Reduce Physician Burnout with the Physician Philosopher – Podcast #103

Announcer: 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. Here's your host, Dr. Jim Dahle.

WCI: Welcome to White Coat Investor Podcast number 103, Reduce Burnout with The Physician Philosopher. Pradeep Audho is an independent insurance broker and the owner of PKA Insurance Group, Inc. He's based in Boston but works with clients nationwide. His focus is on disability and life insurance. Pradeep has over 15 years of experience providing clients with disability and life insurance. He represents all the major pure own occupation disability insurance carriers. He's very laid back and approachable and is not a pushy salesperson. You can request life and disability quotes on his website at pkainsurance.com, or you can reach credit by phone at 978-314-7795. That's 978-314-7795.

WCI: Welcome back to the podcast. It's good to have you here. I'm thankful that you're listening, that you're telling others about it. It's been growing and growing. It's been pretty incredible for something we saw as very much a side project to the blog, that's really become pretty impressive in its reach actually. I think we're seeing 20,000 or 25,000 downloads an episode these days.

WCI: Our quote of the day today comes from JL Collins, who said, “Those who live paycheck to paycheck are slaves. Those who carry debt are slaves with even stouter shackles”. I think there's a lot of truth to that there.

WCI: Just briefly, I wanted to talk a little bit about some of the differences between the three White Coat Investor communities that we have online. The first one was the White Coat Investor Forum. A forum is nice and that it's all on the White Coat Investor site, so we can actually have a little bit more control over what it looks like, and who's participating there, so on and so forth. It's been around for two years, almost two and a half years now and it has a really great cohort of people, very knowledgeable people that will help you with your financial questions. It's a good place to really dive deep into the details, and have people be able to come back and help you with follow up questions as well.

WCI: The second community is the White Coat Investor Facebook group. It is a private Facebook group, you have to be a high income professional and you can't be a financial professional to be in there unless you're that month's sponsor. This is a much larger group. It's got to be 17,000-18,000 people by now and suffers from all the problems with Facebook. Anytime you have Facebook, things get very large very quickly. Some people aren't putting a lot of thought into it, sometimes they just put in quick answers because they're just on their phones. Sometimes, it's a little bit difficult to find the signal for all the noise.

WCI: The benefit of it is, geez, it's 17,000 or 18,000 people on there willing to help you out. It's just the sheer size of it, and how quickly you can get questions answered and get multiple opinions and put up polls and those kinds of things that you can only do on Facebook. Because people are on it all the time, they can interact with you on their way, at lunchtime, or in between patients, or all these little chunks of time we have throughout the day where we're likely to pull our phone out and get on to it. It's got that benefit there of just being a very large, very responsive community.

WCI: The third community is the sub-Reddit. For those who are into Reddit, it's a unique format. You get to vote up and vote down the things you like, it's very little of any kind of promotion, you're just not allowed to promote much on Reddit, and that includes us even though we started the sub-Reddit. It's a great environment for those who are used to that and who like that. I would suggest checking out Reddit. There's a lot of great information across Reddit, so give yourself a chance to check those things out.

WCI: I know you're on your way into work, or maybe your way home from work, or hopefully you're exercising, you're out on a run or bike ride or maybe … I hope you're not listening to this on a bike ride or even running if you're in a busy place, but it's good to listen to this stuff to improve your life with those moments of time that you have. But the rest of your life is difficult. It's hard to practice medicine. You see terrible things happen to people and that starts to weigh on you. It's a long training period. The hours are long, they're sometimes not convenient times.

WCI: People are always amazed when I tell them as an emergency doc that only about 20% of the shifts that emergency docs work are actually during bankers hours. Most of them are in the evenings, nights, weekends, holidays, et cetera. It's difficult what you do and thanks for doing it.

WCI: Today, we have a very special guest that I want to introduce to you. James D. Turner, goes by Jimmy, has been blogging as The Physician Philosopher for the last year and a half. You can find the blog at physicianphilosopher.com or in the links in the show notes.

WCI: As of this month, his blogs is the newest member of the WCI blogging network, so you're going to be hearing an awful lot about him in the coming months and years, and I thought it'd be good to get him on the podcast to introduce him. Jimmy is an academic anesthesiologist practicing in North Carolina. He's not very far out of training and at all, only about 20 months at this point.

WCI: In today's podcast, we're going to get to know him and his work a lot better. Welcome to the show, Jimmy.

Jimmy: Thanks, Jim. Thanks for having me on. I'm really excited about this.

WCI: All right, let's get into the questions here. Let's start at the very beginning. Can you tell us a bit about your parents and your upbringing?

Jimmy: Sure. I was born in Raleigh, North Carolina and then I'm the third of three kids, so I was the baby. I have two older sisters. We moved around about, oh gosh, about 12 times before I was the age of 10 or 11, so I moved around a lot, anywhere from New Jersey to Florida, which I guess is where I'm technically from, it's the easiest thing to say since I was there since about fifth grade. My dad is a nuclear engineer, he's retired. He retired before I was in high school. My mom was a homemaker for most of the years growing up. I think for the most part we lived an upper middle class upbringing, except for when my family went through bankruptcy when I was about 10, that's really my first memory of money. For the most part, my parents were hard workers and provided a good life for us growing up. We eventually settled down in Florida all the way through high school.

WCI: I don't think you can drop a bomb like that in the introduction without expanding on it a little bit. A lot of us come from a not particularly well-to-do background, but I don't think a lot of us grew up in a family that went through bankruptcy. How do you think that affected you and your views on money?
Jimmy: It absolutely had a profound impact on me. The ironic thing was that didn't really show itself until later when I became financially literate. I was financially illiterate for most of my life growing up until really just about fellowship. My experience growing up was that one year in New Jersey we got pretty much everything we wanted for Christmas, I was a 9 or 10 year old. The next year we got very little and we were all of a sudden living with my grandparents. My parents were racking up six figures of credit card debt as they liquidated their 401ks, basically had no assets to their name. They eventually filed bankruptcy.
Jimmy: My parents, despite being extremely hard working people, were also not very financially literate, so I was very used to just using credit cards to buy anything growing up, which obviously had an impact on me later on. Just made sense to borrow money for medical school and it didn't seem very real. All of that had an impact on me. I also, because of that experience, can relate to having much and having very little, which helps being able to find contentment in life because I recognized what it's like when you don't have much.

