Our guest today on The White Coat Investor podcast is Dr. Josh Daily. He's a pediatric cardiologist who recently was diagnosed with a brain tumor. He wanted to share his experience of walking the path from diagnosis to healing. He shares his wisdom on how to prepare financially for the unexpected, including what he wishes he would have done differently. He also talks about the importance of cultivating relationships and making the most of life because you never know when your life will change.


Upbringing and Money 

Let's start at the beginning, so people can get to know you a little bit better. Tell us about your upbringing and what it taught you about money.

“I grew up here in Arkansas, middle-class family. My father was a pastor. We had plenty of money for food and clothes but not a lot more beyond that. From an early age, I learned the value of living within your means and limiting debt. We used the old envelope system. I remember we would go to the bank once a month and had all our envelopes and used all cash and we didn't buy anything we couldn't afford, and we didn't have any debt other than the mortgage. I grew up very much in that atmosphere. I'm a natural saver in addition to that, and that has served me well.

What I didn't learn is anything about investing, anything about insurance. I didn't know what a mutual fund is. Certainly, I didn't know what an index mutual fund is. And it wasn't until, really, fellowship that I kind of delved into that area. Then I jumped in since that point and have become very interested to read almost everything on the blog and now give regular lectures to medical students and residents and fellows and other faculty members, and I really enjoy the topic a lot.”

All in, a true White Coat Investor. Tell us a little bit about your education, training, and your career to this point.

“I grew up in Arkansas. I did undergraduate education with a degree in physics here and then did medical school here. I decided I wanted to be a pediatric cardiologist and went to Cincinnati Children's for both residency and then fellowship, was there for six years, and then came back to Arkansas a little over seven years ago. I am probably in my eighth year as faculty since coming back. During that time, I also got a master's in education. I realized I really enjoyed teaching and wanted to have formal training in that area. Since that point, I was initially the associate fellowship program director and now fellowship program director of Arkansas Children's.”

Let’s get to the reason why we brought you on the podcast today, Josh. It's not the happiest reason in the world, but last December, you developed a serious medical issue. Can you tell us about it?

 

Receiving Diagnosis of Craniopharyngioma

“At the time, I had a lot going on in my life. We had recently moved into a new home. I additionally had my fourth child, and at that time, I had four young kids, two under 2. In the midst of all of that, I found that I was tired frequently. We'd get the kids down, and I would just feel like I needed to go to bed. Additionally, I gained some weight, which was frustrating, but I attributed it all to having a fourth child, being up a lot at night with a baby, and just a busy life. I finally saw my PCP late November, and we did some screening labs. My testosterone level came back extremely low. The rest of my labs overall looked OK. At that point, the PCP wanted to start me on testosterone therapy and thought it was primary hypogonadism and didn't do additional investigation.

I did a lot of reading and talked to a friend of mine who happened to run a testosterone clinic, and he really encouraged me to do some additional investigation. He sent some additional labs and my FSH and LH came back very low, indicating it was a central process. At that point, I tried to get an outpatient MRI. It was in the midst of COVID. They were way backed up, and they were scheduling two months out for MRIs, which was somewhat frustrating. Meanwhile, I'd had two episodes of fairly intense headaches—one of which was in the context of a viral illness, so I attributed it to that—and the second was after a COVID booster. So of course, I attributed it to that. Finally, one evening, I had the worst headache of my life. It kept me up throughout the night, and I was vomiting. I was in med school. I know enough about the red flags. The next morning, I went to our local ED. I called a friend of mine who's an ED doc. The resident got me in quickly and got the MRI ordered. I got a little bit of pushback, but eventually got the MRI later that afternoon and found out I had a brain tumor and I had about a 2 1/2 by 3-centimeter mass in my third ventricle, extending from my pituitary into my hypothalamus and compressing my optic chiasm.

I was admitted to the neurosurgery team and basically had my whole body scanned as well as a lumbar puncture. They sent all the tumor markers as well as a variety of labs. The radiologist and the neurosurgery team thought it was initially a germinoma, and we discussed proceeding with radiation therapy, which is apparently basically the way to treat that. But we decided to wait. I ended up being discharged from the hospital, and I basically called everybody I knew with expertise in this area. Luckily, I had multiple friends who were neuroradiologists, and they all looked to the scans and concluded that the original team had drawn a wrong conclusion. This was not a germinoma. It was something called a craniopharyngioma, which maybe I learned about in med school, but I didn't remember. I quickly read everything I could get my hands on about craniopharyngiomas. While they're not cancerous, they're typically in a very high-risk location. They're associated with a lot of morbidity.

I ended up going back and seeing the original neurosurgeon to discuss options. I got multiple second opinions from large academic centers and had very conflicting recommendations that were made, from proceeding with a high risk biopsy—which in and of itself, would've been high risk based on its location—to proceeding with total resection, knowing that there was a very high risk that I would be panhypopituitarism afterward with almost a 100% risk of having diabetes and hepatitis, as well as risk of damage to the optic chiasm or hypothalamic injury, which can be devastating. That was vs. considering a newer treatment using something called BRAF inhibitors, which I knew nothing about before all this. But it's basically a kind of chemotherapy. It was just really an investigational stage. I got multiple recommendations, and they were all conflicting. There wasn't a consensus. I did literature review. There hasn't been a lot that's been published recently. I also struggled with the fact that there's not public reporting of data in the field of neurosurgery, which is very different than my field in congenital heart surgery.

I'm reliant on a neurosurgeon who says, ‘Oh yeah, I've done a couple of these a year. Yeah. My outcomes are good. Oh, there's about a 50% chance that you'll have DI afterwards,' and it's based entirely on their bias. There's really no way to verify that. It's a very difficult decision to make. After a lot of prayer and consideration, we picked a neurosurgeon who decided to proceed with total resection, recognizing the risk for morbidity, in particular, and some risk for mortality. I underwent surgery February 2 of this year. The bottom line is I had a great result. He got the entirety of the tumor. He preserved my hypothalamus. There was no damage to optic chiasm, and I had no additional pituitary dysfunction afterward. I was on testosterone, Synthroid, but I have developed no DI whatsoever, which I was fully anticipating having DI likely the rest of my life.

The first couple weeks after surgery were a little rocky, I was very uncomfortable. But overall, the outcome was excellent. I did have a third nerve palsy, which basically meant that I could only slightly open my right eyelid. As we all learned in med school, my eye was fixed down and out. So, I had double vision. That has since almost entirely recovered, and now I'm basically back to normal at this point.”

That is an awesome outcome. I’m super happy to hear about that. Let's go back to that afternoon or evening in the ED. You went over to MRI, you came back, you sat there for 45 minutes. The emergency doc walked in, sat down on that little black rollie stool and said, “Josh, I hate to give you this news, but you've got something growing in your head.” What were the first things that went through your mind when you heard that news?

“Mostly fear. I just felt really afraid. Confusion, shock. In spite of all the signs being there, I think in the back of my mind, I thought, ‘Oh, that's not really what's going on. This is probably something else.' But to be confronted with a reality, I had a brain tumor, what all that may mean, a lot of confusion in particular that they didn't know what it was with certainty and there wasn't a clear course forward. There was a strong emotional response, but, in the moment, I recognized while there was a time to process it emotionally, that was not the time, because I needed to be fully engaged and make sure the diagnosis was correct and the treatment was appropriate and that I was taking the best path forward.

But over the next few months, I had a lot of time. It was about a seven-week period from diagnosis to surgery. While the initial focus was entirely on making sure I got the right diagnosis and making the best decision, toward the latter part of that, I was able to take some time, really process what this meant for me, what this meant for my family, what this meant for my future. There was a lot of processing all of those emotions during that time.”

More information here:

Make Sure to Lower Your Financial Blinders

 

Life Insurance — Did He Have Enough? 

You are a White Coat Investor by any definition of the word. You've got your financial knowledge. You've put plans in place. You actually teach this stuff. You wanted to come on the podcast to talk a little bit about the finances of your family and how they changed and things you thought about and maybe wish you'd done in the past before this happened. So, like most people you want to make sure your family is fine should something happen to you. Looking back on your previous planning, what did you do right? What did you do wrong?

“During that six- or seven-week period between diagnosis and surgery, I had time to sit down, review the finances, develop a specific financial plan for this scenario—while we had an overarching financial plan for our family—and then go over everything with my wife. As you mentioned, there were some things that I'd put in place that I was so grateful I had. Another is a regret, where I wish I had prepared in a little bit different way.

