Podcast #83 Show Notes
The Business of Medicine: Teaching Personal Finance to Students and Residents with Dr. Jason Mizell
Dr. Jason Mizell has been teaching a personal finance course, the Business of Medicine class, at his academic institution for medical students and residents for several years. It is inspiring to see what he has created and the difference he is making in the lives of these trainees. There is a growing number of academic doctors publishing on this subject in the last few years, and I hope to see those numbers increase. This episode is all about Jason's Business of Medicine class, which should becomes standard curriculum throughout medical schools. I hope this episode gives the idea more publicity so medical students start demanding it from their schools. As has been well discussed on this blog and in the podcast, physician financial mistakes and subsequent regrets are all too common. A link between these financial mistakes and the lack of education physicians receive cannot be ignored.
In This Show:
In This Show:
Podcast #83 Sponsor
This episode is sponsored by Adam Grossman of Mayport Wealth Management. Adam is a Boston-based advisor and works with physicians across the country. Unlike most other advisors, Adam offers straightforward flat fees for both standalone financial planning and investment management. Whatever stage you're at in your career, Adam can help you get organized with a personalized financial plan and can help you implement it with a low-cost index fund portfolio.
Adam is a CFA charterholder and received his MBA from MIT, but more importantly, you'll benefit from Adam's own personal experience with many of the same financial obstacles and opportunities that face physicians. To learn more, visit Adam's website mayport.com/whitecoat to download a free e-book especially for physicians.
Quote of the Day
Our quote of the day today comes from Morgan Housel, who said,
“Good investing is about earning pretty good returns that you can stick with for a long period of time. That's when compounding runs wild.”
Dr. Mizell a.k.a. Preacher Mizell
Dr. Jason Mizell is a colorectal surgeon from the University of Arkansas School of Medical Sciences. I know some of you know about his work through academic circles and it has been mentioned on the blog over the years. He even got up on stage for a few minutes at the White Coat Investor conference last March and talked about his work. I think it is interesting that his other career option while in undergraduate was becoming a minister. I think this contributes quite a bit to his missionary zeal that I see him doing now with physician financial literacy. He is really inspiring, saying,
“the goal of all of it is just to serve and love people, and really to glorify God doing it. I tell people even now, when I get ready to operate on them, that I'm loving on them by cutting on them, which is kind of a bizarre job. But, that's what I tell them because it is. It's all just a way, no matter what I do, it's all just with the undercurrent of wanting to love people and be able to do what God has called me to do, which is just take care of people. Whether it is telling them about their money, and trying to help them prepare for their future, or surgery, or actually standing in a pulpit somewhere, it all has the same underlying motivation.”
We talked quite a bit about his upbringing living in a mobile home in a small country farming town in northwest Louisiana, where his first job was shooting crows off watermelon for $5/hour. He had a very different upbringing than I did. I very much had a middle class upbringing. He kind of grew up lower class. I mean, if you're living in mobile homes, in most cities in this country, you were working class, for sure. We talked about how that affected his attitude and the skills he was taught about money growing up. He felt like he learned two things. One is to be comfortable with what he had. And two is it doesn't take a whole lot really to get by. Now, as a more well-off parent, it has been hard for him to convey this without putting his kids in the position that he was in. We all have that struggle. What have you found that helps in your parenting?
One thing that Jason has done is give quite a bit of his money away and talks with his children about that giving, feeling like what he doesn't want to do is to save a lot of money on the front end and miss a lot of opportunities along the way to take care of people, have fun with them, and to bless them through his job and income. They are saving and investing but not shooting for early financial independence and retirement because of their charitable giving. It is awesome how he is finding a balance between now and later. Giving your money away certainly can change your attitude about money. Dr. Mizell said,
“I have to trust that God's going to take care of us, and that the individual that is receiving the money clearly needs it more than we do. It helps me not become a Scrooge, and not be too much of a hoarder. It helps keep my priorities and what I hope and pray is that it would do the same for our kids and help them to see, regardless of how much they end up making, that really the goal, at really any class of socioeconomic status, can be to continue to use money to help take care of others. I try to show our kids when we are giving, so they recognize it. I think kids sometimes aren't clued in. I don't tell them to be bragging, but I say, “Look, this is what we're doing. This is why we work.” I hope it is the life lesson for them as well, as they go along to see why we do what we do, and it's not just to hoard it.”
An Academic Interest in Personal Finance
Dr. Mizell didn't feel like he was well prepared for the business side of medicine when he was finished with his training. That was the big motivator for his academic focus on physician finance. He wanted to make sure that he prepared his students and residents for life after surgery, so they were not starting out with the same deficits that he did. What he noticed once he got settled in Arkansas is that there were a few people on staff who were very qualified in aspects of finance and initially he was an organizer of those talented people. For instance a surgical oncologist was a CFP with a business, another physician on staff was very knowledgeable with the healthcare side of things, etc so he created a curriculum around a few individuals and brought that to his chairman. He was given permission to have a certain time each month set aside to teach the residents. He organized it. Some resources were already available just no one had taken the initiative to create the curriculum.
He had an educator in the department help him structure it a little bit to determine how well they were actually teaching. That was the first paper he wrote on the experience back in 2013. It was on the course that they implemented in 2012 to help residents with their finances on the business side and practice side of things. They would also give them lectures once a month in the evening, which was more personal finance. Every month they would get two lectures. One during the grand rounds hour, about business and their practice, and then one later on that month, usually giving them dinner or something and teaching them about personal finance. They saw a lot of excitement that someone was beginning to teach them about things they have never thought of, and no one had ever really taken the time to invest in them and teach them those different facts. So this all started with just his residency program.