WCI: Let's move into the next phase of your life, tell us about your schooling, your training, and your career up until this point.

Jimmy: I went to a really, really small school in South Carolina called Erskine. It's 600 students total, so there's about 150 students per class. I met my wife there and played soccer as well. Then I went to Wake Forest for medical school, residency and fellowship. I did residency in anesthesiology and fellowship in regional anesthesiology, so my expertise is in placing peripheral nerve blocks, thoracic epidurals for patients that are having surgery over rib fractures. I'm now in my second year as an attending at Wake, so I've been in Winston-Salem for about 11 years now.

WCI: All right, let's talk for a little bit about The Physician Philosopher. Why'd you start this blog? This couldn't have been in the first 40 or 50 physician financial blogs. You must have looked at those and said, “There's something here that's missing and I can fill it”. What did you think was missing?

Jimmy: Actually, I think when I joined, Crispy Doc has a running list of personal financial bloggers, I know you do too. Back when I joined I think that I was probably number 40 or 50, like you said, maybe even 60. Some of those experiences growing up really shaped my view of money. I had a couple of other experiences in medical school that were a very rough introduction to the financial industry.

Jimmy: When I was a third year medical student we had our first kid, she's about to turn eight. Actually, soon after this podcast goes live, so I guess I should say Happy Birthday to my little girl. But when we had her I thought that the appropriate thing to do, the fatherly thing to do, was to buy life insurance. I approached somebody who was the brother of one of my friends, and basically said, “Hey, I need term life insurance”. Thankfully, I knew at least that much back then, but I knew very little else. He said, “Yeah sure, we can get you life insurance, but you should probably also consider getting disability insurance because why not? You're otherwise healthy, right?” I said, “Well I have an essential tremor, I take propranolol for that. But yeah, for the most part I'm pretty healthy”. But I've since seen the reason to apply for disability insurance. I didn't have any income. I thought that I could do that later.

Jimmy: I said no a few times and the insurance agent ended up talking me into it, which doesn't seem like a big deal, except for the fact that I got denied as a medical student in the very end of third year. Then fast forward a few years to residency where they offered the guaranteed disability insurance policy and the really only stipulation for the guaranteed policy, which doesn't have any medical exam, no medical history taken, so they wouldn't have known about my tremor or the propranolol that I take, the only stipulation is that you can't have been denied personal disability insurance before. Since this insurance agent convinced me to apply as a third year medical student, I to this day cannot get personal disability insurance and have to rely on a group policy only. That was a pretty rough introduction.

Jimmy: Literally not even 12 months later I'm sitting in intern bootcamp, which is this series of lectures or seminars where we're instructed about things that are related to medicine and outside of medicine that might help prepare to be an intern or a resident physician. They bring in this financial advisory firm. It felt very slimy. Knowing nothing about money back then, hair on the back of my neck stood up, didn't really trust it, but didn't really know why.

Jimmy: Three or four years into residency this firm that my medical school thought was trustworthy enough to give us advice on student loans and investment options, the CEO was sanctioned and charged by the SCC and thrown in jail for fraud for nine years. I had a rough introduction that taught me that if I was going to learn anything about this stuff that I was probably going to need to do it on my own. Eventually, that led me to your book “The White Coat Investor” several blogs, and I started to become financially literate, and became passionate about it. Then started talking to everybody about it. What I realized was that despite all of the blogs out there, these 50 or 60 blogs, that there was still a huge need. There was a large number of people that don't know anything about this stuff despite all of the really good material that's out there. I felt like I could really help fill part of that need and do it in a unique way where I connect topics that haven't really been previously connected, like burnout and financial independence, and the psychology and philosophy behind money, so how our relationship with money shapes our decisions.

Jimmy: The third thing I guess is that most of the other blogs out there it comes from a voice of expertise that people have already done it, they've already accomplished it, they've already ascended the mountain. Mine is not the same voice. I'm a millennial, I'm young. I am a guy that's walking alongside these people and going through the same things that they're going through right now for many of these people that are still figuring this stuff out. I felt that was a unique perspective and I could be more of a companion on the journey instead of coming from a hey, I've done it, let me tell you how to do it too.
WCI: What do you think, does that give you more credibility or less credibility?

Jimmy: I guess it depends on what you're looking for. I haven't done it. I clearly have a path to get there and can explain it to you in a knowledgeable and intelligent way. I think that I don't lack credibility in terms of the knowledge base. But yeah, if people are certainly looking for someone sometimes that has already done it, and if they're looking for that there are sites for them. For others, they want someone that is in the journey with them and recognizes that there's someone next to them in the arena that's fighting like a gladiator and trying to deal with these tough topics too. I think it really depends on who you are and what you're looking for.

WCI: Of course, I'll tell you, that only works for a few years because then you've done it and then you're the guy who knows.

Jimmy: Yeah, yeah, that changes quickly.

WCI: It's definitely with the blog that's a temporary condition unfortunately, for better or for worse.

WCI: If you had to sum up the message of your blog in one or two lines, what would you say it is?

Jimmy: The Physician Philosopher blog exists to help doctors fight burnout by using financial independence as a tool. I guess that's the one-liner. The background to that is we know that there's a burnout epidemic, 40-50% of doctors are burned out. It seems like there's this dedicated road to burnout for physicians.

WCI: Dedicated road, I like that.