First, I recognized that, as is often the case within families, there’s one spouse that does most of the finances, and that was me and I was very interested in it and managed it all. My wife didn't necessarily know where our accounts were or passwords or user names. There was a lot of logistics in terms of arranging all that and making sure she was up to speed with where all our accounts were and how she should manage them. I had life insurance and I'm very grateful I did, but I wished I had purchased more. I had about a $1.5 million policy and then another $50,000 policy that was through work that was free. At the time I'd originally purchased those, I think it was a reasonable amount for our family, but in the interim, my family had grown and now had four young kids. We had a new house that was more expensive, and our cost of living had increased. Once I actually got into the details of what it would take for my wife to stay at home and raise four kids and continue that standard of living, the $1.5 million wasn't going to cut it. And that was a little disheartening at the time.

One of the things I discovered that I didn't really understand on the front end is the benefit of Social Security survivorship benefits, which in my case are very substantial. Basically, the way those work is for minor children. They will receive about, in my case, $2,300 a month until they turn 18. Then, for a surviving spouse who's caring for a minor child at age of 16, she would receive $2,300. That’s capped at around $5,300 a year, but that works out to about $64,000 a year that they'd get. And in our case, because I had a brand-new baby and had four kids at home, my wife would get almost the entirety of that for the next 16 years and some of it for the next 18 years. That, when combined with my term life policy, would allow them to maintain a lot of the things we'd done, although some adjustments would be necessary, as well.

In addition to that, I recognized that while purchasing term life insurance, I was primarily thinking in terms of replacing my income. There's a lot of other things my wife would have to replace if I died. One, she'd be a single parent. And while she does stay at home at the moment, I provide a lot of childcare and we parent together, and there would be costs associated with her getting help to do that. Secondly, I manage our finances entirely and, as you know, good financial advice is expensive. I had to arrange for experts to help my wife, in the scenario in which I died, to manage all that. It comes with a cost. Plus, all the different expenses associated with maintaining a home and a lot of other tasks I did that would ultimately need to be replaced financially. I needed to replace more than just my income for her to maintain the same standard of living. I hadn't thought through that well on the front end. I had a vague sense of it but hadn't really done the numbers, especially recently. We had to make a few cutbacks in the scenario in which I would die, but ultimately, they could keep the home and keep our school the same way we'd planned on doing it for our kids and keep a lot of things in place, but cut back in a few other areas. I wish I had enough that I could have just said, ‘You don't need to worry about this, keep all this the same. You're going to have more than enough.' But that wasn't the case, unfortunately.”

How much do you wish you had when you finally ran the numbers after your diagnosis? I mean, you had $1.5 million. Do you wish you had $2, 3, 5 million?

“Well, obviously in that higher situation, I would've bought a lot if someone would've sold it to me. I wish I'd had probably in the neighborhood of $3 million. Our net worth at the time was about $1.1 million. That, combined with the net worth and the survivorship benefits, would've given her tremendous freedom. With a lot of margin built in, which in a very stressful environment, and her raising four kids, I would've liked for her not to have to worry about money at all.

I'm not eligible to purchase that now, given that I just had a brain tumor resected. I do have the ability to purchase an additional $500,000 of life insurance through my work once a year. I tried to do that at the time of the diagnosis, but it wasn't the one month of the year where you can do that. I intend to do that this year, and I may make further adjustments in the future when I am eligible to get term life insurance again.”

Have you talked to an agent about it? When do they think you may qualify to buy more?

“I've had some initial conversations and I had a lot of conversations right after the diagnosis to figure out if there's any way I could. Basically, there wasn't a clear path forward at that time. You may have more expertise in this than I did. What I was told is each policy has a little bit different criteria but certainly not in the first year after a resection. There's no way I'd qualify with any reasonable positive health status.”

Five years is what I've heard thrown around in the past, but I'm not an agent. This is something I'd take to an agent and have them shop you around informally and ask. Because in one company, it may be one year and another company might be three and another one might be five. It's highly variable.

More information here: 

How to Buy Life Insurance

 

Disability Insurance

Enough about life insurance. Let's talk about disability insurance. What role has disability insurance played in your life in the last year and do you expect it to play going forward?

“My risk of disability is much greater than my risk of death, especially with the type of tumor this was. In particular, the risk of blindness. I'm a diagnostic cardiologist. I look at echoes all day, and so I would've been disabled had that happened. I have a policy from Standard, own occupation, that would replace 60% of my income post tax. I know you have had multiple guests that have come on that talked about disability insurance extensively recently. My policy overall aligns with what a lot of your recommended advisors would recommend. I didn't think about that as much on the front end because I knew it was there. But I did wrestle a little bit on the back end. I had a third nerve palsy, and I basically could use one eye, up until a few months ago.

Binocular vision is probably important to what I do, but I could probably do it with one eye. I did some research informally, and I got in to see an ophthalmologist as quickly as I could—not because I was hopeful that they recommend that I do something different. I know the literature—you give it time to recover—but I wanted it clearly documented how pronounced my third nerve palsy was. Then it was right after surgery with a clear start date. I wanted all that clearly in my medical charts. Now that being said, it's recovered entirely, and I was able to get back. I did my job with one eye, and overall, I think I did fine. If I was left with a single eye, I probably would've been able to practice with a few little modifications, but overall I think it wouldn't have impacted my practice considerably.”

Did you miss any significant amount of work? Did you put in a disability insurance claim this year?

“I didn't. I work at an academic institution, and I had four plus months of sick leave built up and plus a lot of vacation time. I ended up being out for two months, and I still have multiple months of sick leave built up. I was paid fully, and it wasn't a big deal at all. My disability insurance policy would kick in after six months. I obviously never reached that point. We have a large emergency fund that we built up to a point that we would have been fine for six months with no income coming in.”

What do you think at this point about your job choice? Not your career, but your job choice. You're an academician, you're working for a big medical center that has all these fancy paid time off benefits and stuff that a lot of people in private practice don't have. What are your thoughts on that now that you've kind of had to take advantage of some of those benefits?

“One, I'm very grateful for them obviously, and there are pros and cons of being in private practice vs. in academics. This is one of the benefits of being at a large academic center. I work with a large group. We're the only pediatric cardiology group in the state. We have enough of us that my time out was able to be covered by my colleagues. It makes me very grateful for those I work with, and I didn't have to worry about income during that time. I had so much sick leave built up. I had an excellent health insurance policy with, really, a minimal amount out of pocket that I ended up having to pay when was all said and done. I was very grateful for that. I can’t imagine if I'd been in private practice, and all of a sudden, the revenue stopped coming in and I'm still trying to pay people's salary. How challenging that would've been on top of so many other things. While that's not the reason I chose an academic career, it's one of the significant benefits, certainly.”

More information here: 

Disability vs. Life Insurance 

 

Social Security Survivorship Benefits 

Now, you talked a little bit earlier about Social Security survival benefits. And you learned a lot about this in the process, especially when you realized maybe you're a little underinsured with the term life insurance. Tell us how those are calculated and what you had to do to qualify for those.

“Anyone can actually log into the Social Security website and see exactly what their benefits will be. Basically, if you paid at least 10 years’ worth in Social Security, then your children are eligible for survivorship benefits. If you're young enough, it can even be less than that, the way they do the calculation. It's a far more significant amount than I understood. While I don't understand the entirety of the calculation, I know exactly what my numbers would be, which is far more applicable obviously in my situation. Basically, $64,000 a year for the next 16 years for my life on top of the term life insurance would make her maintaining our standard of living so much more doable. It was an unexpected blessing in the midst of a difficult time once I realized how much she'd end up getting.”

In your calculation, you came up with, what would you say—$64,000 a year?

“Yes, basically for the next 16 years. Then, it would drop a little bit for two more years and a little bit more for a couple years. Because minors get it if they're under 18 and then my wife would get it if she's taking care of one of my children under 16. It caps out at about $5,300 a year.”

As I'm talking to you, I'm logging into the Social Security website because I'm curious what mine is. I know I did a post on this a few years ago, but I'm very curious. This isn't hard to do if you have your Social Security login. If you don't, you should get that. But you get a statement every year and if you go in there, you log in, they send you a text because it's got two-factor authentication. The first line in My Social Security is, “Your Most Recent Statement.” I click on it, then I click on the link, “Your Social Security Statement,” and it pops up.

I look at this and it says “Retirement Benefits.” It says if I retire at 70, I'll get $4,200 a month assuming I work the same from now until I retire. It says my disability benefits, if I got disabled, would be $3,041 a month. My “Survivors Benefits” says I have earned enough credits for eligible family members to receive survivor benefits. If I die this year, members of my family who may qualify for monthly benefits include a minor child: $2,337. Spouse if caring for a disabled child or child younger than age 16: $2,337. Spouse, if benefits start at full retirement age and total family benefits cannot be more than $5,455. That's presumably what I'd get with all the kids I've got. Multiply that by 12, and we're at about what you have. I think it's about $65,000. That is not insignificant. I mean, to get that from a portfolio, we're talking about a $1.5 million portfolio to generate that sort of a withdrawal rate at a 4% withdrawal. In some respects, that's more valuable than your nest egg was at the time.