Business of Medicine Class in the Medical School Curriculum
This curriculum with the surgery residents went on full force for a couple of years but Jason noticed that a lot of the residents had already made bad financial decisions whether it was credit card debt, buying a big house, or buying a big new fancy car on a modest resident salary, or whatever. He realized he needed to catch them earlier and prevent these problems before they occurred. At the time a fourth year medical student was also interested in business and asked if he would be willing to take some of the topics he was teaching to residents and teach them to the medical students. They collaborated together and came up with a more extensive curriculum, broadened it, and generalize it to medical students. Jason thought that the best time to offer it would be in the spring of their fourth year, as they're really pretty much done with everything, and their brains are on cruise control plus he could say, “look, you're going to be filling out information about your insurance, your health insurance, or your retirement plan, in about three months, whenever you move to your new institution. You really need to know this. You need to understand how it affects your taxes.” There is so much buy-in from them during that spring of their fourth year.
I think there are three brilliant things Dr. Mizell did when setting up this course:
- Perfect timing in the spring of MS4. It's just in time, so as soon as they start earning money, come July 1st, they've just recently been given all this information.
- The course is optional. Dr. Mizell didn't have to convince anybody that this is something that had to be put into the curriculum and yet, despite it being optional, 80% of the students enroll in it.
- It is in the evenings so spouses and partners can come and he can get speakers from the community to help teach.
I just think the Business of Medicine course has been super successful, so much so, that when I have people ask about this, how should we get this kind of curriculum into a medical school? I tell them to do it like Jason does. He takes about 20 hours to cover all the content, but students get two hours worth of credit.
The course Dr. Mizell teaches is about 60% personal finance and about 40% what he calls business, like practice management stuff. Here is what it entails:
- Billing and coding
- Updates in healthcare
- Starting your practice, creating a practice, practice metrics. Things like how would you compare this private practice to that private practice.
- Insurance, like auto, and home, and disability insurance
- Debt reduction
- Student Loan Management
- Estate planning
Those are the general topics.
Publishing on Finance in Journals
Jason tells us about the process of publishing on personal finance and investing and how he was able to do that. He said it has been difficult because the niche for undergraduate publications for finance education is a very small niche. If you try to go toward an educational journal, that is difficult because they are going to have a lot of very strong educational rigor to try to grade your paper. His course is not a very rigorous educational sort of course. He has a lot freedom and general objectives for the talks but a lot of times the talks will take a different turn. Students will start asking questions. They will get all off track, but that is fine with him because he wants them to learn what they want to learn and get their questions answered.
Being very specific with the content is hard. It can look sort of educationally not so sound. Undergraduate journals are pretty strong journals and it is hard to get published in there so it is been hard to find places to land these papers. What Dr. Mizell typically does is find journals where there have been a lot of studies showing the need, but there have not been very many papers showing the fix. He will say look, “this is my curriculum that I did. This is the fix for that problem that you mentioned last year in that other paper by so and so.” That is actually what he did to publish the article on the four years of this curriculum that will come out in January in the Journal of Medical Practice Management. He felt that was kind of a weird journal to be publishing educational curricula in. But, that is where it landed because they had several papers that said this is a big need.
A lot of people have set the stage over the last few years so it will probably be a little easier going forward for other people that may want to publish information on their curriculum because there is definitely more of a documented need than there was when he started doing this in 2012 and published his first article in Journal of Surgical Research. You can contact Dr. Mizell for the full article.
In addition to articles being published in medical journals, lectures on personal finance and investing are now taking place at national meetings, to0. Dr. Mizell gave a talk at the national meeting for colorectal surgeons. Earlier this year I spoke at the American College of Emergency Physicians Scientific Assembly, which is the biggest meeting in our specialty. It is wonderful to see the topic discussed in these big national meetings.
Advice for Academic Docs
I asked Jason what advice do you have for another academic doc, at another institution, who wants to either start a curriculum, or publish on this topic. He said,
“It has been a nice niche. It is so still underdeveloped and an untapped market that there's still a lot of room there, and a huge, huge need. I had a chairman at a college of medicine that's been very friendly toward me and given me a lot of room to develop this. There are other universities, unfortunately, that just won't give their faculty that kind of exposure and ability. But still, though, even with that, I would say just do what you can. I mean, a little education, and a little lecture here and there, is better than nothing. Don't get too frustrated or overwhelmed if you're not able to come up with a 20-hour course. I started pretty small and then it developed into what it is.”
You don't have to be an expert. You don't have to come up with a monster huge curriculum to start off. You just start chipping away. As you are able to show that your learners are enjoying it, and they're learning, and they're supportive, then you can take that to administration and say, “Look, I've got people here that really need it. They want it. You can use your learners to drive the influence with administration and start breaking down walls, and make yourself available.”
If there was one person like Dr. Mizell at every academic institution in the country this information gets out there very, very quickly. I think that's pretty awesome. I don't think it's that hard to do. There is certainly somebody interested in it at every one of those institutions. There is such a huge need that you can do a lot good with not a whole lot of effort because so many of these residents, and medical students are really quite scared, in a bad financial place, and can use a lot of help.
If you find this podcast helpful please leave a review at iTunes. This helps these residents and medical students and other professionals find the podcast and get this needed information.
WCI: Welcome to White Coat Investor podcast number 83, teaching personal finance to students and residents with Jason Mizell. This episode is sponsored by Adam Grossman of Mayport Wealth Management. Adam is Boston based advisor, and worked with physicians across the country. Unlike most other advisors, Adam offers straightforward flat fees for both standalone financial planning and investment management.
WCI: Whatever stage you're at in your career, Adam can help you get organized with a personalized financial plan and can help you implement it with a low cost index fund portfolio. Adam is a CFA charter holder and received his MBA from MIT. More importantly, you'll benefit from Adam's own personal experience with many of the same financial obstacles and opportunities that face physicians. To learn more, visit Adam's website, mayport.com/whitecoat to download a free eBook, especially for physicians.
WCI: I wanted to give a little plug for our student loan refinancing deals. These are the best deals on the internet. If you want some money back, and more importantly a lower rate on your student loans, be sure to go to the White Coat Investor website. Go to the recommendations tab, and the first thing below it is student loan refinancing. We've got eight or ten company's there that will give you the best possible deals that you can get on your student loans. If refinancing your student loans is right for you, I mean, it's time to leave the government programs, then be sure to go there to get the best possible deals.