Jimmy: It's set up for that. We have these people that are hard working dedicated perfectionists that worked hard to get to where they are. They sacrificed their 20s. They work really long hours and miss weddings, and funerals, t-ball games, that sort of stuff. At the end, they expect there to be this giant light that's going to make everything worth it. They went through all this stuff, it's going to be worth it, and then they get there and the light, it's not what they expected it to be. They buy the cars, and they buy the house, the private schooling, all of that stuff and find out that it actually makes it worse, even though that stuff was bought to make them happy because they didn't find it when they finished. I'm really out there to help the burned out doctor who was once in love with medicine try to find that again by using financial independence to fight back.

WCI: It's interesting, every blogger has to sit there at the beginning and say, “What am I going to call this? What am I going to put at the top of this blog?” You ended up calling yours The Physician Philosopher, how come? Why'd you choose that name?

Jimmy: I still remember sitting down on the couch next to my wife trying to figure out what we were going to name this thing. My wife's an elementary school teacher and so she appreciation the alliteration of the name. We went through a lot of different things, but unfortunately we would up with a bit of a tongue twister, it's a little hard to say. I might as well have named it She Sells Seashells Down by the Sea Shore. It's tough to type too for some people.

Jimmy: All kidding aside, I'm an anesthesiologist, I'm a physician, so that part fit. Then I was a philosophy major in college who tends to think outside the box and think about traditional problems in a bit of a different light. I felt like it was an apt name for the blog.

WCI: What do you like best about blogging?

Jimmy: I guess there's two things that I really like about blogging. The first is helping people. I love getting the email that says, “Hey, this post was really helpful for me. Really helped me deal with some tough topics and put the things in right perspective. That makes it all worth it in the end.

Jimmy: The second favorite part is writing. I love putting some headphones on, turning some music on, and then writing. It's a bit of catharsis for me and it's honestly one of the ways I've dealt with my own burnout.

Jimmy: I will say that my least favorite part, and I'm ashamed to say this in front of you because I know what your thoughts are on it, but it's promotion and technical stuff, something I've had to learn and I've had to learn to like because it's a necessary part of the job. But unfortunately, it's not something that I just can't wait to do. I really enjoy the writing and connecting with people much more.

WCI: I think that's the case for most people. Most people go into blogging because they like to blog, they like to write, they like to generate content. Then sometimes they decide to do it professionally and realize that when you're doing it professionally that part of the job is only about 10% of the job, unfortunately. Unfortunately, it usually is the best part. It's certainly the best part for me. Of everything I do, that's what I like the best is just sitting down and writing a blog post, but there's just so much more to it, if you actually want people to read it, number one. Number two, if you actually want to make money doing it you're going to spend a lot of your time doing other stuff, unfortunately.

Jimmy: Yeah. I've found that to be true. In real life, I'm not really big on self-promotion. I don't like pointing a lot of lights on me. I'm very much happy to be the sidekick that allows other people to get the light instead. But like you said, if you don't do some self-promotion on blogging, no one reads your writing and in the end, you're not going to accomplish your goal, which is to help people because they're not even going to know it's out there.

WCI: Yeah it's an unfortunate truth. If you don't promote yourself you don't do nearly as much good as you could do.

WCI: Speaking of which, this physician financial blog sphere has absolutely exploded in the last five years, particularly the last two or three years. Why do you think that is?

Jimmy: Well I think that what's happening in medicine is an interesting phenomenon. I think that, particularly for younger physicians, I think for many of the older ones too, that we're starting to see a shift towards work/life balance and trying to find that right fit that allows us to accomplish our job and what we want to do with the rest of our life. I think there have been some bloggers that are younger that have come on the scene in trying to put a voice in that space. Some people attack that from a minimalism perspective like Doctor McFrugal or from a burnout perspective, Crispy Doc or Reflections of a Millennial Doctor, and several up and coming bloggers.

Jimmy: That said, I think that the obvious reason is that there are other bloggers that have done this, enjoyed what they did and have done quite well with it. For a while, you were publishing your income reports on the White Coat Investor. I'd be lying if I said that I didn't read those and didn't say, “Wow, that's really something”. I think that a lot of other people read that too. You've since taken them down I understand, but that was absolutely a part of it I think for many people that got started.

WCI: I didn't publish it quite so openly this year as I did the last. I took last year's down for the most part. But honestly, my reason wasn't necessarily that I didn't want to inspire competition, I was just worried my kids were going to get kidnapped. At a certain point, you go, “Okay, maybe we need a little more discretion here”.

Jimmy: Yeah, that's fair.

WCI: It's super fun to write about your net worth when your net worth is $10,000 or minus $200,000, that's cool, it's cute. Everybody likes it, everybody can relate. As you start hitting the seven figure numbers, all of a sudden it's not generating the same feelings in a lot of the people that read it, unfortunately.
Jimmy: I believe it.

WCI: Maybe it inspires some, but I think it inspires some less than worthy feelings in some other people, unfortunately.

Jimmy: Yeah.

WCI: You have a book out this year “The Physician Philosopher's Guide to Personal Finance: The 20% of Personal Finance Doctors Need to Know to Get 80% of the Results”. I think that makes you just the fourth or fifth physician financial blogger who's also an author, that's counting people like William Bernstein, who I don't know if he wrote any books while he was still practicing medicine. That was after he was done I think that he started writing the books. But it's a pretty select book there. Why did you write the book?

Jimmy: Well I'm really excited about this book, I've gotten a lot of really good feedback on it. But ultimately, I wrote the book because it's a book that I would have wanted to read. I felt like there was still a space to write in this topic. It flows in a chronological order after some introductory chapters on personal finance and conflicts of interest in the financial industry. It basically tells you the 20% that you need to know at any given step along the way. That's something that I wish I had.