More information here:

A Widow’s Financial Plan

Preparing for Tragedy: Ensuring Your Partner Can Manage Without You

 

Blended Families and Death Benefits 

You've published a post on The White Coat Investor about the finances of divorce in the past. I understand you now have a blended family. Tell us a little bit about how that played into all of this.

“That was one of the more difficult aspects of navigating this. I was divorced over five years ago and have since remarried and have two children from my prior relationship and then two little girls now with my wife. I have full custody. All four kids live with us all the time. It gets really tricky in the scenario in which I die. Because as the law is written, step-parents have very few legal rights. One of the things that we had to do is, a few years ago, we had met with a state attorney and had a really complex plan in place based around this. We revisited that and made sure everything was aligned. But my desire that the children, my two eldest, stay with my wife in the event of my death was made as clear as possible. Then I tied as much as I possibly could financially to that happening.

The last thing I wanted to do is have this big financial incentive for someone else to try to get custody of my kids. We structured things in a way that would minimize the likelihood of that happening and made it as clear as possible what we wanted to have happen. But it was difficult. I still vividly remember that first night in the hospital when I was diagnosed. I was there by myself and my wife was at home with the kids. She came and saw me, went back home, then told our kids some of it. Then my eldest, who at the time was 10, wanted to FaceTime me. The first question was, ‘Dad, are you going to die?' We talked about that for a little bit. Then the next question was, ‘Dad, what's going to happen to me if you die? Am I going to still live in our house? Am I still going to be part of our family?'

I couldn't say with 100% certainty that that would be the case. We did everything we could to increase the likelihood that that would happen. Obviously I didn't die and I'm still here and that's not an issue at the moment, but it gets really tricky. One of the reasons I wanted to make sure that my wife was financially provided for is I wanted her to be able to do whatever she needed to from a legal perspective, to make sure that she kept the boys. Finances can be very helpful to that end.”

I'm very curious about the details of the estate planning. You may not want to share all of this, but I'm curious how you set that up to disincentivize somebody else getting custody of the kids as much as possible? Did this mean leaving everything to your wife as much as you could? How'd you set that up, essentially?

“Yes. We created a trust and everything is within the trust, and it all goes to my wife and I trust her. It can be tricky in some step-family situations in which you remarry and then the new spouse gets everything at your death and then may not give anything to your kids from a prior marriage. There's a lot of complexity. I fully trust my wife, and she is deeply connected to all of our kids and views them all as her own. I trust her implicitly. In that context, this made the most sense that basically everything went to my wife. I trusted her to take care of the boys. That's the gist of it. There was a little bit more from a legal perspective, but that's the basics of how we structured things.”

 

How Priorities Change After a Diagnosis  

How has this experience changed your priorities and your plans for the future?

“I've given it a lot of thought. In the midst of wrestling with what that may mean for my next season of life, first and foremost, I had a lot of clarity in the midst of, especially in those seven weeks between diagnosis and surgery. It's amazing how a situation like that provides clarity in life in terms of what matters most. At the end of the day, it's relationships. I'm grateful for my job. I get to do meaningful work and help people and I make a good living, but I care far more about my wife and kids than that. I don't intend to structure my life fundamentally differently. I'm a little bit quicker to tell my kids I love them. I'm quicker to tell them the things I admire about them, the good that I see in them and the way I see that manifest in their life. I'm far more intentional about casting a vision for my boys, the kind of men they'll become, and my daughters, the kind of women they'll become. I have those kinds of conversations far more frequently now than I did before. It gives me clarity with regard to making decisions around what I say ‘yes' to and ‘no' to at work. I'm grateful for my job and it aligns well with my current move, my design, the things that are important to me, but I do not want to work more than I work now.

I think I have reasonable balance in work-life integration. But if there's an opportunity to work my way up the ladder but that is going to involve more nights away, then that's pretty clear. That's not worth it to me. Especially at the season of life we're in with four young kids at home and the importance of me being deeply involved and engaged in their lives. From a big-picture perspective, it clarified some priorities that I previously would've articulated if I had, but I think it made it even clear how important that was to me.

From a work perspective, I've actually decided to take some time and think about what I want the rest of my career to look like. I'm working with an executive coach now to wrestle with some of those things. I actually just had a consultation with someone that does aptitude testing and have been tested and reviewed my results in a thoughtful way about what kind of roles would be a good fit for me and what wouldn't. I'm intentionally cultivating some aspects of my job that I think may be meaningful down the road in terms of allowing me to spend more time doing the things that matter most and less time doing the things that just really frustrate me, which every job has. But the more I can minimize those, the better. It was also clear I make plenty of money. I mean, I’ll take a raise if someone gave it to me, but where our family is now, that's not going to meaningfully increase our quality of life. Time is more valuable than money, especially with four young kids at home at the income I make in a low cost of living area. Even if there was the opportunity to make more money in a job that was more demanding, it's simply not worth it with where I'm at now. I see that far more clearly than I did even a year ago.”

I tell a lot of people to live like a resident. Kind of frontload their savings, frontload their financial plan early in their career so that will pay dividends later. I occasionally get pushback, no surprise from doctors who see people dying and becoming disabled early in life. Clearly, there's a balance. You don't want to put off all the fun stuff in your life until you're 60+ because you might not get to 60+. But I'm curious about your perspective of how you think people should balance saving for a comfortable retirement with living in the here and now in case our life ends up being shorter than we expect.

“I fully recognize that there's a balance that can be difficult to discern at times, and both are ultimately important. I am naturally a saver, so I am naturally drawn toward that end of the spectrum. I've had to kind of pull back from that at times. I don't regret at all how much we saved because, while I may have been saving for retirement, that was also money that would've allowed my wife to continue the life that we desired and take care of my kids. It wasn't like that was only money that would allow me to live a comfortable retirement. There were other benefits to that, as well.

As I think about striking that balance, it's not so much ‘Do I spend a lot of money now or save a lot?' Those are obviously different ends of the extreme. There's a spectrum, and you can discern where you live. As I think is clear in the happiness literature, experiences provide more happiness or are more meaningful than our things. I'm a little bit more apt to spend money on experiences, especially experiences that cultivate meaningful relationships in my life. But driving a nice car, I don't really care about and isn't that important. It'd be fun to drive a nicer car for a couple months and then my happiness level would adjust, and I'd be just as happy as I was before. And probably even more frustrated with one of my kids who scratched their name in the side of it with rock. Those kinds of things that we all experience with our kids. I would discourage new physicians from spending a lot of money on luxury items, but I would encourage them to thoughtfully prioritize the money they spend on things that will cultivate the relationships that are most meaningful to them.

For instance, while I am not a huge Disney person, we're doing a trip to Disneyland this year. That's something that's important to my wife and my kids. That's something we made a priority. It's painful for me to see how much it is. I actually have followed some of your advice, and my wife is just paying for it. I know the big picture about how much it'll cost, but I'm not the one actually paying with the credit card. We're going to be fine, but I know how painful that would be that for me to actually be the one paying for every ticket and the hotel and the airline and all of those kinds of things. We are prioritizing those kinds of experiences a little bit more than we would have before, but we're certainly not elevating our standard of living with regard to purchasing things.”

Was there ever a time in those seven weeks between diagnosis and surgery, when you thought, “I should have spent more money on such and such?”

“For life insurance. That's the one thing that I thought I wished I'd spent more money on. I'm not sure that there was anything else. There were relationships that I wished I had prioritized more and some of prioritizing relationships can be associated with spending money in terms of traveling and seeing my brother and my sister who live other places or doing a trip with my dad, doing a fishing trip with him or things like that. But beyond that, I don't know that there's anything else that I wished I had purchased or spent money on.”

 

Prepare for the Unexpected 

Our time is getting short, but what have we not talked about that the 30,000 or 40,000 people that are going to listen to this episode ought to know?

“As I have thought about my experience and really my desire in sharing my story with you is not so much that we get into all the details of Social Security and term life. While I think that's beneficial, my hope is that, in sharing my story, you could put yourself in my shoes and recognize that you may be in great health, life may be going well, but the unexpected certainly can happen. It happened to me, and it happens to our colleagues every single year. And that in doing that, you'd be motivated to really think in a thoughtful way about your life and about your future. First and foremost, that you would prepare for the unexpected from a financial perspective, but also that you would take stock of your life and the things that are most important to you and how you're living your life to this day.

We've all heard the story of Alfred Nobel who read an obituary about him when he was still alive. His brother had died and it was mistaken that the journalist thought that he had died. So, he wrote an obituary about him and about the legacy that he left. He was so impacted by how others perceived him in the legacy he had left with regard to the warfare that he promoted that he obviously created the Nobel Prize and shifted the focus of his life entirely in the next season. I think that kind of experience is really helpful for every one of us. To pretend as though we have a diagnosis, ‘What would I regret? What would I not regret about what I had done? How can I live my life differently in light of that?'