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WCI: We also have a new Pinterest. I'm not even sure if you call it a Pinterest page or Pinterest board, or what we have, but we got something up on Pinterest. I'm also trying to be a little bit more active on Instagram. Check those out and please follow us, and share this information with those you care about because it is important information. Doctors who are financially secure, are better doctors, they're better spouses, and partners, they're better parents, and they're better people. Let's help you get your finances in order and help you reach out to those around you and help them as well. That freedom and that happiness that comes from knowing you're not messing everything up, and not having financial stress in your life, really does make life better.
WCI: Our quote of the day today comes from Morgan Housel, who said, “Good investing is about earning pretty good returns that you can stick with for a long period of time. That's when compounding runs wild.” Now, let's get into our special guest we have today. We have a special guest today on the White Coat Investor podcast. We have Dr. Jason Mizell. He is a surgeon from the University of Arkansas School of Medical Sciences. Is that the correct name for it, Jason?
Dr. Mizell: Yeah, that's correct.
WCI: All right. We're excited to have him on here today because he is a pioneer in the academic community for promoting physician financial literacy. We'll get into all kinds of cool stuff that he's done about it later in the show. I know some of you know about his work through academic circles, and I know it's been mentioned on the blog over the years. Also, he actually got up on stage for a few minutes at the White Coat Investor conference last March and talked about his work. It's pleasure to have you here Dr. Mizell.
Dr. Mizell: Thank you. It's a pleasure being here. I really appreciate it.
WCI: First, let's get to know you a little bit better. Can you tell us a little bit about your upbringing and your family?
Dr. Mizell: Yeah, sure. I grew up in a very small country town, farming town, northwest Louisiana. My high school had 55 students. My graduating class, which was the largest graduating class ever from my school, so very small. We didn't really have neighbors. It was just people who lived across the pasture kind of thing. You know, so it wasn't anything that was very big. I went to Louisiana Tech for undergraduate with plans for the most part, to go into medicine, but I'd also considered about the possibility of actually going into the ministry, and becoming like a pastor.
Dr. Mizell: As I went through medical, or I went through college, I took all the biology classes, and then took the MCAT. I felt well, if I knew well enough on MCAT to get into med school, I will. If I don't do that well, then apparently God has other plans and so I'll go into the ministry and that kind of thing. That was really my plans in undergraduate. My family was not very well off. We grew up fairly modest. My mom didn't work, but my dad worked offshore for in the Gulf for the oil field. I had what I needed, but nothing really extravagant. We never took vacations except just to go see family on the holidays.
Dr. Mizell: My home was a mobile home and the first time I actually lived in a house without wheels was when my wife and I got married. You know, so we didn't have a whole lot. It was pretty much mobile homes my entire growing up. Things were fine. It was a good place to be. It was a nice country town. My first job was driving through watermelon patches, shooting crows for $5.00 an hour. That was the kind of job you had where I grew up. It was a fun little place to grow.
WCI: That's awesome. Shooting crows off the watermelon. That's great.
Dr. Mizell: Yeah, $5.00 an hour.
WCI: I wonder if this other job option as a minster, contributed a little bit to your missionary zeal that I see you doing now with physician financial literacy.
Dr. Mizell: Yeah. I think so. It's really … the goal of all of it is just to serve and love people, and really to glorify God doing it. I tell people even now, when I get ready to operate on them, that I'm loving on them by cutting on them, which is kind of a bizarre job. But, that's what I tell them because it is. It's all just a way, no matter what I do, it's all just with the undercurrent of wanting just to love people, and just you know, be able to do what God has called me to do, which is just take care of people.
Dr. Mizell: Whether it's telling them about their money, and trying to help them prepare for their future, or surgery, or actually standing in a pulpit somewhere, it all has the same underlining motivation.
WCI: That's pretty awesome. I'm trying to come up with a great joke about how the fact that you're a colorectal surgeon, but I couldn't think of anything appropriate.
Dr. Mizell: Yeah, that happens a lot. It's hard sometimes with those in my profession.
WCI: You had a very different upbringing than I did. I mean, I very much had a middle class upbringing, for sure. It wasn't upper middle class by any means, but it was middle class, without a doubt. My father was an engineer. You know, we didn't live in any mobile homes. You kind of grew up lower class. I mean, if you're living in mobile homes, in most cities in this country, you were working class, for sure. How do you think that effected your attitudes, and skills that you were taught up money at home growing up?
Dr. Mizell: I feel like when I learned a lot of, really I guess, maybe it was two things. One was to be comfortable with what I have and knowing that it doesn't take a whole lot really to get by. That's been hard for me as a parent to convey that without putting my kids in the position that I was in. It's a forced learned sort of thing. You know, if my parents could've given me more, I think they would have.
WCI: Yeah, you can't really do it artificially, can you?
Dr. Mizell: Right, right. It's very difficult. I learned to be comfortable with what I had. I was able to really get a better idea of what I need, and what I didn't need, and then the value to really work for something when I did need it, or really, really wanted it. Not very much was given to me outside of, you know, my basic needs, which were totally taken care of. If there was something else I wanted, then I kind of had to work for it. That again, is a challenge as a parent to try to instill that.
Dr. Mizell: I think it did help a lot, for now, that whenever we do have more money, that I'm able to just still keep that perspective, by default. Really, you know, I have a better idea of really what we need as a family, and what's a gift, and a luxury?
WCI: Yeah, it must have been tough, wanting a new pair pants, and having to think about how many crows you were going to have to kill get them.
Dr. Mizell: Yeah, a good pair of pants is about 30 crows.
WCI: All right. Let's talk a little bit about your career first. Tell us about your schooling, training, and your career as a surgeon so far.
