jokingly called it “comparisonitis” in part because it's more helpful to laugh about it because you're on social media and you see your friend and her children look perfect and her house looks perfect and her hair looks perfect and her career looks perfect. And this could happen with men or women, and it can be easier instead of saying, “Oh, I'm having self-comparison, I'm having envy, this is triggered.” And just say “I'm having a bout of comparisonitis right now. I'm having a flare. It's kind of like the gout and I just need to get off.” You don't need colchicine. You need to get off the social media when you're having a flare of comparisonitis.

Yes, we know obviously social media has led to, in the most severe things, we hear of people committing, children, especially teens, committing suicide and really drastic awful outcomes. But on a much greater volume of people is this degree of insecurity, depression, feeling left out, feeling isolation. And that grows with social media. And I think the biggest conclusion is that it's not just children and teens who are susceptible to this, but we as adults very much so as well.

Dr. Jim Dahle:
Do you think the good can outweigh the bad or should we all just get off Facebook and Twitter and Instagram?

Dr. Darria Long:
I think about this a lot because for me as a doc on television, I have a lot of followers on Instagram and that is part of my work. I think about this regularly. I think it can be beneficial. I think there are studies from some of the happiness researchers at Harvard looking specifically at what actions on social media can be protective. We know that just passive consumption of social media, just sitting there doomscrolling, which incidentally is what TikTok is designed to do. It is designed, you finish one video, it just goes to the next, that auto play feature. Doomscrolling, passive consumption is directly correlated with depression and burnout.

On the flip side, actively getting involved, using Instagram or Facebook to find a friend, message them, engage with them, be in a friend group. whether that's on Facebook, those groups and those networks, they have enabled. If you think about that, groups with medical conditions, groups of specific types of children and work careers and the groups that they can have together and create that community on Facebook, there's a value there.

Like many things, it is neither a yes-no question, it is we need to be aware of this. Like Paracelsus said, “The dose makes a poison.” We can use this in a way that is good, but we can also, too much of it in the wrong way can be very harmful.

Dr. Jim Dahle:
Good advice. All right. Well, the majority of our audience is doctors and their trainees. And the data these days is showing 50%, even 60% of doctors are burned out. They have at least some symptoms of burnout. Depersonalization, cynicism, emotional exhaustion, etc. What advice do you have for doctors in particular about burnout?

Dr. Darria Long:
I think that's a great question, Jim. And one of the reasons I did the burnout study is because I thought there's more to this than self-care. We don't need another doctor on appreciation day bringing me pizza. That's not going to help my burnout, or donuts or anything.

What are things that can be done? I think especially when it comes to physicians, one of the traps that can happen for burnout is to say, “Here are the things that you individually as a physician can do to reduce your burnout. Your personality and self-care, things you can do.” And while that is true, coherence, building things like that, building our network, spending time with your friends and that support network around you and calling them, getting off of social media, eating well, sleeping well. All of those things, yes, can build your resources and decrease your burnout, decrease that “do-it-all discrepancy” margin.

With physicians especially, we have to look at all the demands that we face. Specifically from a work standpoint, as we found in our study, and other studies have found, flexibility and autonomy are two very important things. And this is especially the case for physicians, for top level executives. What is the flexibility that you have in your career? What is the autonomy that you have over it? And your schedule makes a huge difference in your ability to reduce your burnout. When you're looking at a new job, what flexibility will you have over your schedule and choices to be able to make for that?

I think another one is, one of the things in our study of executive women is how much women are more likely, and I think this also falls to doctors as well, to do the unpaid corporate housework. Women are doing the housework at home and then they come back and they're doing the unpaid corporate housework in the office. Look at that. As you mentioned ACEP. I think ACEP is a great thing. I think ACEP has been a wonderful thing for me to be involved in.

Not saying ACEP as an example, but look at all of the volunteer things. Or what is your hospital expecting you to do? What is the unpaid stuff? That extends from maybe committees that you're on, mentoring that you're doing. Those things that are important. You either have to decide, “Do I drop these things or do I go back to my administration and say this needs to be compensated? I need to do one or the other.” But don't just keep doing all these unpaid corporate housework that we are very good at as physicians.

I remember when I was at Harvard on faculty that we'd all write these medical chapters and textbooks. We never got paid a dime for that. Nobody else in any other industry would ever say, “Oh, you want me to go write a chapter in a textbook? Sure, let me do that.” Take however many hours it took me to write that chapter and do it totally for free, out of the goodness of my heart. No. So, be very careful with that. Go to your administration with the worth of that.