There's actually a book I just finished reading by Daniel Pink, called The Power of Regret, where he actually summarizes all the science behind the process of regret and ways that we can use that to live more meaningful lives, to make better decisions. That’s one of the things I would recommend. But I would encourage all of you to take a moment and think about what if this was you? What if you were in my shoes, what would you regret? What would you not regret? What would you do differently? Then to step back and think about how you want to live your life differently in light of that—both from a financial perspective, but more importantly from the perspective of priorities and relationships in your life.”

Dr. Josh Daily, thank you so much for coming on the podcast. Thank you for what you do in your career as a pediatric cardiologist. Thank you for the financial education you're providing to your peers and trainees. And thanks for coming on the podcast and talking about such a personal experience with us. We really appreciate it and are super happy about the outcome you're experiencing from it.

I hope you enjoyed that interview as much as I did. I'm so happy that Josh is doing so well after that surgery. As you can tell from his comments, it didn't necessarily have to go that well. Thank you to the docs that took care of him. There's a surgeon involved. There's an anesthesiologist. There's a whole bunch of people that consulted for him. Thanks to all of you that helped take such good care of him so we could all benefit from this great episode.

 

Do you ever find yourself wishing there was somewhere to go to ask your finance, insurance or investing questions? The White Coat Investor community is a great place to turn. We have a thriving community across all of our social channels – facebook, twitter, instagram, reddit and our WCI forum. We have been discussing solutions to your money problems since 2011. Join the conversation with thousands of other White Coat Investors. Follow WCI on your favorite social media platform for financial resources, tips and strategies. Just head to your platform of choice and search for the White Coat Investor. 

You can do this and The White Coat Investor can help.

 

Quote of the Day

Randall Bell said,

“If you want to see your future, look where your mind habitually goes when it wanders.”

 

Milestones to Millionaire Podcast

#86 — Multimillionaire OBGYN

This physician has reached an eight-figure net worth by paying off debt early and investing in himself with a surgery center. His advice is to not try to keep up with appearances, pay yourself first, and be the tortoise not the hare. You will win the race. He is clearly financially independent but continues to practice medicine.


Sponsor: WCI Real Estate Opportunities Group

 

Full Transcript

Transcription – WCI – 283

Intro:
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 283 – Preparing financially for the unexpected with Dr. Josh Daily.

Dr. Jim Dahle:

Do you ever find yourself wishing there was somewhere to go to ask your finance, insurance or investing questions? The White Coat Investor community is a great place to turn. We have a thriving community across all of our social channels – facebook, twitter, instagram, reddit and our WCI forum. We have been discussing solutions to your money problems since 2011. Join the conversation with thousands of other White Coat Investors. Follow WCI on your favorite social media platform for financial resources, tips and strategies. Just head to your platform of choice and search for the White Coat Investor. 

You can do this and The White Coat Investor can help.

Dr. Jim Dahle:
Welcome back to the podcast. October is a beautiful month in Utah. I'm not in Utah as you listen to this. I'm actually in Croatia. I hope I'm having a great time, but as we record it, I'm definitely here in Utah. It's actually September 8th. This doesn't drop for a full month. So, if there's anything we say in this episode that seems completely behind the times because there's some meltdown in the last month, that's why.

Dr. Jim Dahle:
We actually did have that happen in the beginning of the pandemic. People were like, “Why aren't you mentioning anything?” And it was because we'd recorded everything a couple of weeks earlier.

Dr. Jim Dahle:
But anyway, our quote of the day today comes from Randall Bell. “If you want to see your future, look where your mind habitually goes when it wanders.” There's a lot of truth to that.

Dr. Jim Dahle:
Thanks to all of you out there in listener land for what you do. We appreciate you supporting the White Coat Investor mission and helping promoting financial literacy with your peers. But we also appreciate your day-to-day work. I know it's difficult and if no one said thanks today, let me be the first.

Dr. Jim Dahle:
All right, it is now October 6th, as you're listening to this or the next few days afterward. There is something huge happening in the next week that you should be aware of. We're going to open registration to WCICON23.

Dr. Jim Dahle:
Now we've done a number of these. We did one in Park City. It sold out in six days. We did one a couple of years later in Las Vegas. It sold out in 23 hours. Then the pandemic hit. We did a virtual one in 2021. And then in 2022, we went to Phoenix and had a wonderful event. Really a fantastic venue down there in Phoenix. This is a venue at the Desert Ridge JW Marriott there in Northeastern Phoenix, just north of Scottsdale.

Dr. Jim Dahle:
And we're going to go back there this year. We did not actually sell out last year, mostly because the pandemic was still going strong when we were doing registration. But we've decided to keep pricing, at least for those of you who buy at the early bird period exactly the same as last year.

Dr. Jim Dahle:
And so, despite the fact that everything else in your life has gone up 10% in price or more, if we're talking about gas and groceries, this conference costs you exactly the same as it did a year ago. And so, if you want to register for that, the time to do so, if you want to be sure you're able to come, is October 10th at 7:00 PM Mountain.

Dr. Jim Dahle:
Now, I don't know. Maybe this thing sells out in 12 minutes. I have no idea. That's great if it does. It's also great if it takes a while to sell out because then you can buy all the way up until a conference starts. But for what I suspect is going to happen, I suspect that this year is probably going to sell out at least in person.

Dr. Jim Dahle:
And so, the virtual option will still be available all the way through the conference. But if you want to come in person, I would suggest registering early. Not only do you get a much better price, but you're insured that you're going to get to go.

Dr. Jim Dahle:
And the place to sign up for all this is at www.wcievents.com. All the information about the conference is already up there. You can go check it out. You can even register to get a reminder to register when the conference registration opens on October 10th at 7:00 PM.

Dr. Jim Dahle:
We've got lots of great options there. We're going to keep that premium option that we had last year that gives you premium seating. You get to come to a special reception with all the speakers. You get a special item in your swag bag. It's really cool to do the premium thing. We have a limited number of those, but we also have the regular general admission.

Dr. Jim Dahle:
We're going to do a spouse or partner add on as well. And this year is actually going to offer more. You're going to be able to come, or your spouse is going to be able to come to a couple of mornings of workshops as well as go to all the keynote talks and also, come to all the meals, the lunches and stuff.

Dr. Jim Dahle:
A lot more of a robust spouse partner package there. So, your spouse or partner gets to experience a couple of half days, attend all the lunches and wellness activities and join everyone at the open reception. They get the best parts of the conference for a dramatically lower price. And then they have free time in their own to network with other spouses or just enjoy some great rest and relaxation on the resort property.

Dr. Jim Dahle:
We're going to have all those same wellness activities we had last time, the pickle ball was super popular. We had lots of other great stuff as well. We had a 5K, we had some golf things. We had some great evening events by our sponsors. The sponsors I think are pretty much all sold out at this point. They've got a lot of great things that they're bringing to the conference as well. We have great speakers.

Dr. Jim Dahle:
Christine Benz is coming back. She's never been to a live WCICON. She was one of the keynote speakers at the virtual one. We're excited to have her come back. She's I think the only speaker we've ever had that asked us to donate her speaking fees to her favorite charities. But she'll be back from her work at Morningstar.

Dr. Jim Dahle:
We've got Ashley Whillans coming. She's going to be talking a lot about wellness. We also have, as has been the trend in the past, people that have impacted my life greatly. We have a keynote speaker that has had a massive impact on my life. A fellow by the name of Stacy Taniguchi. He has a PhD now. He didn't when he impacted my life though.

Dr. Jim Dahle:
He actually taught me some science in high school and also functioned as one of my leaders, my youth leaders, my boy scout leaders when I was a kid. He's a Denali Mountain guide for a number of years there when I was a kid and has been done and doing all kinds of fun other adventure stuff since then. But he gives a fantastic talk, Katie and I were able to attend a few months ago and he's going to come give it at WCICON. And if you don't find that motivating for the rest of your life, I don't know what you will.

Dr. Jim Dahle:
We've got lots of other great people, both returning speakers, as well as people that have never spoken at WCICON. We've got Alexis Galati and Andrew Paulson and Andrew Roberts and Audrey Roberts. You may know BC Krakowski from her blog. Ben White has written a book on student loans.

Dr. Jim Dahle:
Bonnie Koo is going to be back for the first time since I think 2018 was the last time we had her in the conference. Brian Foley, the OG of the physician financial bloggers is going to be there. Financial advisors, Chad Chubb, and Daniel Ren are going to be there. Dan’s got a really great podcast. He's actually doing some live things on it lately that I'm trying to get lined up with him.