Dr. Mizell: Undergrad was Louisiana Tech, and then I went on straight from there into med school at LSU. I did by med school, and then stayed on there for surgery training for five years at LSU in Shreveport. And then, matched into colorectal, which I was kind of all over map for awhile about that. I didn't know if I was going to do general surgery, or whatever. Ultimately, decided on colorectal. We were in Dallas for one year and then got recruited to come here to Little Rock. We had never been here before. I did not interview here as a medical student, so this was a very new area, although it's not very far off from where I grew up. It's just an unexplored areas for me.
Dr. Mizell: We like it a lot. We've been here now, we got here in 2010 and have been here ever since here at the academic medical center, which is the only here for the state. Any training programs, for the most part, all run through here. Once I was about halfway through my fellowship, I realized that I really wanted to take a more active role, and education, and teaching, and training, and so ultimately decided on an academic institution.
WCI: Very cool. No surprise to me that you're in academics because you're an excellent teacher.
Dr. Mizell: Oh, thanks. I appreciate that.
WCI: Let's get a little bit personal, to start with. You know, share as much as you feel comfortable with, but tell us about your own financial life. You know, how far are you out of training? Do you still have student loans? How far are you away from financial independence? What kind of accounts do you invest in? What's your savings rate? What's your asset allocation, et cetera?
Dr. Mizell: Okay. Like I said, we finished up, my wife and I finished up in 2010, fellowship. She was a high school English teacher whenever I was in med school, and then residency. Once we had our second child, she did not go back into teaching and so that, I think I was a third resident at that point. I would moonlight as a resident, you know, basically cover a weekend or some random times during the week to help cover her salary, which wasn't hard as a teachers salary. Once we got here, Arkansas has a nice retirement plan. You know, being a state institution and a nonprofit, so we have a 403B and a 457. They have a decent match, which is an incentive to come here because not many people want to just routinely come to Arkansas.
Dr. Mizell: They have to have some benefits. The cost of living here is good. We bought a house when we first moved here because we had two kids, and my mother in law lives with us, and so she was with us at the time. We've since bought another house. Sold our original one and moved into another one because we now have four kids. Just needed some extra space. The having the retirement plans here, you know, I match those, or I max those out, which is even as an academic, which we don't make as much as in private practice, it's still able to max out those retirement accounts. That's a nice benefit of being in academics, able to put more pretax stuff away.
Dr. Mizell: I do have some after tax accounts. Our student loans, or my student loans are at 2.8%, so I don't have a big drive to put a lot of money into those. I pay extra on them, but I'm trying to make sure I max out all of my other accounts, and things like that. Our financial, I guess, plan is a little different than most, I would say. It's a little atypical. Like, my wife and I, as I mentioned earlier, really feel like this job and the salary that I get is really God's blessing, and even money is tool to love on people. That's really what we do.
Dr. Mizell: We give quite a bit to charity, more so than I think a lot of people would recommend. Like when I originally talked to our financial planner, Sarah Catherine, who you had on the podcast not too long ago, she sort of made a chart for us whenever I met with her a long time ago for the first time. We were sort of out of her range of what should be given to charity, but that's really what we want to do. We do a lot of hosting events. Like, my wife loves to have people over to our house, whether it's friends from school, or friends from church, or whatever.
Dr. Mizell: We do have a fair amount of money given to those things. I never know what God's going to ask us to do. I don't have a good plan on when I would say we would become financial Independent. I think we're doing well. We are saving a lot. We don't really have a lot of random expenses that just luxury items. Our cars are paid off and things like that. We don't have a lot of fancy things. I don't think we are as financially set as we could be, based on the salary of a surgeon, but it's just because we give a lot of it away, and spend a lot of people, and our house, and doing things.
Dr. Mizell: I feel like what I don't want to do is to save a lot of money on the front end and miss a lot of opportunities along the way to take care of people, and have fun with them, and to bless them through our job, and stuff like that. I hope that answers your question.
WCI: Yeah, for sure. It's awesome how you're finding a balance there between now and later. I know that's hard for a lot of people that really get into personal finance, and they just, you know, gobble it up, and eat it, and eat, and sleep, drink personal fiance. And then, every time you buy something, you're looking at it going, wow, that's another 30 days of working, you know, at the end of my career. That's, you know, I don't want to go out with my friends tonight because that means I got to work longer. It's going to take me four hours to make that money, or whatever.
WCI: I think it's true. You know, you can't take it with you when you go. You've got to find a balance. You do have to save something, but you don't have to be financially Independent at 40 to be financially successful. I think a lot of people sometimes lose that, and lose that balance. It's important to have it.
Dr. Mizell: Yeah, I totally agree. I feel like my wife has to frequently remind me that I am falling into that mindset. You know, because I do get ultra conservative, particularly when you're teaching it and you're standing up in front of students and residents, encouraging them to be smart, and have a budget, and this and that, knowing in the back of mind that sometimes, I'm not doing what I'm preaching. That's just because that's maybe, you know, where we are, and what we want to do. Like you said, everybody had their own priorities. We just try to make sure we find that balance.It is a struggle to not be uber conservative, and to try to hoard it, you know, but to give it away, and have the right heart whenever you're doing it.
WCI: Yeah, maybe we ought to get into that a little bit more. I mean, it sounds like you give away more than most doctors. What do you think that does to your attitude toward money?
Dr. Mizell: I think it helps not hold on too tightly because when I give, I have to trust that God's going to take care of us, and that the individual that is receiving the money, clearly needs it more than we do. It helps me not become a Scrooge, and not be, you know, too much of a hoarder. It helps keep the priorities and what I hope and pray is that it would do the same for our kids and help them to see, regardless of how much they end up making, that really the goal at really any class of socioeconomic status, can be to continue to use money to help take care of others.
Dr. Mizell: One of the biggest things that I try to do, whether it's through our church, or whatever, I try to show our kids when we are giving, so they recognize it. I think kids sometimes aren't clued in. I don't tell them to be bragging, but I say, “Look, this is what we're doing. This is why we work.” And things like that. I hope it's the life lessons for them as well, as they go along to see why we do what we do, and it's not just to hoard it. It's for a life of seashells on the beach whenever we're 75, you know?