That also comes down to how you are paid. A lot of doctors, if you're only RVU paid, then you are paid effectively before seeing those patients. Maybe for charting. What about all the other emails, the other admin, the other leadership things you're expected to do? Go to your leadership to make sure that you are either being compensated for those or minimizing the non-paid work you're doing.

Another thing that we have seen, now I've talked to since I speak regularly about burnout, end up seeing some different models that work in different places where they work better. I think institutions where they do give the physicians more flexibility and autonomy over their schedule, institutions where they help pick up the extra stuff sometimes. In some places they provide Bright Horizons childcare. I always joke as a working mom, I'm only one stomach bug away from it all falling apart. So, does your employer provide Bright Horizons childcare? Another one in Texas, they have free DoorDash. You got to get dinner at home and you're running late. Things like that they can do.

And then also one of the things I speak to institutions about is how do you take out all the little obstacles and things that don't need to be done from a doctor? Can you take that off of their plate? Whether that is filling out their CME, their ACLS, credentialing, having admins help them with prior authorization and treatment denials, things like that.

There are things that institutions can do to make their physicians feel more valued, have more time, have more energy to really do a better job of taking care of their patients. And when institutions do that, they see that they have better talent retention, they have better physician retention, and it does not cheap for an institution to bring on a new physician. It's beneficial for the institution as well. So, find those things and take that to your institutions as well.

Dr. Jim Dahle:
Yeah, it's not cheap, that's for sure. I've got a friend that's a physician recruiter and he gets paid $50,000 to bring a doctor to a hospital. It's not cheap. Turnover for doctors is a serious expense. You alluded to this earlier that this is particularly bad I think for women because lots of professional women find they've still got the lion's share of duties at home. What advice do you have for them to help them get a better division of labor once they go home from work?

Dr. Darria Long:
No, man, this is a good question. Yes. For women, it is especially hard. And when we have had this qualitative research, they express a couple of fears. One is, especially in medicine, “I did medical school, I did residency, I did fellowship, I worked my you know what off to get to a point that somebody is respecting me as a physician here.” It’s what so many of them say.

And then if they have a child, it becomes this issue of either they're afraid that if they do try to cut back, they get put into maybe some mommy track, which they worry they can't recover from or they say, there's nothing formal there or there's no way to do so. There's no way to really cut back. It's like either you quit or not.

There's no part-time, formal track or they don't want to show it because they're very afraid that if they say “I'm having a hard time or this is difficult or I have to go for a practice”, that they will lose the respect of their colleagues. They will lose promotion abilities, maybe research things.

So, they kind of fake it. Fake it. “Everything is great, nothing is wrong. Of course, I can take on that extra responsibility, that extra leadership role, that extra administrative role because I'm having no problems managing everything.” And then they're secretly and quietly crumbling at home trying to manage all of these things.

One is for institutions and for managers to really create for women formal tracks, to say “You have a family” or maybe you're caregiving your parents. It is not only for moms, it's for fathers and anybody as well who might have something. Is there a formal track to reduce?

A physician is such a valuable resource. If you can keep that physician in the clinical workforce and maybe cut them down to 50%, what are the ways we can do that? We're smart people. We can think creatively about this and get somebody off the 80 hour per week track if they need to be. That's one of the things. And talking openly about that, I think having female physician groups, that you are able to support each other, share best practices and go en masse to leadership to really ask for things is really helpful.

Dr. Darria Long:
Another thing is we talk about having disconnected time. When you are on vacation or when you go home at the end of the day, are you able to be disconnected and finding that time? It can be difficult because you have to go home and you have to chart. But how can you find that when you go on vacation? Different hospitals sometimes do things like an inbox buddy. I know a lot of physicians, they do an epic inbox buddy. They're on vacation, so they have another attending checking their epic inbox. So now at least for that week that they're gone, they're not having to check their epic inbox and they're actually able to be present with their family.

And then I think also when you are home, yes, I did a whole TED talk on how to delegate and automate and things like that. But I think first is to really look to what resources you have, whether that is your partner and having a discussion with your partner and how you will share resources, whether that is having whatever childcare or resources you need to get you the help.

Because again, you don't have to do it all. And it is okay to be a physician mom and say, “I'm not going to be doing the beautiful crafts at my child's school, but I'm going to be present for this, for this one event or that event.”

Again, it comes down to really just being deliberate about your choices and what you're spending time on and outsourcing when you can. Because as a physician you probably have a little more income flexibility. So, outsource. Outsource the things you don't want.