Dr. Jim Dahle:
Dike Drummond and David Graham are coming back. Dawn Baker is coming back. We got Dewan Farhana and Dimitrios Tsatiris. Disha Spath is going to be our host again at the conference. She's also running a workshop there that you'll want to check out.

Dr. Jim Dahle:
Eric Hoffmeister is coming back. [07:25 Inaudible] is going to be there talking about asset protection. You've seen him writing for years in the physician financial space. RobRoy Platt is going to come to estate planning. Jim Lang is coming back. Jordan Fray’s got talk. I think he's on the virtual side of the conference, but if you come live, you get that as well.

Dr. Jim Dahle:
Kate Mangona is going to come back. The Physician on FIRE, Leif Dahleen is going to be there. Letizia Alto is going to be there. Nisha Mehta is going to be there. Paul Merriman is going to be there. Peter Kim is going to be there. Stephen Pamatmat who's won the WCI financial educator award is going to be given a talk as well. Stephanie Pearson is going to be there.

Dr. Jim Dahle:
All kinds of great speakers are going to be here and you want to be there too. WCICON is not just a CME conference. It is an experience. People go home from this with their lives changed and with new impetus for both them and their partner to really get their financial ducks in a row.

Dr. Jim Dahle:
So, it's going to be a great conference. I'm looking forward to meeting as many of you as I can there. If you want to register, October 10th, 7:00 PM Mountain. The conference itself, by the way, is March 1st through 4th of next year at the JW Marriot Desert Ridge in Phoenix.

Dr. Jim Dahle:
March is a fantastic time to be in Phoenix by the way. If you want some sunny warm weather, get out of Michigan, get out of Maine, get out of New York, wherever you're at, come down to Phoenix, enjoy the sun for a few days at a fantastic property, have a great conference, network, see your friends, meet the people whose work you've been reading or listening to for years and enjoy WCICON. You can get more information at wcievents.com. It's going to be great. So be sure to check that out.

Dr. Jim Dahle:
All right, we need to get our guest on the line here today. We have somebody that I've known for a while, but who had some bad things happen to them recently. Now they kind of have a happy outcome, but it didn't necessarily have to go that way. And I got them thinking a lot about life and finances and how they intersect. And so, we're going to be talking about that on today's podcast. Let's get Josh on the line.

Dr. Jim Dahle:
Our guest today on the White Coat Investor podcast is Dr. Josh Daily. He's a pediatric cardiologist I had dinner with a few years ago while visiting in Arkansas. I was taking part in Jason Maisel’s course there at the university of Arkansas. Arkansas, what is it? UAMS. Is that what it is?

Dr. Josh Daily:
You got it. Yeah.

Dr. Jim Dahle:
Great course he does. Eventually I told him, Jason, you got to pay me more to come all the way to Arkansas. And he said, “You know what? I'm going to have Josh give your talk.” So, Josh gives my talk out there, which is perfectly fine with me. I appreciate you doing that.

Dr. Jim Dahle:
But Josh has had some interesting things happen to him since I had dinner with him a few years ago that we're going to talk about today on the episode. Before we get into that though, let's start at the beginning so people can get to know you a little bit better. Tell us about your upbringing and what it taught you about money.

Dr. Josh Daily:
Sure. I grew up right here in Arkansas, middle class family. My father was a pastor. We had plenty of money for food and clothes, but not a lot more beyond that. And from an early age, I learned the value of living within your means and limiting debt. We used the old envelope system. I remember we go to the bank once a month and had all our envelopes and used all cash and we didn't buy anything we couldn't afford, and we didn't have any debt other than the mortgage. And I grew up very much in that atmosphere and my natural saver in addition to that, and that has served me well.

Dr. Josh Daily:
What I didn't learn is anything about investing, anything about insurance. I didn't know what a mutual fund is. Certainly, I didn't know what an index mutual fund is. And it wasn't until really fellowship that I kind of delved into that area. And then I jumped in since that point and become very interested to read almost everything on the blog and now give regular lectures to medical students and residents and fellows and other faculty members, and really enjoy the topic a lot.

Dr. Jim Dahle:
Yeah. All in, a true White Coat Investor.

Dr. Josh Daily:
Yeah. You got it.

Dr. Jim Dahle:
Tell us a little bit about your education training and your career to this point.

Dr. Josh Daily:
Sure. I grew up in Arkansas. I did undergraduate education with a degree in physics here and then did medical school here. I decided I wanted to be a pediatric cardiologist and went to Cincinnati Children's for both residency and then fellowship was there for six years and then came back to Arkansas a little over seven years ago, probably in my eighth years as faculty since coming back.

Dr. Josh Daily:
During that time, I also got a master's in education. I realized I really enjoyed teaching and wanted to have formal training in that area. Since that point, I was initially the associate fellowship program director, and now fellowship program director of Arkansas Children's.

Dr. Jim Dahle:
Let’s get to the reason why we brought you on the podcast today, Josh. It's not the happiest reason in the world, but last December you developed a serious medical issue. Can you tell us about it?

Dr. Josh Daily:
Sure. At the time I had a lot going on in my life. We had recently moved into a new home. I additionally had my fourth child and at that time had four young kids, two under two. So, I had a lot going on.

Dr. Josh Daily:
In the midst of all of that, I found that I was tired frequently. We'd get the kids down and I would just feel like I needed to go to bed. Additionally, I gained some weight, which was frustrating, but I attributed it all to having a fourth child being up a lot at night with a baby in just a busy life.

Dr. Josh Daily:
I finally saw my PCP late November and we did some screening labs and my testosterone level came back extremely low. The rest of my labs overall looked okay. At that point, the PCP wanted to start me on testosterone therapy and thought it was primary hypogonadism and didn't do additional investigation.

Dr. Josh Daily:
I did a lot of reading and talked to a friend of mine who happened to run a basically testosterone clinic and he really encouraged me to do some additional investigation. He sent some additional labs and my FSH and LH came back very low indicating it was a central process.

Dr. Josh Daily:
At that point, I tried to get an outpatient MRI. It was in the midst of COVID. They were way backed up and they were scheduling two months out for MRIs, which was somewhat frustrating.

Dr. Josh Daily:
Meanwhile, I'd had two episodes of fairly intense headaches. One of which was in the context of a viral illness. So, I attributed to that and the second was after a COVID booster. So of course, I attributed to that. And then finally, one evening I had the worst headache in my life. It kept me up throughout the night and I was vomiting. I was in med school. I know enough about the red flags.

Dr. Josh Daily:
And so, the next morning I went to our local ED. I called a friend of mine who's an ED doc. The resident got me that quickly, got the MRI ordered, I got a little bit of pushback, but eventually got the MRI later that afternoon and found out I had a brain tumor and I had about a two and a half by three centimeter mass in my third ventricle. Those extended from my pituitary into my hypothalamus and compressing my optic chiasm.

Dr. Josh Daily:
I was admitted to the neurosurgery team, had basically my whole body scan, had a lumbar puncture. They sent all the tumor markers as well as a variety of labs. The radiologist and the neurosurgery team thought it was initially a germinoma and we discussed proceeding with radiation therapy, which is apparently basically the way to treat that.

Dr. Josh Daily:
But we decided to wait. I ended up being discharged from the hospital and I basically called everybody I knew with expertise in this area. And luckily, I had multiple friends who were neuroradiologists, and they all looked to the scans and concluded that the original team had drawn wrong conclusion. And this was not a germinoma. It was something called a craniopharyngioma, which maybe I learned about in med school, but I didn't remember.

Dr. Josh Daily:
But I quickly read everything I could get my hands on about craniopharyngiomas. And while they're not cancerous, they're typically in a very high-risk location. They're associated with a lot of morbidity.

Dr. Josh Daily:
I ended up going back and seeing the original neurosurgeon and discussion options. I got multiple second opinions from large academic centers and had very conflicting recommendations that were made from proceeding with a high risk biopsy, which in and of itself, would've been high risk based on its location to proceeding with total resection, knowing that there was a very high risk that I would be panhypopituitarism afterwards, and almost a hundred percent risk of having diabetes and hepatitis, as well as risk of damage to optic chiasm or hypothalamic injury, which can be devastating versus considering a newer treatment using something called BRAF inhibitors, which I knew nothing about before all this, but basically as a kind of chemotherapy. It was just really an investigational stage.

Dr. Josh Daily:
So, I got multiple recommendations and they were all conflicting. There wasn't a consensus. And I did literature review. There hasn't been a lot that's been published recently. And I also struggle with the fact that there's not public reporting of data in the field of neurosurgeon, which is very different than my field in congenital heart surgery.

Dr. Josh Daily:
I'm reliant on a neurosurgeon who says, “Oh yeah, I've done a couple of these a year. Yeah. My outcomes are good. Oh, there's about a 50% chance that you'll have the DI afterwards” and it's based entirely on their bias. And there's really no way to verify that. So, it's a very difficult decision to make.