Jimmy: I found this stuff really late, so I wanted to write a book that was targeting younger people, so medical students, residents, early career attending physicians, to try to help them figure this stuff out because while you can fix things after you've fallen off the road, it is much easier if you prevent it from the get go. I'm very big on teaching financial literacy to medical students and residents, and felt like this book could serve that purpose. I guess in the end, there was an opportunity to write a book and it was written from my voice, and my perspective, and my thoughts on the topic, and thought that might be helpful for some people.

WCI: What is the 20% of personal finance that doctors need to know? How do you know when you're looking at something whether it's in the 20% or the 80%?

Jimmy: I think that's tough, the easiest way to find that out is to buy the book, obviously. But it's different for everything. For every step along the way you don't probably need to know about complicated investing, or algorithm based investing, or anything at maybe any point, but there are certain topics along the way that are the 20% you need to know. Student loans it going to be your 20% for quite some time. It's just like medicine, when you understand that 20% that's going to get you 80% of the results, you're going to do a really good job.

Jimmy: But I think it really boils down this, personal finance is honestly not that complicated. You earn a good income, you have a plan for your debt, you save some money based on the fact that you're living below that income you earn, and then you put money into the market so that it can work for you. That said, even though it's a very simple design, it's often very complicated, just like a diet or exercise. Just because I know that I should eat well doesn't mean that I didn't eat cookies and cream ice cream last night, that's just what humans do. I think the 20% is really understanding those basic topics, and then setting up a plan and sticking to it so that you can find your success with your personal finances.

WCI: Your writing seemed to focus a lot on contentment, longevity and burnout, yet, you were admittedly working 1.3 FTEs, you have a significant side gig, and you're planning to be financially independent before mid-career, how do you reconcile all that?

Jimmy: That's a good question. I admittedly my first year picked up a few extra shifts because I was trying to pay down my student loans faster. I stopped doing that about a little less than a year ago when my wife started full-time. But the other part of that is that my department, we have a really awesome anesthesia department at Wake, but that said, our services are continually being asked for by other places, so we're continually expanding to other hospitals, to other services, like interventional radiology or GI. Because of that, we've had a hard time keeping up with hiring in that giant expansion that we've experienced in the last 15 months. I'm working 1.3 FTE, I would prefer to be working 1 and I'm steadily working my way to getting down there. But at the end of the day, there's certain number of physicians that work in the anesthesia department and there's a certain number of shifts that need to be covered.

Jimmy: As for the side gig stuff, really, at that end of the day, I'm extremely passionate about this topic and about teaching people about personal finance, and how to find freedom through and escape burnout. Even if I wasn't getting paid to do this, even if I never made money on it, I would still probably be talking to people about this stuff, whether through a blog, or a podcast, or what have you. It doesn't feel like work to me because I'm passionate about it. While I am doing some other things on the side, I'm trying to find balance in it all. Yeah, I do write about these topics and it set me up for burning out myself, but I'd keep doing it anyway because of how passionate I am about it.

WCI: Let's talk a little bit about your own burnout. You published a blog post not long ago saying you experienced a bit of your own burnout this year. Can you tell us about that and what you learned?

Jimmy: I think people focus on burnout, and rightly so, mainly on the job. There are lots of things about medicine that burn people out. That said, I really think it's a matter of work/life balance. If either of those arenas, your work or life at home are off-balance or requiring more work than they used to, you're going to be in a situation where you're going to burn out. I was doing all those things we mentioned above. My first year as an attending was insane. I published three randomized control trials, I won some teaching awards, I worked 1.3 FTE, oh I have three kids and a wife that started working full-time in July.

Jimmy: All of that combined really set me up to burn out because my wife, who is a saint and the best person I know, took care of so many things when I was in training. My wife also happens to be a gifted educator. While I'm slouch at my job it would be unfair for me to expect her to continue to do that because she's a gifted educator that really has the potential to help a ton of kindergarten teachers. She works with kindergarten teachers. She wanted to go back full-time and I completely supported that. What that resulted in is a need for me to help out more at home than I had been previously, because that's fair. I started doing that on top of everything else I was doing and realized that for the first time in my life I do have a limit, and that I had run up against it. I eventually had to start cutting back and asking if people wanted to take shifts that were interested in making more money. Fortunately, we have some of that balance where I work.

Jimmy: That's also when I adopted what I affectionately call my Hell Yes Policy, which basically, the purpose behind that is to say that when someone asks me for involvement in other commitment, or committee, or meeting, or what have you, that unless I'm insanely passionate about it and it really makes me say, “Hell yes,” for the opportunity, then I'm just going to say no. I started saying no to a lot of things and really defining some lines, drawing lines in the sand to help fix that work/life imbalance that I had, because at the end of the day, I really wanted to support my wife in her dreams and passions in her career.

WCI: I love that. Did you guys hear that? What he's saying here is if you can't say, “Hell yes,” to it, say, “No”. That's basically the bottom line. Too many times we become yes men in medicine and we keep getting asked to do these things, to serve in these committees, to do this project, to write this paper, to mentor this student, whatever. At a certain point, you just can't do it all. Look for those things you feel most passionate about, say yes to those, and say no to everything else. That's how you're going to reduce your burnout.

WCI: Speaking of which, do you really think doctor burnout is any different from what people at other professions feel? I just got done recording an interview with Johnathan Clements, it's going to run a couple of weeks after this podcast, and he mentioned that at one point he was feeling a little bit burned out in his journalism career. Is doctor burnout really any different than other professions, and if so, how? Is it just that doctors are whinier about it or is there really a difference there?