I remember somebody telling me when I was hiring a nanny, she said, “Make sure you have the nanny do all the things you don't want to do so that minute you get home or you stop doing work, you use that precious time to now be spending time with your children as opposed to doing laundry or chopping vegetables or something.” Have them do that. There's no shame in that. And there's lots of ways to find that without having to hire a governess so you can outsource in a more cost-effective way.

Dr. Jim Dahle:
You use a phrase frequently that I really like. Being unflappable or unoverwhelmable. What lessons about balance and burnout has practicing emergency medicine taught you?

Dr. Darria Long:
Oh, well, to use unflappable, I love unflappable. It sounds like you're about 80 years old when you use it but I think it's perfect because it says, how can you go, and you have some situation no matter how stressful, and yes, being in emergency medicine, maybe I self-selected to emergency medicine because I had some of this but I think being in emergency medicine also helps you no matter what craziness comes in the door, how do you keep your cool? And that's useful if it's a multi-trauma coming in, it's also useful if it's your children and they suddenly have 14 different things coming up next week that you need to be able to attend or need to be ready for.

A couple of different things. One is what you do in the moment or what you will have done is we talk about triage. We talk about triage in the emergency department, and the reason triage the matter is there's research from Robert Sapolsky that shows that it's the ability to isolate and to be able to differentiate what is threat versus non threat is crucial for our stress levels.

Our brains are not intrinsically capable of doing that because you might have 14 different things on your to-do list, and then you get another email that comes in that's about of request to do, and they all seem equally noisy. They all seem urgent and emergent, that you have to be able to handle all of them. And now you have 16 things you have to do, but you have to pause and say, “Okay, what's my most important thing? What's my red in the ER? Who's my level five that I need to go take care of immediately? What's my most important thing now that I need to handle?”

When you have 80 different things coming at you, you triage. And I do this constantly during my day. Even today, I had some things come up and it's like, “Okay, what's my one most important thing that I have to get done?” Because if you've gotten that one or two or three most important things done, and when things get really stressful, you're okay because the important priorities are covered.

Number two is automating as much as possible. What are all the decisions that you make every single day? Steve Jobs wore the same thing every day. You don't have to do that. I think that's a little bit boring, but how can you automate different tasks, things in your schedule, carpool, meals, any number of things, workplace, meetings, things. How can you automate as much as possible?

And then you also have to delete. Jim, we in the ER are able to say, “What are the things that we're not going to take care of? What are the things that are not emergent that I'm going to tell you to follow up with your primary care doctor for?” And we have to be able to look at our to-do list, and in your life out of the ER translating back say, “Okay, here's my most important things I'm triaging, but then here's the things I'm going to take off my list.”

And that comes down to the do-it-all. We do not have to do-it-all, by whatever definition of do-it-all that we're looking at from my idealized definition, if there are things on your to-do list that you can take off. So, you're triaging, you're automating, and you're deleting the things that maybe they are there because you felt like, “Well, all the moms do this. This is a good thing. This is what makes a good parent.” Take that off. If it's not something that's a high priority for you and it's just taking you away from your most important things, then you delete. So, triage, automate, delete.

Dr. Jim Dahle:
I love it. Great framework to think about that. All right, our time is now getting short, but I wanted to give you a chance. By the time all is said and done, something like 30,000 people are going to listen to this podcast, mostly high income professionals. What have we not talked about that you think this audience ought to know?

Dr. Darria Long:
Two things. One, we touched on in the beginning. For me, television again was something that I didn't expect and was something off of which I've now made a career. I think anybody who's looking at doing television or being a thought leader, it's important to always look at what is the yield for it. If anybody is interested who is listening to this and watching this, again, for me it was doing national TV and that is the business model.

But for other people, maybe it's growing your practice, in which case you don't need to do national TV. You don't need to be on CNN to grow your local practice if you're an ENT doctor. It's doing local news, it's being involved in the local media circuit and local newspapers and things so people see you as a local thought leader to drive your practice.

I would say use media, not just say, “Hey, I want to get on the Today Show”, but by figuring out what is your goal, your end goal, and then you can leverage media. However, fix that. And it's much easier if it’s “I need to drive my local practice.” Okay, now you know what you're doing. Just use media strategically because yes, you don't want it to become an expensive hobby. I have seen that happen to people. So, know where you want to take it.