Dr. Josh Daily:
After a lot of prayer and consideration, we picked a neurosurgeon who decided to proceed with total resection, recognizing the risk for morbidity in particular, and some risk for mortality.

Dr. Josh Daily:
I underwent surgery February 2nd of this year. And the bottom line is I had a great result. He got the entirety of the tumor. He preserved my hypothalamus. There was no damage to optic chiasm, and I had no additional pituitary dysfunction afterwards. I was on testosterone Synthroid, but I had developed no DI whatsoever, which I was fully anticipating having DI likely the rest of my life.

Dr. Josh Daily:
The first couple weeks after surgery were a little rocky, I was very uncomfortable. But overall, the outcome was excellent. I did have a third nerve palsy, which basically meant that I could only slightly open my right eyelid. And then as we all learned in med school, my eye was fixed down and out. So, I had double vision. That has since almost entirely recovered. and now I'm basically back to normal at this point.

Dr. Jim Dahle:
Pretty awesome. Pretty awesome outcome. I’m super happy to hear about that. Let's go back to that afternoon or evening in the ED. You went over to MRI, you came back, you sat there for 45 minutes. The emergency doc walked in, sat down on that little black rollie stool and said, “Josh, I hate to give you this news, but you've got something growing in your head.” What were the first things that went through your mind when you heard that news?

Dr. Josh Daily:
Mostly fear. I just felt really afraid. Confusion, shock. In spite of all the signs being there, I think in the back of my mind, I thought, “Oh, that's not really what's going on. This is probably something else.” But to be confronted with a reality, I had a brain tumor, what all that may mean, a lot of confusion in particular that they didn't know what it was with certainty and there wasn't a clear course forward.

Dr. Josh Daily:
So, there was a strong emotional response but, in the moment, I recognized while there was a time to process it emotionally, that was not the time because I needed to be fully engaged and make sure the diagnosis was correct and the treatment was appropriate and that I was taking the best path forward.

Dr. Josh Daily:
But over the next few months, I had a lot of time. I was about a seven-week period from diagnosis to surgery. And while the initial focus was entirely on making sure I got the right diagnosis and making the best decision toward the latter part of that, I was able to take some time, really process what this meant for me, what this meant for my family, what this meant for my future. And there was a lot of processing all of those emotions during that time.

Dr. Jim Dahle:
Now you are a White Coat Investor by any definition of the word. You've got your financial knowledge. You've put plans in place. You actually teach this stuff. And you wanted to come on the podcast to talk a little bit about the finances of your family and how they changed and things you thought about and maybe wish you'd done in the past before this happened. So, like most people you want to make sure your family is fine should something happen to you. Now, looking back on your previous planning, what did you do right? What did you do wrong?

Dr. Josh Daily:
During that six- or seven-week period between diagnosis and surgery, I had time to sit down, review the finances, develop a specific financial plan for this scenario while we had an overarching financial plan for our family and then go over everything with my wife.

Dr. Josh Daily:
And as you mentioned, there were some things that I'd put in place that I was so grateful I had. Another is a regret, where in the midst of it, if I recognize it, I wish I had prepared in a little bit different way.

Dr. Josh Daily:
First, I recognized that as is often the case within families, there’s one spouse that does most of the finances, and that was me and I was very interested in it and managed it all. And my wife didn't necessarily know where our accounts were or passwords or user names. And so, there was a lot of logistics in terms of arranging all that and making sure she was up to speed with where all our accounts were and how she should manage them.

Dr. Josh Daily:
I had life insurance and I'm very grateful I did, but I wished I had purchased more. And I had about a $1.5 million policy, and then another $50,000 policy that was through work that was free. And at the time I'd originally purchased those, I think it was a reasonable amount for our family, but in the interim, my family had grown and now had four young kids. We had a new house that was more expensive and our cost of living had increased.

Dr. Josh Daily:
And once I actually got into the details of what it would take for my wife to stay at home and raise four kids and continue that standard of living, the $1.5 million wasn't going to cut it. And that was a little disheartening at the time.

Dr. Josh Daily:
One of the things I discovered that I didn't really understand on the front end is the benefit of social security survivorship benefits, which in my case are very substantial.
Basically, the way those work is for minor children. They will receive about, in my case, $2,300 a month until they turn 18. And then for a surviving spouse who's caring for a minor child at age of 16, she would receive $2,300.

Dr. Josh Daily:
Now that’s capped at around $5,300 a year, but that works out to about $64,000 a year that they'd get. And in our case, because I had a brand-new baby and had four kids at home, my wife would get almost the entirety of that for the next 16 years and some of it for the next 18 years. So that when combined with my term life policy would allow them to maintain a lot of the things we'd done, although some adjustments would be necessary as well.

Dr. Josh Daily:
In addition to that, I recognized that while purchasing term life insurance, I was primarily thinking in terms of replacing my income. There's a lot of other things my wife would have to replace if I died. One, she'd be a single parent. And while she does stay at home at the moment, I provided a lot of childcare and we parent together and there would be costs associated with her getting help to do that.

Dr. Josh Daily:
Secondly, I manage our finances entirely and as you know good financial advice is expensive. And so, I had to arrange for experts to help my wife in the scenario in which I died to manage all that. And it comes with a cost. Plus, all the different expenses associated with maintaining a home and a lot of other tasks I did that would ultimately need to be replaced financially.

Dr. Josh Daily:
And so, I needed to replace more than just my income for her to maintain the same standard of living. And I hadn't thought through that well on the front end. I had a vague sense of it, but hadn't really done the numbers, especially recently. And in the midst of that, I did all of that.

Dr. Josh Daily:
And we had to make a few cutbacks in the scenario in which I would die, but ultimately, they could keep the home and keep our school the same way we'd planned on doing it for our kids and keep a lot of things in place, but cut back in a few other areas.

Dr. Josh Daily:
And I wish I had enough that I could have just said, “You don't need to worry about this, keep all this the same. You're going to have more than enough.” But that wasn't the case unfortunately.

Dr. Jim Dahle:
How much do you wish you had when you finally ran the numbers after your diagnosis? I mean, you had $1.5 million. Do you wish you had $2-3-5? What do you wish you had?

Dr. Josh Daily:
Well, obviously in that higher situation, I would've bought a lot if someone would've sold it to me. But I wish I'd had probably in the neighborhood of $3 million. Our net worth at the time was about $1.1 million. And then that combined with the net worth and the survivorship benefits would've given her just tremendous freedom. And with a lot of margin built in, which in a very stressful environment, her raising four kids, I would've liked for her not to have to worry about money at all.

Dr. Josh Daily:
And so, I'm not eligible to purchase that now, given that I just had a brain tumor resected. I do have the ability to purchase additional $500,000 of life insurance through my work once a year. I tried to do that at the time of the diagnosis, but it wasn't the one month of the year where you can do that. But I intend to do that this year and I may make further adjustments in the future when I am eligible to get term life insurance again.

Dr. Jim Dahle:
Yeah. Have you talked to an agent about it? When do they think you may qualify to buy more?

Dr. Josh Daily:
I've had some initial conversations and I had a lot of conversations right after the diagnosis to figure out if there's any way I could. And basically, there wasn't a clear path forward at that time. And you may have more expertise in this than I did. What I was told is each policy has a little bit different criteria but certainly not in the first year after a resection. There's no way I'd qualify with any reasonable positive health status.

Dr. Jim Dahle:
Five years is what I've heard thrown around in the past. But that's, again, I'm not an agent, this is something I'd take to an agent and have them shop you around informally and ask. Because in one company, it may be one year and another company might be three and another one might be five. It's highly variable.

Dr. Josh Daily:
Yeah.

Dr. Jim Dahle:
All right. Well, enough about life insurance. Let's talk about disability insurance. What role has disability insurance played in your life in the last year and do you expect it to play going forward?

Dr. Josh Daily:
My risk of disability is much greater than my risk of death, especially with the type of tumor this was. And in particular, the risk of blindness. I mean, what I do, I'm a diagnostic cardiologist. I look at echoes all day, and so I would've been disabled had that happened. And I have a policy from standard, own occupation, would replace 60% of my income post tax.

Dr. Josh Daily:
And I know you have had multiple guests that have come on that talked about disability insurance, extensively recently. And my policy overall aligns with what a lot of your recommended advisors would recommend. I didn't think about that as much as the front end because I knew it was there. I did wrestle a little bit on the back end, so I had a third nerve palsy and I basically could use one eye, up until a few months ago.

Dr. Josh Daily:
And binocular vision is probably important to what I do, but I could probably do it with one eye. So, I did some research informally and I got into see an ophthalmologist as quickly as I could, not because I was hopeful that they recommend that I do something different. I know the literature, you give it time to recover, but I wanted it clearly documented how pronounced my third nerve palsy was. And then it was right after surgery with a clear start date. And I wanted all that clearly in my medical charts.