WCI: Yeah. Now, you've developed an academic interest in personal finance. Why? How did you get into that? How is that becoming your niche? I mean, in all of colorectal surgery, you settled on personal finance.
Dr. Mizell: Yeah, yeah, that's about as far off as people can imagine, you know? It's funny, when I started here, the second day or so that I started, after fellowship, they brought me my CPT and my books and I didn't have a clue what the use of those books was, and what they were for, and how that translated into billing and coding. I really had this moment of feeling extremely unprepared for a big part of my job. At an academic hospital, I wanted to make sure that I taught my residents and students surgery. I also wanted to make sure that I prepared them for the life after surgery, which I felt like I wasn't very well prepared for.
Dr. Mizell: I sort of took this vow of, you know, I will not teach students with the deficits that I had when I was a student and resident. It just started me on this course of filling this gap. What I noticed, as I settled in here in Arkansas, was that here were a few people on staff who were very qualified. And so, what I initially was, was really more of the organizer of people who were very talented. One guy was head of CFP and had a business, but he was also a surgical oncologist, so roped him in. Another guy, really knew more about the healthcare side of things, so I brought him in, and created this curriculum with a few other individuals. Just organized it.
Dr. Mizell: Talked to my chairman and got permission to have a certain time each month to teach it. It really, a lot of pieces fell in place with some resources already being available, but nobody had just taken the initiative to create the curriculum. We had an educator here in the department that helped me structure it a little bit to determine how well we were actually teaching. That was that first paper that I wrote back in, I guess it came out in 2013. It was on the course that we implemented in 2012 to help residents with their finances on the business side, and practice side of things.
Dr. Mizell: And then, we would also give them lectures once a month in the evening, which was more personal finance. Every month they would get two lectures. One during our grand rounds hour, about business and their practice, and then one later on that month. We'd usually give them dinner or something and we would teach them about personal finance. We just saw a lot of excitement in that in the residence and somebody beginning to teach them about things they have never thought of, and nobody had ever really just significantly taken the time to invest in them and teach them those different facts. That was how it all started.
WCI: Now, you started in one residency program and it was just the surgery residency. And then, you expanded it at a certain point to the medical school. Tell us about what it took to get it into the medical school curriculum?
Dr. Mizell: That curriculum went on, you know, full force the surgery residents of a couple of years. What noticed was that as the residents, as I would survey them, I noticed that a lot of them had already made a lot bad decisions, even as first, second, and third year residents, whether it was credit card debt, or buying a big house, or buying a big new fancy car on a modest resident salary. I realized that there were problems that had already happened. I needed to catch them earlier and prevent that before it occurred. It was a fourth year medical student at the time, who had an interest in business, and came to me and said, “Hey, would you be willing to take some of these topics you're teaching the residents and make them for students?”
Dr. Mizell: He and I kind of collaborated. I came up with a more extensive curriculum, and broadened it, and generalize it to medical students. As I thought about their curriculum, I thought that the best time to offer it would be in the spring of their fourth year, as they're really pretty much done with everything, and their brains are sort of checked out on, on cruise control, and all of their big expenses are done, for the most part, as far as interviews, and their time. They're just basically on vacation for about four months.
Dr. Mizell: I said, “Well, let me do it then. That way they've got a little more skin in the game too.” So that whenever I can say, “Look, you're going to be filling out information about your insurance, your health insurance, or your retirement plan, in about three months, whenever you move to your new institution. You really need to know this. You need to understand how it effects your taxes.” There's so much buy-in from them during that spring of their fourth year. They're able to focus on it too. Like, they're not having to study, you know, basic science anymore. They're able to actually focus on money in a guilt free sort of way.
Dr. Mizell: They don't have to worry about oh, I can't listen to what you're saying because I've got to go finish studying more biochem or whatever. It's a nice blend. The students have loved it. They've gobbled it up. I've been, this spring, will be the fifth year of doing that course.
WCI: Now, when I came out and spoke as a guest lecturer, that was what? The second year.
Dr. Mizell: Yeah.
WCI: The first time I came.
Dr. Mizell: That correct.
Dr. Mizell: Yeah.
WCI: I think this is brilliant. The location and the way this course is run, right? It's run and I'll tell you why, right?
Dr. Mizell: Okay.
WCI: Like you mentioned, it's in the second half of your MS four year. It's the perfect timing. It's just in time training, right? I mean, granted, you're not getting to tell them to don't take out a bunch of student loans, but the truth is, there's not a lot of difference you can make there, once you've chosen your medical school anyway. It's just in time, so as soon as they start, you know, earning money, come July 1st, they've just recently been given all this information. I think that's really great about it.
WCI: I love that it's optional. In that, you know, you didn't have to convince anybody that this is something that had to be put into the curriculum and yet, despite it being optional, what percentage of the class has taken it now?
Dr. Mizell: Well, we started off the first year was about half of the class. We have about 160 students each class. Now, the last three years, we've consistently run about 125 out of 160, so it's about 80% of the students take it, they enroll in it.
WCI: I mean, 80% of them are coming voluntarily, you know? And then, you run it in the evenings, which is pretty awesome because then spouses, and partners can come. You know, it's a little bit less formal and you can get some people coming in from the community to help teach it, and that sort of stuff. I just think it's been super successful, so much so, that when I have people ask about this, how should we get this kind of curriculum into a medical school? I tell them to do it like you do. Do it as an optional class at the, you know, toward the end of the fourth year. Whether you string it out over months, or whether you do it every night for two weeks, you know, I think is just a great, great way to run the class.
WCI: I just wish somebody had given me that in medical school. Of course, if they did, there might not be a White Coat Investor, but you know. Still, you know, wouldn't be great if there was one of those run in every medical school in the country. That'd be pretty awesome. I think that would allow me to step away from the White Coat Investor because it just wouldn't be needed anymore, you know, it'd be great.