And then I have one more burnout tip that I like to share when I am speaking called “Batch the small stuff.” When we talk about the small things. When I talk about triage in my talk, you get the reds are your most important things. These are your level five patients. The yellows are your level three patients. The greens are your level one patients. You still have to get them seen but how can you get your level one patient seen in a way that doesn't keep you from taking care of the level five septic shock that's in room nine?

Similarly, in our lives, we have greens. Greens are things that we have to get done but are really not our mission critical things. Maybe they are “Hey, send $8 for Mr. Jones coach's gift or make sure you're you sign up for this Girl Scout cookie link, or make sure you sign up to bring in donuts for Janet's retirement party.” These little tiny things.

Research shows that these little tiny things really can be interruptive to your day. And so, I think of them kind of like the compsognathus in Jurassic Park. You remember those little tiny dinosaurs? As a single one, they're like, “Oh, cute, little dinosaur. What's up?” As a herd of compsognathus, they'll devour you.

And that's what these little tiny tasks are like. “Just one? Sure, I'll send that $8 over. I'll buy that one thing on Amazon.” By just one, they seem fine but constantly throughout the course of your day, constantly interrupting you, trying to do patient care, trying to do the important things, it's distracting you. These are your BTSS – Batch The Small Stuff. If it's more adult audience, I don't always say “stuff.” I use another word that's “s” but it doesn't matter. You get my drift.

Create a folder called BTSS in your inbox and every time one of these requests comes in, do not stop and do it, just drag it, drag it to that folder. And then periodically, once a week, once every couple weeks, or when you are doing something like carpool, which is where my soul goes to die, is sitting in the carpool line or you're on hold with a pharmacy or insurance or something. Pull out your little earphone, pull out your BTSS folder and go to town. And you will get 10, 15 tasks done in 40 minutes. You get your green things that you got to get done without taking over your whole day and without derailing the things that are really important and that move the needle.

Dr. Jim Dahle:
Awesome. Great tip. For those who want to learn more about Dr. Darria, you can actually go to one of her websites, drdarria.com is one. And then of course, as she mentioned, this business Trueve.

Dr. Darria Long:
Trueve.

Dr. Jim Dahle:
trueve.com.

Dr. Darria Long:
Trueve. It's a combination of “true” like source of truth, and the French word “trouvé”, which means to find.

Dr. Jim Dahle:
Ah, very nice. Very cool. You can get more information about her there. Thank you so much for coming on the White Coat Investor podcast and sharing some of the results from your study as well as these other helpful tips for burnout.

Dr. Darria Long:
Thank you so much, Jim. And I would also say if anybody is interested, they're welcome to connect with me on Instagram at drdarria. When I'm on Instagram, usually my content is again, keeping women, making it easy for women to keep their families healthy and safe and accident free. And to know what to do if something does happen with that peace of mind to follow me there. And always love hearing from physicians, hearing stories. If there are stories that physicians think that need to be shared with the general public, share them with me and we can help educate the public together.

Dr. Jim Dahle:
Awesome. Thank you so much for what you're doing.

Dr. Darria Long:
Thanks Jim.

Dr. Jim Dahle:
All right. She's got a lot of energy. It’s pretty amazing. How much she can accomplish in in her life and in her career. But you know what? She’s like everybody else. We only have 24 hours in a day. You've got to delete out of your life those things that aren't moving the needle for you.

I love her tips about automating, about triaging, and about just deleting stuff out of our lives. I think that is probably the most powerful thing. It's interesting, anytime Katie or I try to take something else on in our lives, we got to look at what else we're doing and decide, “Well, what's coming out? If we really want to do this, what's going to come out of our lives? Are we going to travel less? Are we going to spend less time with our kids?” And if not, then it's got to come off of something else or volunteer work or paid work or those sorts of things. Because it just doesn't make any sense to squeeze out the most important things in order to do more things that aren't necessarily all that important.

 

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Don't forget, as I mentioned at the beginning of the hour, Financial Bootcamp, sign up for that at whitecoatinvestor.com/financialbootcamp. The free 12 week email course could save you or make you millions of dollars over your lifetime. Become financially educated, become financially literate, become financially disciplined. These emails will help.

Thanks for those of you who've been telling others about the podcast and giving us five star reviews. One just last month came in from DougN123, who said, “Great podcast. WCI should be required reading & listening in medical school and residency. I started listening around 2016 and have listened to every episode since and have learned so much. I am now retired from medicine and still enjoy listening/reading and learning from both the WCI podcast and blog. Thanks for the great work and helping us docs get our finances on track!” Five stars. Thanks so much. Great review. That does help us to spread the word.