Dr. Josh Daily:
Now that being said, it's recovered entirely and I was able to get back and I did my job with one eye and overall, I think I did fine. And if I was left with a single eye, I probably would've been able to practice with a few little modifications, but overall I think it wouldn't have impacted my practice considerably.

Dr. Jim Dahle:
Did you miss any significant amount of work? Did you put in a disability insurance claim this year?

Dr. Josh Daily:
I didn't. I work at an academic institution and I had four plus months of sick leave built up and plus a lot of vacation time. And so, I ended up being out for two months and I still have multiple months of sick leave built up. I was paid fully and it wasn't a big deal at all.

Dr. Josh Daily:
And the way my disability insurance policy would kick in is after six months. So, I obviously never reached that point. And we have a large emergency fund that we built up to a point that we'd be fine for six months with no income coming in.

Dr. Jim Dahle:
What do you think at this point about your job choice? Not your career, but your job choice. You're an academician, you're working for a big medical center that has all these fancy paid time off benefits and stuff that a lot of people in private practice don't have. What are your thoughts on that now that you've kind of had to take advantage of some of those benefits?

Dr. Josh Daily:
One, I'm very grateful for them obviously, and there are pros and cons of being in private practice versus in academics. And this is one of the benefits of being at a large academic center. I work with a large group. We're the only pediatric cardiology group in the state. And we have enough of us that me being out was able to be covered by my colleagues. It makes me very grateful for those I worked with, and I didn't have to worry about income during that time. I had so much sick leave built up.

Dr. Josh Daily:
I had an excellent health insurance policy with really a minimal amount out of pocket that I ended up having to pay when was all said and done. So, I was very grateful for that. I can’t imagine if I'd been in private practice and all of a sudden, the revenue stopped coming in and I'm still trying to pay people's salary. How challenging that would've been on top of so many other things. Well, that's not the reason I chose an academic career. It's one of the significant benefits, certainly.

Dr. Jim Dahle:
Now you talked a little bit earlier about social security survival benefits. And you learned a lot about this in the process, especially when you realize maybe you're a little underinsured with the term life insurance. Tell us how those are calculated and what you had to do to qualify for those.

Dr. Josh Daily:
Yeah. Anyone can actually log into the social security website and see exactly what their benefits will be. And basically, if you paid at least 10 years’ worth in social security, then your children are eligible for survivorship benefits. And if you're young enough, it can even be less than that, the way they do the calculation. And it's a far more significant than I understood.

Dr. Josh Daily:
And while I don't understand the entirety of the calculation, I know exactly what my numbers would be, which is far more applicable obviously in my situation. Basically $64,000 a year for the next 16 years for my life on top of the term life insurance would make her maintaining our standard of living so much more doable. It was an unexpected blessing in the midst of a difficult time once I realized how much she'd end up getting.

Dr. Jim Dahle:
In your calculation, you came up with, what would you say? $64,000 a year?

Dr. Josh Daily:
Yes, basically for the next 16 years. And then it would drop a little bit for two more years and a little bit more for a couple years. Because minors get it if they're under 18 and then my wife would get if she's taken care of one of my children under 16. And it caps out at about $5,300 a year.

Dr. Jim Dahle:
As I'm talking to you, I'm logging into the social security website because I'm curious what mine is. I know I did a post on this a few years ago, but I'm very curious. This isn't hard to do if you have your social security login. If you don't, you should get that. But you get a statement every year and if you go in there, you log in, they send you a text because it's got two factor authentication. And the first line in my social security is your most recent statement. So, I click on it. I click on the link, your social security statement and it pops up.

Dr. Jim Dahle:
And I look at this and it says retirement benefits. It says if I retire at 70, I'll get $4,200 a year assuming I work the same from now until I retire. It says my disability benefits, if I got disabled would be $3,041 a month. And my survivor benefits, it says you have earned enough credits for your eligible family members to receive survivor benefits. If you die this year, members of your family who may qualify for monthly benefits include a minor child, $2,337. Spouse if caring for a disabled child or child younger than age 16, $2,337. Spouse, if benefits start at full retirement age and total family benefits cannot be more than $5,455.

Dr. Jim Dahle:
So, that's presumably what I'd get with all the kids I've got. Multiply that by 12 and we're at about what you have. I think it's about $65,000. So, it's not insignificant. I mean, to get that from portfolio, we're talking about a $1.5 million portfolio to generate that sort of a withdrawal rate at a 4% withdrawal. So, in some respects that's more valuable than your nest egg was at the time.

Dr. Josh Daily:
Yeah, it was. Yeah, definitely than my term life insurance policy.

Dr. Jim Dahle:
Yeah. Yeah, for sure. Okay. You've published a post on the White Coat Investor about the finances of divorce in the past. And I understand you now have a blended family.

Dr. Josh Daily:
I do.

Dr. Jim Dahle:
Tell us a little bit about how that played into all of this.

Dr. Josh Daily:
Yeah, that was one of the more difficult aspects of navigating this. And so, I was divorced all over five years ago and have since remarried and have two children from my prior relationship and then two little girls now with my wife. And I have full custody. And so, all four kids live with us all the time.

Dr. Josh Daily:
And it gets really tricky in the scenario in which I die. Because as the law is written, stepparents have very few legal rights. And so, one of the things that we had to do is a few years ago, we had met with a state attorney and had a really somewhat complex plan in place based around this. And we revisited that and make sure everything was aligned. But my desire that the children, my two eldest, stay with my wife in the event of my death was made as clear as possible. And then I tied as much as I possibly could financially to that happening.

Dr. Josh Daily:
The last thing I wanted to do is have this big financial incentive for someone else to try to get custody of my kids. And so, we structured things in a way that would minimize the likelihood of that happening and made it as clear as possible what we wanted to have happen.

Dr. Josh Daily:
But it was difficult. I still vividly remember that first night in the hospital when I was diagnosed, I was there by myself and my wife was at home with her kids. She came and saw me, went back home, told our kids some of it. And then my eldest who at the time was 10 wanted to FaceTime me. And the first question was “Dad, are you going to die?” And we talked about that for a little bit. And then the next question was “Dad, what's going to happen to me if you die? Am I going to still live in our house? Am I still going to be part of our family?”

Dr. Josh Daily:
And so, I couldn't say with a hundred percent certainty that that would be the case. We did everything we could to increase the likelihood that that would happen. And obviously I didn't die and I'm still here and that's not an issue at the moment, but it gets really tricky.

Dr. Josh Daily:
And one of the reasons I wanted to make sure that my wife was financially provided for is I wanted her to be able to do whatever she needed to from a legal perspective, to make sure that she kept the boys. And finances can be very helpful to that end.

Dr. Jim Dahle:
I'm very curious about the details of the estate planning. You may not want to share all of this, but I'm curious how you set that up to disincentivize somebody else getting custody of the kids as much as possible? Did this mean leaving everything to your wife as much as you could? How'd you set that up essentially?

Dr. Josh Daily:
Yes. We created a trust and everything is within the trust. And it all goes to my wife and I trust her. It can be tricky in some stepfamily situations in which you remarry and then the new spouse gets everything in your death and then may not give anything to your kids from a prior marriage.

Dr. Josh Daily:
So, there's a lot of complexity. I fully trust my wife and she is deeply connected to all of our kids and views them all as her own. So, I trust her implicitly. In that context, this made the most sense that basically everything went to my wife and I trusted her to take care of the boys and make sure they're taken care of. And so that's the gist of it. There was a little bit more from a legal perspective, but that's the basics of how we structure things.

Dr. Jim Dahle:
So, how has this experience changed your priorities and your plans for the future?

Dr. Josh Daily:
Well, I've given it a lot of thought and in the midst of wrestling with what that may mean for my next season of life, first and foremost, I had a lot of clarity in the midst of, especially in those seven weeks between diagnosis and surgery. It's amazing how a situation like that provides clarity in life in terms of what matters most. And at the end of the day, it's relationships. And I'm grateful for my job. I get to do meaningful work and help people and I make a good living, but I care far more about my life and kids than that.

Dr. Josh Daily:
And so, there was some clarity in the midst of that. I don't intend to structure my life fundamentally differently. I'm a little bit quicker to tell my kids I love them. I'm quicker to tell them the things I admire about them. The good that I see in them and the way I see that manifest in their life. I'm far more intentional about casting a vision for my boys, the kind of men they'll become, and my daughters, the kind of women they'll become.

Dr. Josh Daily:
I have those kinds of conversations far more frequently now than I did before. And it gives me clarity with regard to making decisions around what I say “yes” to and “no” to at work. I'm grateful for my job and it aligns well with my current move, my design, the things that are important to me, but I do not want to work more than I work now.