Dr. Mizell: I feel like the students have really been very, very receptive to it. One thing, the first couple of years, I didn't require attendance. I was afraid that once I started doing that, that people wouldn't show up because they were really just taking it because it was sort of a freeloader kind of class, where they got a couple of hours credit. But, once I started requiring attendance, the enrollment actually went up. They continue to come even though they know they can't just not show up and still get credit. They do participate, and they ask good questions, and they really are very engaged.
Dr. Mizell: It makes it fun and now our speakers, now we've got a pretty good lineup of speakers that are engaging as well. It's a fun time. I also send out to all of the residency programs, to all the residents and let them know that it's being taught. A lot of them don't know, have never had it. You know, because they came from other medical schools. I have a lot of other residents that show up from random different departments that will come to the talks that are of interest to them, whether it's planning for retirement, or you know, college savings for your kids, or budgeting, or whatever. We do extend it beyond just the medical students. It's not like a closed enrollment. We have a lot of other elective people that show up as well.
WCI: How many hours total is the class?
Dr. Mizell: It takes about 20 hours to cover all the content, but they get two hours worth of credit. They have to have about 30 hours to graduate their senior year. This counts as two hours, but the course is actually 20 content hours.
WCI: Okay. Can you give the listeners some idea of what's covered in the course?
Dr. Mizell: Yeah, sure. It's about 60% personal finance, about 40%, what I call business, but really that's more like practice management stuff. Like, I give two hours of talks on billing and coding. We have somebody that'll come talk about updates in healthcare, and what's happened in the last year. We talk about starting your practice, and creating a practice, like practice metrics. How would you compare this private practice to that private practice. Those are sort of the practice side of it. But then, we do things like insurance, like auto, and home, and disability insurance. We do budgeting. Sarah Catherine comes for a couple of hours and talks about budgeting and debt reduction.
Dr. Mizell: One of the things I really like is our student loan people come. I tell all the students beforehand, they have to bring their computers, and already do all their log on information. We have one to one and a half hours just devoted to student loans. Students come, they log into their account. They go through and they really see the effects of repay vs paye vs IBR, and different things. They leave that lecture knowing exactly what they should do, and when they should do, you know, whenever they start looking at their student loans. We can talk to them about, you know, PSLF and things like that.
Dr. Mizell: It helps them leave these lectures with a plan. You know, they're not having all these concerns, and worries, but they can finish up knowing, okay, I've got it set. I know what I'm supposed to do. I'm not having to rely on myself, or go find someone randomly on the internet, but we've got people that tell them what they need to know. We talk about taxes, and estate planning, and stuff like that. Those are the general topics.
WCI: You published on this topic. This isn't the easiest topic to, you know, certainly get CME credit for at a conference. I know that having tried to run my own. You know, it's maybe not as respected in the academic fields as some other more medical, more you know, more health specific topics. Tell us about the process of publishing on personal finance, and investing, and how you were able to do that, and any difficulties you might have run into there.
Dr. Mizell: You're right. That has been difficult because the niche for undergraduate publications for finance education is a very small niche. If you try to go toward an educational journal, that's difficult because they're going to have a lot of very strong educational rigor to try to grade your paper. This course is not a very rigorous educational sort of course. We have a lot freedom, and we have general objectives for the talks. A lot of times, the talks will take a different turn. You know, students will start asking questions. They'll get all off track, but it's fine with me. I don't care. I just want them to learn what they want to learn and get their questions answered.
Dr. Mizell: So, to being very specific with the content is hard. It can look sort of educationally not so sound. But then, it's not a surgery thing anymore, so I can't do my surgical education journals. Undergraduate journals, like medical teacher, and some of the other ones, teaching and learning in medical, things like that. Those are pretty strong journals and it's hard to get published in there. It's been hard to find places to land these papers. What I typically do is, there have been a lot of studies showing the need, but there have not been very many papers showing the fix.
Dr. Mizell: What I've done is when I try to find journals that have published papers on the need, I'll say look, this is my curriculum that I did. This is the fix for that problem that you mentioned last year in that other paper by so and so. That's actually what I did to publish the four years of this curriculum. It will come out in January, it'll be in print in January. That journal was the Journal of Medical Practice Management. That's kind of a weird journal to be publishing educational curricula in. But, that's where it landed because they had several papers that said, you know, this is a big need.
Dr. Mizell: It's been a little tricky, but I think what a lot of people have done is set the stage over the last, particularly year to two years. I think it probably will be a little easier going forward for other people that may want to publish information on their curriculum because there's definitely more of a documented need than there was when I started doing this in 2012.
WCI: What journal was that first paper published in?
Dr. Mizell: It's a surgical education journal, Journal of Surgical Education, JSE. That one was surgery specific, it was surgery residence. But then, now this new one is more broad, Journal of Medical Practice Management. For a lot of other disciplines, you know, pediatrics, or whatever, there are most disciplines have an education journal that it will be able to be published in, but when you try to broaden it out to all medical students, it gets a little more tricky.
WCI: Very cool. We'll put a link to that journal and that article in the podcast notes, so be sure to check that out if you want to see it.
Dr. Mizell: Okay.
WCI: I mean, your publishing on it, is this now your main academic niche or is this kind of a secondary niche for you?
Dr. Mizell: Yeah, I would say it's my main for academics. I'm pretty involved in our colorectal society. Oddly enough, it's been an interesting blend there as I … like last year I was on the program committee for our national colorectal meetings. I'm doing a lot of, you know, stuff there and basic science. And then, clinical science for colorectal and surgery. But, because I was on the program committee, I offered it up to the president, to the chair about doing a financial planning for the colorectal surgeon. They said, “Sure. We've never had that at our national meeting.” I was able to have an hour and a half of time at our national meeting.
Dr. Mizell: People are beginning to notice me a little bit, even in my clinical arena for talking about practice management. I'm going this weekend to a resident and fellows colorectal course and talking about personal finance. I'm getting a few of those calls now. As far as publications, yeah, it really isn't. We're doing more and more things here. An honors and finance track, and an interest group, and stuff to really become even more invested here at UAMS. Yeah, as far as publications go, it's really my main focus. This paper coming out, I'm really glad to finally get it out of fours years of data so I can really show that what we've been doing is leading to measurable behavioral changes, because we've had a lot of those as well.