All right, for the rest of you, we've come to the end of the episode. Keep your head up, shoulders back. You've got this, we're here to help. We'll see you next time on the White Coat Investor podcast.

 

DISCLAIMER

The hosts of the White Coat Investor are not licensed accountants, attorneys, or financial advisors. This podcast is for your entertainment and information only. It should not be considered professional or personalized financial advice. You should consult the appropriate professional for specific advice relating to your situation.

 

Milestones to Millionaire Transcript

Transcription – MtoM – 158

INTRODUCTION

This is the White Coat Investor podcast Milestones to Millionaire – Celebrating stories of success along the journey to financial freedom.

Dr. Jim Dahle:
This is Milestones to Millionaire podcast number 158 – Hospitalist pays off student loans in just over two years.

 

SPONSOR

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This course is the material that should have been taught to you in college, medical school, or residency, but never was. Fire Your Financial Advisor also has a version eligible for CME credit. So, get your financial life in order today. Go to whitecoatinvestor.com/courses to sign up. You can do this and The White Coat Investor can help.

And on that page, you can actually learn about our other courses as well. We have one that's Continuing Financial Education. We put together using material from our conference every year. We also have our No Hype Real Estate Investing course and several other courses there. So, check them out.

Are you a student? If you're a student, you should be coming to our webinar. This podcast drops on the 19th. The webinar is the 21st, so you might've already missed it if you don't listen to this in the first three days after it dropped. But if you go to whitecoatinvestor.com/studentwebinar, you can sign up, 06:00 o'clock Mountain Time, February 21st. It is live and fun. And we're going to be there teaching about what students need to know about finance.

The truth is, I can't come out and talk to you all in person. Never could. There's too many schools, too many students. Frankly, it's too expensive to go out because schools can almost never have any money to pay me to come out, much less pay me something for my time. So, this is what we do instead. We put together this webinar once a year. This is the lecture I would give you if I came to your medical school and talked to your class. You're going to learn about why your patients need you to be financially literate. We're going to learn about how to become a financially successful doctor. We're going to talk for those of you with a little bit of money or second careers or whatever, how to invest during medical school.

We're going to talk probably the most important subject for you students out there, how to not worry about your student loans. We're going to talk about how to save money during residency interviews and why buy a house during residency may not be a great idea.

But coming financially literate early in your career can be worth millions of dollars over the course of your career. You can't afford to wait until the big attending paychecks roll in to learn this stuff. You need to learn it now. So, we'll see you on the 21st. Sign up again, whitecoatinvestor.com/studentwebinar.

 

INTERVIEW

All right, we got a great guest today. Stick around afterward, we're going to talk about emergency funds. All right, let's get our guest on the line. My guest today on the Milestones to Millionaire podcast is Claire. Claire, welcome to the podcast.

Claire:
Thank you so much for having me. I appreciate it.

Dr. Jim Dahle:
Tell us what milestone we're celebrating with you today.

Claire:
I paid off all of my student loans a couple of months ago, and that's what we're celebrating. I'm super excited about it.

Dr. Jim Dahle:
Awesome. Congratulations. How much did you pay off?

Claire:
$235,000 after all of the interest in all of that.

Dr. Jim Dahle:
Wow, that's a lot of money.

Claire:
It is a lot. Yeah. It's definitely a lot of money. Not as much as some of the people in my residency had, but certainly a fair chunk of change.

Dr. Jim Dahle:
What do you do for a living? How far are you out of residency?

Claire:
I'm a hospitalist. I'm working on my third year at the hospital that I work at now. So I am six years out of medical school now.

Dr. Jim Dahle:
Wow. Lots of people have more debt than this. How'd you keep your debt that low during medical school?

Claire:
Yeah, great question. A thing that really, really helped is having somebody that I lived with. I had a partner at the time that paid for room and board, so I only had to take out the amount for tuition. And then I think I took out an extra maybe $10,000 or $15,000 towards the end of medical school to help pay for residency interviews and things like that. But I definitely didn't spend all of that much on residency interviews. So, that helped a lot. It saved me probably $100,000, $120,000, $140,000 on room and board. That definitely helped.

Dr. Jim Dahle:
Yeah, I find this amazing, because I look at the statistics, I look at the exit survey every year the medical students fill out. And the MDs say they come out with about $200,000 on average of those who owe money. This doesn't include the ones who don't owe anything. The DOs, it's like $240,000, the dentist, it's like $270,000.

Claire:
Goodness.