Jimmy: I'll answer that last question about the whinier aspect of physicians with a resounding no. I don't think that doctors whine more. There's something different about our career. When you match people in medicine to the general population, both residents and attending physicians have a disproportionately higher rate of burnout. That said, my wife is a teacher and I can tell you that in her career she's experienced lots and lots of burnout in education because teachers are underpaid, and overworked and feel like they're undervalued. I don't think that it's a unique phenomenon just to medicine, but I do think that the burnout in medicine is probably different for other people because of that road to burnout where we sacrifice those 20s, and we miss all those things and we just set ourselves up for this road that we really can't do anything about. If you think about it, you come out of medical school with the average student, 80% of the students having $200,000 in student loans and they're forced into a job in residency where they basically can't pay that debt back so it's just going to continue to accrue. They're fine with that in the meantime while it's Monopoly money, it's not real, they don't have to pay it back yet.

Jimmy: But then they finish, they get to their job and they don't have the autonomy or the privileges they thought they would have as a working physician, an attending physician whose finished their career. It's been taken by EMRs, or administrators, or insurance companies. It really is kind of a set up. Unfortunately, many people find that autonomy stripped away from them, so they try to fix these problems with all the big purchases. I think that's a very unique thing because a resident goes from making a medium income for the country to make four, five, six times that overnight. Despite all of that, we still have disproportionately higher rates of burnout, so something must be different.

WCI: It's interesting, there is a certain sub-segment in medicine, I don't know how large the percentage is, but this group of people that basically doesn't really think burnout is real. Even acknowledging the existence of this group causes me to get hate mail, it turns out. These people jokingly say, “You hate your job, there's a support group for that, it meets on Friday nights at the bar”. Or they say, “It's called work because they have to pay you to do it”. What do you say to those folks, that percentage of people that think burnout's basically a bunch of hooey?

Jimmy: I get pretty feisty about the subject because I think that what they're trying to say is they think that these people are weak, these people that are having difficulties with their work/life balance that they're burning out. These people are too weak to take their job and the problems that come along with it.

Jimmy: There's a great video by Doctor Ed Ellison that talks about studies where they look at medical students as graduate students coming into their graduate school and they are compared to other graduate programs, they have the highest ratings of wellness resilience coming into medical school, compared to any other graduate program. Yet, when they leave, they have the lowest. Something's happening in our training paradigm that results in this stuff. I'd asked these people if they're really paying attention to the statistics. Medscape, Mayo, several other places have shown that burnout rates are up 40-50%, that's 1 in 2 doctors. The suicide numbers are no better. Women physicians are 130% more likely than the general population to commit suicide and men are 40% higher. I don't know where these people are getting the idea from, but a doctor a day kills themselves and we have a problem in this country and it's very real. Unfortunately, some people don't like to pay attention to these statistics and heap it on their backs of people, and say that they just need to pick themselves up by their bootstraps.

Jimmy: Really, at the end of the day, doctors are a perfect setup for this stuff. We're perfectionist. We're hardworking. We don't like to ask for help. All of that results in a situation where people can be struggling and because of people like this that don't believe that burnout's real, there's a stigma and they're afraid to ask for help. I think that not only are those people wrong, but I think they're actually harming others by thinking that.

WCI: It's interesting. I have written about burnout some, not a lot, and spoken about it more than I've written about it. It turns out that throwing a little bit of burnout into a talk seems to help it qualify for CME, so I often do in some of the speaking engagements I do.

Jimmy: That makes sense.

WCI: But I've divided it into four issues that seem to affect docs. The first of which is systemic issues, these problems with abusive jobs, EMRs, all these problems that are particularly coming acute in the last few years, maintenance and certification stressors, those kinds of things. That's the first category.

WCI: The second is the stresses of the profession that simply can't be eliminated, dealing with sick people, things that just aren't going away, watching people die, that kind of thing, it's a difficult job, et cetera.

WCI: The third category is financial stress which often begins early in the career with the student loan debt, but can be exacerbated by poor financial decision making.

WCI: Then the last one is the personal factor, the amount of resiliency in the person.

WCI: If you had to assign percentages to those four things, the systemic issues, the professional issues, the finances, and the individual person, what percentage would you assign to each of those for burnout?

Jimmy: What I think is a little bit different about this subject where I think the burnout is a systematic or systemic problem, if you really look at the studies that have tried to determine what the causes of burnout are for physicians, whether you look at the Medscape study or other ones, really you can clump a lot of the causes down into one major cause, which is autonomy. That is something that makes sense because Ed Deci and Rich Ryan, two guys that have looked at work satisfaction and motivation at work have come up with really three key components to be satisfied at work: autonomy, meaning that you have the freedom to do your job how you wish, competence, meaning you're good at it, then relatedness, which is a fancy word saying that basically you get support from your workplace.

Jimmy: I think that those three categories fit into the four that you mentioned in a way because autonomy is something that most people feel like has been stripped away from them, whether it's an electronic medical record system, insurance companies, or CMEs, or things like you were mentioning before in your first category. I certainly think that most physicians are competent at their job, but many of them don't feel that way. They have massive imposture syndrome, particularly when they're young in their career. A lot of doctors are in a situation where they feel like they're not getting a lot of support. They're raising concerns and nothing's being done about them, so they don't have a lot of that relatedness.

Jimmy: I guess at the end of the day I'd say that the majority of it is systematic or systematic and that could be made substantially worse by the financial decisions that people make. You can either find freedom through your financial decisions or you can cause this burnout problem to be much worse. I don't know about exact percentages, but those certainly all contribute.

WCI: You don't sound like you would assign any amount of responsibility or percentage to a lack of resiliency in the practitioner.
Jimmy: I have a hard time believing that people that worked so hard to get through medical school, residency, and fellowship decided to pursue a career in medicine and just what it takes to do that and get there. Who are the top 1-5% of intelligence in the country that these people are just all of a sudden going to be lazy and have a lack of ability to deal with difficult situations. I think that, I've gotten some flack for this before actually from my military readers, but the most common thing to really compare this to is being in the military. When you see things that are disturbing, traumatizing, you mentioned those parts of the job that you can't change, that causes secondary post-traumatic stress disorder, there's studies on this.