WCI: It's wonderful to see the topic hit in these big national meetings. Just earlier this month I was at the American College of Emergency Physicians Scientific Assembly, which is the biggest meeting in our specialty.
Dr. Mizell: Okay.
WCI: I gave a 25 minute lecture and then was part of an hour long lecture on finance. It's great to see it. I mean, obviously, it's never going to be a main topic there and it shouldn't be, but it's nice to see it in a big meeting, you know, having an hour or two dedicated to it, it doesn't seem like too much to ask, to me.
Dr. Mizell: Absolutely.
WCI: That's great.
Dr. Mizell: It is very well attended. It's so rarely talked about. We had a lot of people at the talk. It went really well, and got a lot good questions. That's really where, as you know, you start getting questions where you realize, wow, there are people that are really in a bad place, you know, with their personal finances. They really just need some help, you know, and some good guidance, and have just made some bad decisions. That's really where your eyes get opened quite a bit to the current status of things.
WCI: I mean, you're a published author on this now. Do you feel like your expert on physician finances, and why or why not?
Dr. Mizell: I would say, no, as far as an expert. I mean, I read articles that you guys write, and so many other really good bloggers out there. It doesn't make long, I feel like sometimes, to get in over my head. I learn something every time I read these articles. I really feel like, I had thought at one point about starting a blog, and things, but I really feel like my niche is the education side of it, and delivering the content, and the assessment of it. That's really where I've tried to focus. I wouldn't say … I mean, I don't have a masters in education or anything, so even my ability, per se, to develop educational content is not amazing.
Dr. Mizell: I really feel like one of the things I do well is I try to have a fairly jargon free lecture every time. Even though the people that we're talking to are so smart, I mean they're med students, and residents, and faculty. They just have have so much potential and such good brains. Everybody just assumes that they know, you know, everything there is to know about finances because they're smart people. And so, they say a lot of fancy terms. They get us lost.
Dr. Mizell: When I give talks, I really try to make sure that I give them very basic and make sure that the learner is really able to leave there with a good grasp of finance, rather than going to a lecture where they hear a lot of terms that are totally over their head, but they just have never been exposed to them, so they don't know them. I wouldn't say I'm a finance expert, but I feel like I've got a decent grasp on the current status of where learners are. I'm trying to do as much as I can to try help meet them where they are and bring them up to speed.
WCI: What do you have planned for the future?
Dr. Mizell: Right now, I'm working on getting our, like I said, we have a finance interest group that we started here. What we did is we expanded that to our college of nursing, and our college of, our dental school, and our physical therapy, or sorry, our physician assistant group here. And trying to incorporate the topics that we give to other disciplines in our professional education. I'm working on establishing that. We have this weird investment game that we came up with. We came up like a $100,000 hypothetical dollars and so we've got this competition going on where we are teaching the students about investing, and what that means, and what it looks like. Right now, I think I'm in like eight place on my rate of return, but it's a fun little game.
WCI: Hopefully, nobody goes, you know, double leverage bitcoin, you know, that's the problem with those contests. They're so short, it's almost like rolling the dice, you know?
Dr. Mizell: That right. The interest group has been fun. We're getting that going. We've started this honors in finance track, where incoming first year medical students can enter into it. I've got this whole curriculum for them for each of the four years. When they graduate they'll have an honors in finance on their diploma so that they can show that they've put in some time. There's a lot of projects and objects and things associated with that track. Really just, future plans are developing that track a little more fully, the interest group, and then you know, getting the paper out was huge.
Dr. Mizell: What I've done is taken the next step beyond that. I have all the data right now, but I haven't crunched it yet. Ultimately, what I want to do is I've surveyed about 150 of our … I've got 150 responses on our alumni, and previous graduates from UAMS. I'm breaking them out into two groups. The ones that took my business course and then ones that did not. I'm trying to now measure and see whether or not the course has like made a real difference in their financial status, and see if the ones who took the course are saving more, or have less debt, or less credit card debt, or whatever.
Dr. Mizell: I have that information. I'd like to publish it because really behavioral change is really the goal of any education, you know? If I can show that really educating the students on this finance stuff really helps them become less stressed, and more financially stable, then that's really where the heart of the issue is. The resident wellness piece and financial wellness is so clutch. That's what I'm trying to prove now, or discover if it's making a difference.
WCI: That sounds like a tricky study. Lots of confounding variables there.
Dr. Mizell: Yes. It is, it is.
WCI: That's going to be tough.
Dr. Mizell: That's the caveat with all this. You know, you're kind of looking at a self selected group of students who are really interesting in finance and are probably going to therefore, be better at it. So, is it just because they're interested in and read about it more, or did the course actually make a difference, or whatever? There are some confounding factors there. Just trying to see if what we're doing is making some improvements and if so, where?
WCI: Yeah, that's great. It's great to get the data out there, even if everyone's going to scream correlation is not causation.
Dr. Mizell: Absolutely. You know it's coming.
WCI: What advice do you have for another academic doc, at another institution who wants to either start a curriculum, or publish on this topic?
Dr. Mizell: For academic folks, it's been really great. It's been a nice niche. It's so still under developed, and untapped market that there's still a lot of room there, and a huge, huge need. I had a chairman at a college of medicine that's been very friendly toward me and given me a lot of room to develop this. There are other universities, unfortunately, that just won't give their faculty that kind of exposure and ability. But still though, even with that, I would say just do what you can. I mean, a little education, and a little lecture here and there, is better than nothing.
Dr. Mizell: Don't get too frustrated or overwhelmed if you're not able to come up with a 20-hour course. I mean, my started pretty small and then it developed into what it is. I had to start somewhere. I utilized the resources around me. In the back of my mind, I was thinking well, I have to be an expert in all these different areas, and make sure that I know the answer to all these student questions. But really, what I did is I found the people who were really good experts, and allowed to be the ones to give the talks. I just helped organize them, and encourage them, and show our college of medicine that it was unbiased, and really kind of pave the way.