Dr. Jim Dahle:
And there must be an awful lot of people that didn't borrow the entire cost included in that to keep that number so low.

Claire:
Yeah, absolutely. There were a lot of people in my medical school whose parents were much more well off than I was and I think they had their parents helping them out. And my parents helped me some, but not a ton, which was fine.

Dr. Jim Dahle:
Yeah. But still you ended up with more than reportedly what the average is. You paid off more than above average student loan debt according to the surveys that we see out there.

Claire:
Well, yeah.

Dr. Jim Dahle:
So, what was your income over the last three years to pay all this off?

Claire:
Well, it kind of varied because I was doing some moonlighting. I was doing some moonlighting at the urgent care in town. I haven't done that in about a year, but my W2 from last year, the last year that I got a W2 was $290,000, which is a fair amount. And then I think my W2 for this year is going to be less than that because I haven't picked up an urgent care shift in the last 12 to 14 months now.

Dr. Jim Dahle:
Yeah. Clearly boosting income was part of this “live like a resident” period for you?

Claire:
Yeah, yeah. I started working moonlighting as a resident when I was a second year. Right after the pandemic started, I started working a few urgent care shifts, maybe one a month or something depending on what rotation I was in. And then I worked maybe 10 shifts over the summer in between graduating and starting my big girl job. And then in the first year of my job, I worked maybe one, maybe two shifts a month when they really needed me. They were pretty short staffed for a while.

Dr. Jim Dahle:
My notes from you say you paid off this $235,000 in two years, one month and eight days. But who's counting?

Claire:
Yeah. Certainly not me.

Dr. Jim Dahle:
Yeah. I'm doing the math here and I'm thinking, “Okay, well, she makes $250,000, $290,000. That's $500,000, slightly more than $500,000. You paid off $235,000 with some interest over the last few months anyway. A lot of that time maybe some of it wasn't going up due to interest.

Claire:
Actually there was a long time where it was not accruing any interest. I paid it off before the interest started to reaccrue. That was why I wanted to pay it off then. And also my birthday was coming up and I wanted to be debt free by then.

Dr. Jim Dahle:
Happy birthday. That's a pretty cool birthday gift.

Claire:
Thank you.

Dr. Jim Dahle:
But I'm doing the math here. Half of your income went to these student loans over the last two years.

Claire:
That's probably true. Yeah.

Dr. Jim Dahle:
Half of your gross income. How'd you do that?

Claire:
Well, I just didn't live any different than I've always lived. I drive a 21-year-old car. I didn't buy a house. I have a partner that is on board with this whole thing and is splitting household costs with me. I metaphorically and literally wash my plastic bags, my Ziploc bags. I don't buy new stuff until I need it. And this is just how I've always lived. My parents raised me on a single income for the first 15 years of my life. And so, there's a certain amount of living like this that goes along with that.

None of my hobbies are really expensive. I did residency during the pandemic so I really didn't travel because who wants to sit on a plane breathing everybody's air? Not me. And so, that just made it a lot easier because it wasn't a huge imposition on my lifestyle to live like a resident for a couple of years more.

Dr. Jim Dahle:
How much did it bother you to borrow this money?

Claire:
Well, my parents raised me within your pathologic aversion to debt. But I didn't have a choice. I could either not be a doctor or I could borrow this money and I couldn't not be a doctor. So, that's what I had to do. But it definitely bothered me continuing to have the debt and that's why I paid it off so quickly. Some people did the PSLF and I just couldn't do that. I couldn't live like that for 10 years.

Dr. Jim Dahle:
When did you decide you were going to take this debt in a corner and drop an anvil on it? Did you decide this in medical school or residency, or was it not until you were an attending? When did you really decide that this is the way you were going to deal with your debt?

Claire:
Yeah, I knew, sort of the prevailing mentality in medical school was just it done, just borrow it and just deal with it later because I wasn't making any money at the time. I tried to pay off the interest every six months or so, but that added up pretty quickly. So, I had to stop doing that.

But then when I was in residency, I never stopped paying the minimum which for me was like $64. That doesn't even cover the interest, the daily accruing interest, which is just ridiculous. So, I never stopped paying the interest. And then once the interest stopped reaccruing during the pandemic, which was great, that saved me like $10,000 a year, which is crazy. I just kept paying it off. And every so often, if I had a spare $5,000 or something, I would just throw it at the debt.

And then my parents technically paid off the government and then I owed them at 1% interest. And then once I finally got my job, I just said, “You know what? I can do this. It's going to take a year or two, but darn it, I just want to get this done. I can't live like this. I don't want to live under debt.”