Jimmy: I think most of the problems that occur happen because of the system. I'm slow to blame the physician for having burnout problems. Now, that said, I do think that there are things that individuals can do to make that problem better, but I'm not going to place a lot of blame on them. I just think that when they finish their reality is very different than what they expected during all of those long years of training.

WCI: I think there's a big mismatch for a lot of people. It's difficult to decide what you're going to do the rest of your life when you're 22-23 years old.
Jimmy: Absolutely.

WCI: All of a sudden, you come out at 35, or whatever, out of the other end of the medical training pipeline and you're a very different person. You have very different life goals, and very different interests and it turns out that what you thought you wanted at 22 isn't what you want at 35, then you have to reconcile that. Add in $400,000 of student loans and the fact that you're not qualified to do anything else that could ever possibly pay those loans back just adds additional stress to it.

Jimmy: Sure, absolutely.

WCI: The physician financial blogosphere as a prescribed solution to burnout, which is basically FIRE, financial independence retire early, is that really the best solution to burnout?

Jimmy: No, I don't think that it is. On my site you're not going to see me talk about early retirement very much, part of that is because my target audience is younger. I honestly think thinking about early retirement is not always a healthy thing, particularly young in your career. But no, don't think it's the best solution. Honestly, it's a systemic problem and so it's going to require a systemic or systematic solution. The way that I look at this, the way I explain it to people is it's a bit like the aviation industry in the 1970s. This analogy is coming up I guess at a bit of a hard time with the Boeing incidents that have been happening, but in the 1970s aviation, airline industries, they had accidents all the time, people died all the time. Then not until March of 1977, basically on Ten Reef Island there was an accident that killed about 600. That led the aviation industry to look into things and say, “What's happening? Why is this happening? Why are people continually dying on airplanes?”

Jimmy: What they found out is that there was a culture problem. They had a culture where the pilot was God, he got to decide what happened, when it happened, you couldn't question them. There were not checklists or safety systems put in place and if they were bypassed by the pilot no one could say anything. People in that accident actually knew that something bad was about to happen and yet they still didn't say anything, and literally let the pilot drive them to their death because of how strong the culture was.

Jimmy: I think that's the same that it is in medicine nowadays. In the aviation industry there response to this was something called Crew Resource Management where they basically started looking at the systematic ways they could fix these problems. It led to the safety systems that we use in the aviation industry now that makes it much, much safer to fly.

Jimmy: Honestly, that's the same thing that spawned the Atul Gawande's Checklist Manifesto and the checklists that are used there ad that are used in several hospitals in the country. I think that the solution is not FIRE, it's not to escape it, it's a systematic problem that's going to require systematic solutions. That said, I think that many, many people feel like the system's just not going to get fixed. No one seems to be doing anything about this, despite the problems that we're having, the people in the trenches, the physicians in the trenches that are burning out in medicine feel like no one is coming to their rescue. I do think that there's some onus on the physician to say, “Well if the system's not going to fix itself then I need to look for ways to provide freedom for myself”.

Jimmy: In my opinion, that can be done through financial independence. It provides us a way to win back that autonomy that led to our burnout, or to cut back, or to change things, or to find the shift that we like, or the aspects of the job that we really enjoy and cut back on the things that we don't. Ultimately, it's kind of like a support yourself fund. I think the people that are able to do that can fight against this problem even if the system isn't going to be willing to change, which is ultimately what needs to happen.

WCI: Everyone says the system has to change, it's a system problem, what has to change?

Jimmy: I don't have a great answer for that. I think that there are obvious things that need to change. The electronic medical records system is broken, it's as glorified billing system that is not meant for patient care. Yet, it's sold to physicians as a patient care tool. That death by a million clicks, if you will, needs to be changed. I think too that a lot of physicians feel like administrators who don't do their job can't do their job, are telling them how to do their job, which really frustrates people. The push here that's happened is that 75-80% of doctors are now employed, so they're not their own bosses anymore like they used to be. I don't know how to fix that. That's going to have to come from administration and from hospitals, or finding your own group that isn't owned.
WCI: I think that's difficult in today's trend of consolidation. Even my small democratic group, when I joined it I think I was about the 10th doctor. Even at that time we'd consolidated with three other groups to negotiate with insurance companies and so on and so forth. But even the eight years I've been here this group has expanded from, I don't know, maybe it was 40 or 50 doctors at that point, I think we're now 350 or 400 doctors in this small democratic group. It's just not a small group anymore.

Jimmy: No, it's not.

WCI: It's either that or be eating by the contract management groups out there.

Jimmy: Yeah, that's right.

WCI: I think yes in some ways physicians have given up some of their autonomy by not insisting on owning their practices and on not pushing back against the administration as the medical staff. But in a lot of ways, we're kind of victims of just the way the healthcare economy has been moving, that it's very beneficial financially to consolidate.

Jimmy: That's right.

WCI: I'm not sure how much the individual doc can fight against that trend.

Jimmy: I agree with you actually. I don't think that they can do a whole lot, except for to set themselves up for a way to speak up and talk back, and claim that autonomy. But that's all personal. In terms of the system, it's a very complicated murky problem that I don't know there's a great solution for. But right now, I think that we're really in a stage of awareness, and defining the problem and then we're ultimately going to have to try to fix it somehow, but I don't know that we're there yet.

WCI: I think there have been some good things we've seen develop in the last decade or so. For example, the hospitalist, the idea of a hospitalist. Now we have internists, and pediatricians and even now some surgeons, acute care surgeons, acute care and trauma surgery, whatever you want to call it, that are trying to do what emergency medicine, or radiology, and anesthesia already figured out to where we're working shifts. Then when you're off you're actually off.

Jimmy: Sure.