Dr. Mizell: You don't have to be an expert. You don't have to come up with a monster huge curriculum to start off. You just start chipping away. As you are able to show that your learners are enjoying it, and they're learning, and they're supportive, then you can take that to administration and say, “Look, I've got people here that really need it. They want it. You can use your learners to drive the influence with administration and start, you know, breaking down walls, and you just make yourself available. I send an email to our medicine department recently and said, “Hey, I've been giving talks on business in medicine. Are you interested?” They said sure. I've got that lined up.
Dr. Mizell: You do have to throw yourself out there a little bit. I've lectured to pretty much residency program on campus now about it. I'm starting to get asked back from year to year. You just learn. Every time I give a talk, I learn more, and constantly read, what you guys right and stuff like that. It's really just aim small and then just see what doors open and kind of go from there.
WCI: Yeah, the thing I love about what you're doing is that it's actually financially viable. For you to give lectures to other residency programs at your institution is very easy for you to do. You know, you've kind of got the lecture already prepared. Maybe you have to look over it a little bit. You don't have to travel far to give it. You don't have to take a bunch of clinical time off. It's very easy to do. Whereas, trying to bring somebody like me from Utah to Arkansas to give a talk, and you start going man, I'm missing a day of work here. I'm going to miss a day tomorrow traveling back, maybe a day preparing the lecture. You know, you got to pay me, you know, some four-figure amount to make it even cover my clinical time to come out there and do it.
Dr. Mizell: Right.
WCI: If there was one person like you at every academic institution in the country, you know, this gets out there very, very quickly. I think that's pretty awesome. I don't think it's that hard to do. There's certainly somebody interested in it at every one of those institutions. I just want to support those who are, you know, considering doing this sort of thing. As you can see, you don't have to be an expert. The first time you end your lecture and go to questions, you'll realize, oh my goodness, I've got this.
Dr. Mizell: You're right.
WCI: Just because the questions are such a basic level. You're worried you're going to be interacting with people that are leaving comments on the White Coat Investor blog, but you're not. You're interacting with people that have never read a finance book whatsoever. They don't follow a blog. They don't, you know, their questions are very, very basic. And so, you really don't have to be a complete expert to make a big difference in a lot of people's lives.
Dr. Mizell: Yeah, you're exactly right. Your point about it being very financially viable is totally correct. I mean, in an academic institution. I don't anything about writing, you know, big grants, or doing basic science research, or setting up a lab, but when I came to my chairman and said, you know, what I wanted to do, it cost nothing. You know, except of the audio video to record the lectures. For an early academic career, it was able to get going very quickly. That was great. Even now, my business of medicine course is still very, very low cost.
Dr. Mizell: My speakers are all volunteer their time because they like it. It looks good on their resumes. They know that potentially, downstream, whenever a resident or an early faculty needs to set up a will and trust, then they'll email me, which happens now pretty often and they say, “Hey, who's that lady that gave us the talk on will and trust?” And so, then I'll kick it back to them. They know that's a possibility. They give the talks for free, unless you have a guest speaker, you can get people from your community that usually will just, you know, goodness of their heart, will just volunteer their time. It's easy to get it going, so that's really nice.
WCI: Very cool. It's been wonderful having you on. Our time's starting to get a little bit short, so I think we probably ought of wrap this up. Is there anything else, now that you've got the ear of, I don't know how many people are going to download this podcast, ten or 15,000 people. You got ten or 15,000 people out there interested in physician personal financing and investing, what is your message to them?
Dr. Mizell: It's such a huge need. I would say just continue up the good fight. I mean, there's so many good resources now with blogs and things that are supportive of us on the academic side. Just to get going, and to be kind and considerate to the students or residents, knowing that this is a huge need that is kind of taboo. People don't like to talk about, but to still fight in there, and get them, and let them know that you're trying to help them navigate these early very scary waters.
Dr. Mizell: Like I said, it's such a huge need that you can do a lot good with not a whole lot of effort because so many of these residents, and medical students are really quite scared. They're in a bad financial place and can use a lot of help. I have made a lot of good resident, and student friends because they come to me, and really have some scary concerns, and I'm able to just give them some advice, put their mind at ease, and give them a plan. It's huge for them. On a personal wellness basis, or standpoint, it's great. Keep up the good work, and just fight the good fight. It's fun.
WCI: Dr. Jason Mizell. Thank you so much for what you're doing, and for being on the White Coat Investor podcast.
Dr. Mizell: Thank you for the opportunity. It's been fun. I appreciate it.
WCI: Wasn't that wonderful having Jason on. He's such a saint in this realm, right? I mean, here I am going, I don't want to do this unless I can make a buck doing it. He's doing it basically for free. You know, he's out there educating hundreds and hundreds of people, and trying to help them get a fair shake on Wall Street. I think it's wonderful what he's been doing.
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WCI: Please do go to iTunes, and give us a five star rating, though. That helps others to actually find the podcast, and to be able to get this information so they can apply it in their lives. This episode was sponsored by Adam Grossman of Mayport Wealth Management. Adam is a Boston based advisor and works with physicians across the country. Unless most only advisors, Adam offers straightforward, flat fees for both standalone financial planning and investment management. Whatever stage you're at in your career, Adam can help you get organized with a personalized financial plan, and help you implement it with a low cost index fund portfolio.
WCI: Adam is a CFA Charter holder and received his MBA from MIT, but more importantly, you'll benefit from Adam's own personal experience with many of the same financial obstacles, and opportunities that face physicians. To learn more, visit Adam's website, mayport.com/whitecoat to download a free eBook, especially for physicians. Head up, shoulders back, you've got this. We can help. See you next time on the White Coat Investor Podcast.
Disclaimer: My dad, your host, Dr. Dahle is a practicing emergency physician, blogger, author, and podcaster. He's not a licensed accountant, attorney, or financial advisor, so this podcast is for your entertainment and information only. It should not be considered official personalized financial advice.