Dr. Jim Dahle:
What did your parents think when you started sending huge checks every month?

Claire:
Oh, they were delighted. Like I said, they raised me with a certain attitude towards money and they were delighted and they were encouraging me every step of the way to just get it done, get it done, get it done. And so, that's what I did. They ultimately forgave about $15,000 of the debt, which was really helpful. But other than that, I paid them off and really I was just giving their money back to them, so they were just happy to have it back. But it was a pretty safe investment for them.

Dr. Jim Dahle:
Yeah, yeah. Well, they know you, right?

Claire:
Yeah.

Dr. Jim Dahle:
But there's still some risk. You could have become disabled or died or something like that. There is some risk there for sure.

Claire:
I felt that. Yeah, that is absolutely. I lived in fear that I would just die and then they'd have to pay it off and I'd have taken all their money. I would've felt terrible if that happened. Not that that was like a legitimate fear, but I did think about it.

Dr. Jim Dahle:
Yeah, I know early in the pandemic, all of us were thinking about that as we were walking through the COVID ward.

Claire:
Yeah. I'm glad we're not doing that anymore.

Dr. Jim Dahle:
Yeah, for sure. Did this turn out to be easier or harder than you thought it was going to be?

Claire:
I thought it was going to be really hard and then I make a fair amount of money and once you make that much money, it just accrues really quickly and it was a lot easier than I thought it would be. It still took a couple of years, which I was a little bummed by, but two years is pretty good.

Dr. Jim Dahle:
You're somewhat unusual in that you're driving a 21-year-old car while making $250,000 or $300,000 a year.

Claire:
Yes.

Dr. Jim Dahle:
That's really hard for people not to have a lifestyle explosion when they leave residency. How were you able to not have that? Clearly some of your upbringing played into that. Clearly you wanted your debt gone early. But it's still hard not to have upgraded that car. It's probably a $2,000 car.

Claire:
I bought it for $4,000 right before medical school. It has driven me across the country, the equivalent of about five times. So, it is a good little car, and I reward loyalty.

Dr. Jim Dahle:
Very cool. All right. All of you out there who are sending me emails, who are leaving Speak Pipes about how you must have a $20,000 car, here's a good example.

Claire:
$20,000? Who spends $20,000 on a car? Good Lord. But I will say my poor little car is due for an upgrade. He started to go into what I call AFib, but what the mechanic calls something with the intake valve. So, we are shopping for a new car.

Dr. Jim Dahle:
All right, very good. You certainly deserve it. And now you have the cash flow to buy a very nice car, you can save up for in very few months.

Claire:
I do. I could pay cash now, so that's great.

Dr. Jim Dahle:
Awesome. Well, I hope you treat yourself to that. That'd be a great way to celebrate your birthday and paying off these debts as well.

Claire:
Yes.

Dr. Jim Dahle:
What's next for you after the car?

Claire:
I don't know. I haven't thought that far ahead yet. At some point it would be nice to have a house so I can finally do the garden stuff that I want to without worrying about upsetting my landlord. But for right now, I want to play a little bit of catch up with my 401(k) and just my savings and whatnot. I've been maxing out my 401(k), maxing out the match for my hospital this whole time. And so, something else to focus on is that, but honestly, I don't have a lot of huge financial goals other than replacing my car and maybe getting a house at some point, but that's not coming up anytime soon. The housing prices here are honestly pretty crazy. So, I'm hoping they may settle down.

Dr. Jim Dahle:
Okay. Well, there's some people out there among the 30,000 people listening to this that are family practice residents, they're internal medicine residents, they're coming out of residency this summer. They're going to have a job in a clinic or as a hospitalist and they're sitting on $200,000 or $300,000 in student loans. What advice do you have for them?

Claire:
Just pay it off. It feels so good, honestly. It really does. It's so important to have somebody on board with you, like your partner, your family. It's so, so important. That was really important for me. It was also easier for me. I don't have kids. I don't have expensive hobbies. I don't have a lot of overhead.

If you're a single or partnered resident without any kids, go nuts. That debt is just going to keep dragging you back for the next however many years until you either pay it off or the government manages to pay it off for you. There's no substitute for how good it feels to get out from under it and not have to think “I have to be in my job because I have to pay off my student loans. I cannot leave my job, I can't do anything. I have to just pay off my student loans.” And now I'm not saying that I would leave my job, but now I could. I could just go do something else. And that's really freeing.