Dr. Josh Daily:
I think I have reasonable balance in work life integration, but if there's an opportunity to work my way up the ladder, but that isn't going to involve more nights away, then that's pretty clear. That's not worth it to me. Especially at the seasonal life we're in with four young kids at home and the importance of me being deeply involved and engaged in their lives. So, from a big picture perspective, it clarified some priorities that I previously would've articulated if I had, but I think it made it even clear how important that was to me.

Dr. Josh Daily:
From a work perspective, I've actually decided to take some time and think about what I want the rest of my career to look like. I'm working with an executive coach now to wrestle with some of those things. I actually just had a consultation with someone that does aptitude testing, and had been tested and reviewed my results in a thoughtful way about what kind of roles would be a good fit for me and what wouldn't.

Dr. Josh Daily:
I'm intentionally cultivating some aspects of my job that I think may be meaningful down the road in terms of allowing me to spend more time doing the things that matter most and less time doing the things that just really frustrate me, which every job has, but the more I can minimize those, the better.

Dr. Josh Daily:
And it was also clear I make plenty of money. I mean, I’ll take a raise if someone gave it to me, but where our family is now, that's not going to meaningfully increase our quality of life. Time is more valuable than money, especially with four young kids at home at the income I make in a low cost of living area. And so, even if there was the opportunity to make more money in a job that was more demanding, it's simply not worth it with where I'm at now. I see that far more clearly than I did even a year ago.

Dr. Jim Dahle:
Now I tell a lot of people to live like a resident. Kind of front load their saving, front load their financial plan early in their career so that will pay dividends later. I occasionally get pushback, no surprise from doctors who see people dying and becoming disabled early in life. And clearly there's a balance. You don't want to put off all the fun stuff in your life until you're 60 plus because you might not get to 60 plus.

Dr. Jim Dahle:
But I'm curious about your perspective of how you think people should balance saving for a comfortable retirement with living in the here and now in case our life ends up being shorter than we expect.

Dr. Josh Daily:
I fully recognize that there's a balance that can be difficult to discern at times, and both are ultimately important. I am naturally a saver. So, I'm naturally drawn toward that end of the spectrum. And I've had to kind of pull back from that at times. I don't regret at all how much we saved because while I may have been saving for retirement, that was also money that would've allowed my wife to continue the life that we desired and take care of my kids. So, it wasn't like that was only money that would allow me to live a comfortable retirement. There were other benefits to that as well.

Dr. Josh Daily:
As I think about striking that balance, it's not so much “Do I spend a lot of money now or save a lot?” Those are obviously different ends of the extreme. There's a spectrum and you can kind of discern where you live.

Dr. Josh Daily:
But as I think is clear in the happiness literature, experiences provide more happiness or more meaningful than our things. And actually, I'm a little bit more apt to spend money on experiences, especially experiences that cultivate meaningful relationships in my life. But driving a nice car I don't really care about and isn't that important. And it'd be fun to drive a nicer car for a couple months and then my happiness level would adjust and I'd be just as happy as I would before. And probably even more frustrated with one of my kids scratched their name in the side of it with rock. Those kinds of things that we all experience with our kids.

Dr. Josh Daily:
So, I would discourage new physicians from spending a lot of money on luxury items, but I would encourage them to thoughtfully prioritize the money they spend on things that will cultivate the relationships that are most meaningful to them.

Dr. Josh Daily:
For instance, while I am not a huge Disney person, we're doing a trip to Disneyland this year. And that's something that's important to my wife and my kids. That's something we made a priority. And it's painful for me to see how much it is. And I actually have followed some of your advice and my wife is just paying for it. And I know the big picture about how much it'll cost, but I'm not the one actually paying with the credit card. So, we're going to be fine, but I know how painful that would be that for me to actually be the one paying for every ticket and the hotel and the airline and all of those kinds of things.

Dr. Josh Daily:
So those kinds of experiences we're prioritizing now a little bit more than we would have before, but we're certainly not elevating our standard of living with regard to purchasing things.

Dr. Jim Dahle:
Was there ever a time in those seven weeks between diagnosis and surgery, when you thought “I should have spent more money on such and such?”

Dr. Josh Daily:
For life insurance. That's the one thing that I thought I wished I'd spent more money on. I'm not sure that there was anything else. There were relationships that I wished I had prioritized more and some of prioritizing relationships can be associated with spending money in terms of traveling and seeing my brother and my sister who live other places or doing a trip with my dad, doing a fishing trip with him or things like that. Maybe a few things like that. But beyond that, I don't know that there's anything else that I wished I had purchased or spent money on.

Dr. Jim Dahle:
All right. Our time is getting short, but what have we not talked about that the 30,000 or 40,000 people that are going to listen to this episode ought to know?

Dr. Josh Daily:
As have I thought about my experience and really my desire in sharing my story with you is not so much that we get into all the details of social security and term life while I think that's beneficial, but rather my hope is that in sharing my story, you could put yourself in my shoes and recognize that you may be in great health, life may be going well, but the unexpected certainly can happen. It happened to me, and it happens to our colleagues every single year.

Dr. Josh Daily:
And that in doing that, you'd be motivated to really think in a thoughtful way about your life and about your future. The first and foremost, that you would prepare for the unexpected from a financial perspective, but also that you would take stock in your life and the things that are most important to you and how you're living your life to this day.

Dr. Josh Daily:
We've all heard the story of Alfred Nobel who read an obituary about him when he was still alive, his brother had died and it was mistaken that the journalist thought that he had died. So, he wrote an obituary about him and about the legacy that he left. And he was so impacted by how others perceived in the legacy he had left with regard to the warfare that he promoted, that he obviously created the Nobel prize and shifted the focus of his life entirely in the next season.

Dr. Josh Daily:
And I think that kind of experience is really helpful for every one of us. To pretend as though we have a diagnosis, “What would I regret? What would I not regret about what I had done? How can I live my life differently in light of that? “

Dr. Josh Daily:
There's actually a book I just finished reading by Daniel Pink, called The Power of Regret, where he actually summarizes all the science behind the process, regret and ways that we can use that to live more meaningful lives, to making better decisions. That’s one of the things I would recommend.

Dr. Josh Daily:
But I would encourage all of you to take a moment and think about what if this was you? What if you were in my shoes, what would you regret? What would you not regret? What would you do differently? And then to step back and think about how you want to live your life differently in light of that, both from a financial perspective, but more importantly from the perspective of priorities and relationships in your life.

Dr. Jim Dahle:
Well, Dr. Josh Daily, thank you so much for coming on the podcast. Thank you for what you do in your career as a pediatric cardiologist. Thank you for the financial education you're providing to your peers and trainees. And thanks for coming on the podcast and talking about such a personal experience with us. We really appreciate it and are super happy about the outcome you're experiencing from it.

Dr. Josh Daily:
Yeah. Thank you so much, Jim. I thoroughly enjoy your podcast and I've been greatly influenced by all the work you've done through your blog and your podcast and everything else. I’m very grateful for all the ways I benefit. And I'm glad I could give back a little bit, Jim, so thank you for having me on.

Dr. Jim Dahle:
You're very welcome. It's my pleasure.

Dr. Jim Dahle:
All right. I hope you enjoyed that interview as much as I did. I'm so happy that Josh is doing so well after that surgery. As you can tell from his comments, it didn't necessarily have to go that well. So, thank you to the docs that took care of him. There's a surgeon involved. There's an anesthesiologist. There's a whole bunch of people that consulted for him. And so, thanks to all of you that helped take such good care of him so we could all benefit from this great episode.

Dr. Jim Dahle:

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Dr. Jim Dahle:
Don't forget, sign up for WCICON23. It starts October 10th at 7:00 PM. You can go to www.wcievents.com and get registered for a reminder. So, you get a reminder when it opens just in case it sells out quickly this year.

Dr. Jim Dahle:
The early bird pricing is exactly the same as last year. So, no increase with inflation, but I think that probably, especially with the pandemic really winding down, probably means we're going to get pretty darn close to a sellout, if we don't sell out. And it may happen quickly this year. So, be sure to register early if you would like to come.

Dr. Jim Dahle:
By the way, a lot of these podcasts are not interviews like today's episode. A lot of them are answering your questions. We try to let your desires and your concerns drive this podcast. And the best way to do that is to leave your questions on the Speak Pipe.

Dr. Jim Dahle:
At whitecoatinvestor.com/speakpipe you can record up to a minute and a half of a question and we'll answer it on the podcast. So, if you've got questions that haven't been answered, please leave them there and we'll get them answered on the podcast.

Dr. Jim Dahle:
In the meantime, keep your head up, shoulders back. You've got this and we can help. We'll see you next time on the WCI podcast.

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