WCI: But the problem I see is that doctors go, “Oh, I got these shifts and I get paid so well for them, let's stack on a few more”. I meet these hospitalists who are working 25 12s a month and I'm like, look at the emergency docs, why aren't they doing that? There's a reason. It's because it does not work long-term. You get past 18 or so a month and it's just a recipe for burnout. I think there are some trends I'm seeing within medicine, but I think most of them are a result of either a shortage of a particular type of specialist, or for some reason that doctor electing to work more than is really healthy. Oftentimes, there's a financial impetus behind that.

Jimmy: Absolutely. I think that people they put themselves in a corner and build out these walls of financial decisions that they have to break through. When you have a very expensive lifestyle that requires a high income, if you keep making those decisions then it requires a higher and higher income, and more and more shifts. I think that people have lost the ultimate goal of all of this, which is to get your time and to be able to spend it however you want, whatever that perfect day looks like for you. Instead, we've traded it for things, and stuff and the money that's required to do that.

WCI: Let's talk briefly about a topic that often comes to mind when this gets discussed among doctors. Is it morally wrong for doctors to retire early or even to cut back? Should those doctors not have been let into medical school in the first place? Are they not dedicated to their patients? Are we as physician financial bloggers contributing to the doctor shortage?

Jimmy: I always think this is a funny conversation. What I think's morally wrong is having a physician burnout and suicide problem in our country and watching very little get done with it. That's what's morally wrong to me. There's a problem in the system and we need to fix it. But as for the morality of early retirement and whether that's a thing or not, I remember there was a Business Insider article that came out, it was highlighting Leif, Physician on FIRE, basically went through a week of his spending and it got posted on Doximity. Leif just took so much heat for that because people were like, “This is incredulous. I can't believe that you're retiring early. You're a doctor. You put in some many years of work. It's a shame. They should have never let you in”. He really got roasted pretty badly on that.

Jimmy: I wrote a response to that called “It's Wrong for Doctors to Retire Early” which is a bit clickbaity, but I basically went through all the arguments, the common arguments that people have for this sort of thing and talk about the fact that the logical extension of these arguments don't make sense. It's wrong to retire early. Okay, well at what age is it okay? Is it okay at 60, 65, 70, do you have to work until you're literally in the grave? At some point it becomes okay. Why is it okay in later years? How many years are required by these people that want to make these kind of comments? Is it really the physician's fault that there is a physician shortage? Well, the ACGME slots are limited, so we have tons of doctors that graduated from medical school every single year, they have 100 of $1000s in student loans and they can't get into a residency that will allow them to finish their career and to become board certified attending physicians. That's morally wrong. We have a bottleneck that isn't getting fixed.

Jimmy: I think it's funny because people focus on this thing and have very heated comments to make about it, but we don't want to talk about other things that are actual problems, the bottleneck, or the fact that physicians are burning out at epidemic rates. I don't think there's a lot of truth to those arguments. Obviously, I don't put a lot of weight into them.

WCI: I can tell you feel strongly about them.

Jimmy: Yeah.

WCI: So-

Jimmy: I don't mince my words on that.

WCI: Let's turn the page a little bit and talk about these net worth updates you've put on your blog about your own personal net worth. Do you plan to keep doing that and if so, for how long?

Jimmy: Gosh, I've thought about this. I'm not sure. I think that I'll probably at least put one up for April and July to finish my first two years since I started as an attending. Honestly Jim, the people that know me in real life, I'm a really transparent, open and honest person, literally to a fault. If you want an honest opinion, people know, just come and ask me. I'm going to give you my opinion. It may not be what you want to hear, but it's going to be honest. I don't have a problem being transparent, but as things go along I do start to have the same concern that you mentioned earlier about your family's safety and how much information is out there. If people want me to keep doing it I'll probably consider it, but if they don't notice that I've stopped then I probably won't.

WCI: Your last update in February showed your net worth was barely 6 figures, about 18 months out of training. Do you think that puts you ahead of our behind most of your peers?

Jimmy: I feel like it's kind of a trap question because I'm very much not a person that tries to compare myself to other people when it comes to finances. I think that's actually a healthy habit. That said, we started at -$207,000 when I finished, so being at $100,000 18 months later, that means I improved our net worth by $300,000 in 18 months. I was pretty happy with that progress. I try not to get too caught up with looking at other people, but we could have done better if we cut back more, but I think that there's a balance that people need to find. You can certainly cut back too much. My wife is very helpful in reminding me when I do that, but I think that we've done pretty well.

WCI: I would say getting into the positive in less two years probably does put you ahead of most of your peers based on the emails I get from people, but it's hard to say. There's not really a great graph out there. The one I've seen is that doctors in their 30s, something like 77% or 81%, something like that, have a net worth under $500,000, but that doesn't really tell you when people typically turn positive. We tried to have a celebration this year in the community of Back to Broke, the doctors could celebrate when they got back to a net worth of zero. I don't know that it really caught on very well, but it really is a moment worth celebrating because-

Jimmy: Absolutely.

WCI: … it takes a lot of work just to get back to zero when you're a doctor.

Jimmy: We were extremely excited when it happened and I completely agree, it's a milestone worth celebrating.

WCI: You just mentioned that you paid off a whole lot of student loans very quickly. Can you talk a little bit about how you were able to do that and maybe a little why don't most doctors do that, why don't they wipe out their student loans quickly?

Jimmy: Really, in my mind, the reason that this doesn't happen for most people is because of that road that I talked about, that we are destined for when we finish and then with all of that delayed gratification, which physicians clearly need to be good at because you did it for 7, 10, 12 years after high school. I think that what happens is people say, “Hey, there's light at the end of the road. I really want to reward myself for all of these tough years, long hours,” all the sacrifices that they made, so they really inflate their lifestyle. I think that some lifestyle creep to some extent is fine.