Dr. Jim Dahle:
Yeah, you're really not done with medical school until you've paid for it.

Claire:
No, no.

Dr. Jim Dahle:
Pretty awesome. Well, you should be very proud of yourself. You've done something remarkable and we're certainly proud of you. Thank you so much for coming on the Milestones to Millionaire podcast to share it with others and inspire them to do the same.

Claire:
Yeah, thank you so much. I'm glad that I could meet with you. I've been following you on Instagram for a while and taking advantage of some of your tips and I really appreciate being able to be on the podcast. Thanks so much for having me.

Dr. Jim Dahle:
It’s our pleasure. All right. I hope you enjoyed that interview as much as I did. Claire is great. I love her comment. “$20,000 on a car? That's crazy.” It's true though. It's all about mindset. And when you realize that you can live like the average person in this country yet earn like a physician, it's amazing what you can accomplish financially. Whether that's saving up a big, huge down payment, whether it's paying off your student loans, whether it's getting to FIRE super early in your career, whether it's saving up and buying some fancy Tesla because you're sick of driving your $4,000 car. Whatever it might be, you can do it, but only by having some discipline and some financial literacy.

Don't forget about our Fire Your Financial Advisor online course. You do not have to do this the same way I did. You don't have to read dozens of books. You don't have to read every blog you can find out there. You don't have to check in daily on the forums. You can take a course that will help you lay out a financial plan for a fraction of the cost of what hiring a financial planner will be. It's called Fire Your Financial Advisor. There's another version eligible for CME. You can check them all out, whitecoatinvestor.com/courses.

 

FINANCE 101: EMERGENCY FUNDS

Okay, now I promised you that I was going to tell you about emergency funds. So, what is an emergency fund? Classically, an emergency fund is a pot of money that you can dip into in the event of an emergency that doesn't require you to borrow money. It is cash. Almost always it's cash. It's sitting in your safe at home, in your drawer, under your bed. It's in a checking account. It's in a high yield savings account. It's in a money market fund. Maybe some of it's in something like I bonds or something that you've had for at least a year and can sell on a moment's notice.

But this is money that you can use instead of borrowing. You can use it in the event that you get a call that grandma is dying and you need to come see her before she dies and come to the funeral. It's money you can use when the washer and dryer conk out. It's money you can use when your transmission dies or your $4,000 car dies. You can probably replace that out of emergency fund, but it's classically three to six months’ worth of expenses, not income. If you're making $10,000 a month, you don't have to have a $30,000 emergency fund if you're only spending $5,000 a month. You only have to have a $15,000 emergency fund.

It's all about your expenses. And the more stable your financial life, the less you can get away with. If you're pretty unstable in how your financial life goes, maybe you need six months of expenses. I like to keep mine somewhere where it earns a little bit of interest, but it's still very liquid. That means either a high yield savings account or these days, you can usually earn more in a good money market fund such as the Vanguard Federal Money Market Fund. That's probably where most people have most of their emergency fund.

I do think it's important to have some in a local institution, someplace you can walk in and get cash out in an hour. And I think it's important actually to have a little bit of cash at home. I think that's part of an emergency fund as well. So, make sure you get that in place. Don't go chasing yield with it. It's about the return of your principal, not the return on your principal, but it needs to be kept fairly safe.

Now, does there come a time when maybe you don't need an emergency fund? Sure, sure. If you're retiring and part of your retirement asset allocation is 5% of your money in cash, and that adds up to be, I don't know, $300,000, you don't need an emergency fund too. Your entire portfolio is your emergency fund. There comes a time when maybe an emergency fund isn't so important, but that time is certainly not in the first five or 10 years of your career.

Okay. All right. I think we told you everything we're going to tell you today. That's all we got, man. If you guys want to be on this podcast, you can come on. You can apply at whitecoatinvestor.com/milestones. If you listen to our sister podcast, the White Coat Investor podcast, you can leave your questions for that at whitecoatinvestor.com/speakpipe.

All right, you can do this. The White Coat Investor is here to help you. We're proud of what you're doing, accomplish these milestones, tick them off one by one, share them with friends, family, the White Coat Investor community, and we will cheer you on and use your experience to inspire others to do the same. See you next time on the podcast.

 

DISCLAIMER

The hosts of the White Coat Investor podcast are not licensed accountants, attorneys, or financial advisors. This podcast is for your entertainment and information only. It should not be considered professional or personalized financial advice. You should consult the appropriate professional for specific advice relating to your situation.