Jimmy: In fact, when I talk to people about something called the 10% rule, where basically you take your difference in your take home post-tax pay, and then whatever that difference is, say it's $10,000, then you take $1,000 of that, or 10%, and you spend it on whatever your heart wants. I don't put people to box on this one, you can do whatever you want. I actually did some pretty financially stupid things with my 10%, in truth and transparency there. But I put the other 90% towards our student loans and towards maxing out some retirement vehicles and ended up paying $200,000 off in 19 months. It required discipline. But this 10% rule man, when I finished I got to inflate my lifestyle by $1,000 post-tax a month. I felt like I was living like a king with the changes that we made. I feel like that allowed us to deal with that desire to improve your lifestyle, that you've earned that, while still doing the right and responsible financial thing at the end of the day.

WCI: Yeah, that's a good perspective there. It's interesting, sometimes we forget that investing in personal finance is a single player game. You're playing you against your goals, you're not trying to beat anybody else.

Jimmy: Exactly.

WCI: As long as you are making progress toward what you want to accomplish you're winning the game in that respect. It's Solitaire really.

Jimmy: Sure, exactly.

WCI: Now I now have three partners in the White Coat Investor blogging network, all three of which are anesthesiologists. Do anesthesiologists deserve the reputation as the investors of medicine?

Jimmy: You got to love stereotypes, but I've only worked at Wake and so I can only speak about our department. I may not be the best person to ask about this, but no, I don't really think so. I think that what's happened is that these blogging websites are it caters to people who do shift works. We're doing this podcast interview on a Monday, I have today off. I was post-call from yesterday, so it gives us opportunities to do this. I think that it does give a bit of a slant towards the emergency medicine and anesthesia careers because we have more opportunity to talk about this stuff then someone who's working week on, week off or someone that's working every day, in particular.

WCI: Yeah, for sure. When I started the White Coat Investor it was with a bunch of weekday mornings that I didn't know what to do with. No doubt about it, this would not exist if I had been a classic internist in clinic every Monday during bankers hours-

Jimmy: Exactly.

WCI: … it would not have happened. There's no doubt about that.

WCI: You decided pretty early on really not to blog anonymously. That was not the case for the Physician on Fire or Passive Income MD, they eventually came out of the anonymous blogging closet, but that never really seemed to be much of a thought for you. Why was that?

Jimmy: The site started in November of 2017, which was anonymous at the time, and ended up becoming non-anonymous in February when I published my book. But really the background of that is that, and this is maybe helpful for some people that are considering doing side gigs, I'm an employed physician, so I didn't know what my hospital would think about my blog, particularly given my open transparent nature. I didn't know what to do with it. I thought that it might be safer if I just kept it anonymous.

Jimmy: Then I spent nine months writing “The Physician Philosopher's Guide to Personal Finance” so I had to make a decision because I was really proud of that book. I put a lot of work in it, I really tried to whittle it down to what people need to know so they could read it pretty quickly and not waste a whole lot of time. When I did that, I wanted to put my name on it, I was proud of the book. I approached my chair about the book, about the blog and said, “Hey, I just want you to know that these things exist”. I was extremely nervous going into that meeting actually. My chair was unbelievably supportive. We talked about that relatedness, feeling like you have support from your work place. When that happened, my work satisfaction was maybe at an all-time peak, just because I felt like he was really supporting me in my ambitions. When they have their thinking cap on this really is something that makes them look good. I think that he recognized that. But the hesitancy was just I didn't know what my employer would think about it, to be honest with. Then when the book came out I had to make a decision.

WCI: Going back to the beginning of your blog, your very first post was “How to Choose a Medical Specialty”. Why did you choose that for your first post?

Jimmy: Blogging, podcasting, anything like this is really funny. You get to put your voice out there when you don't have one, you haven't really found it yet, and get to write or talk, and say things that, I don't even know what the word is. I look back at my first posts and I cringe. I wrote about posts back then when I first started on topics that I was commonly asked by medical students or residents that I thought that they might find helpful. Really, I just made a list of things that I commonly get asked that I had an opinion on and started writing. This happened to be the first topic that I chose. But yeah, I think that I've come a long way in terms of defining exactly what the purpose of my site is and where it's heading from here.

WCI: Don't go back and read any of my stuff in the first year or so. There's plenty of stuff in there I'm not super proud of.

Jimmy: Exactly.

WCI: I think I got the message out pretty early on in the first few months, but I've tried a lot of things that just didn't work over the years. It's funny because you don't realize that's okay because nobody's reading.

Jimmy: That's right.

WCI: There's nobody out there reading this stuff. Occasionally, I have someone write me and say, “Hey, I've gone back to the beginning, I've read everything”. I'm like, “Wow, you've read some terrible stuff”. It's interesting the progression of a blogger.

Jimmy: Yeah, for sure.

WCI: Speaking of which, tell us about your plans for the future.

Jimmy: I'm going to continue to grow the site. I'm obviously joining the White Coat Investor Network, which is a huge moment for my site and I'm looking forward to seeing what's going to happen with that. I'm going to continue to fight burnout with financial independence. I've started a Facebook group called Physician Philosophers and it's really for anyone who wants to discuss their journey to FI and their journey to find work/life balance. I might consider making some courses at some point. I've considered doing some more guest podcasting or possibly even doing a podcast of my own someday. I guess just continuing more of the same with trying to get more promotion and outreach out there.

WCI: What does it take to get into that group, do you have to be a philosophy major?

Jimmy: No you don't. You have to tell me your favorite philosopher. It is a physician group, so it's for MDs and DOs, and that's basically it. As long as you're on that road that I've been talking about you're welcome to join.

WCI: Cool.

Jimmy: I wanted people to have a safe place to really say what they thought from their perspective.

WCI: How can listeners follow you and learn more about That Physician Philosopher?

Jimmy: Well you can visit the site, thephysicianphilosopher.com. I put out posts three times a week. You can also subscribe to email lists, which you can find on the front page of the site where you can choose to get updates either weekly or as soon as the post comes out, and you have two different options there based on the number of emails you want because I'm not any bigger fan than anyone else on emails.

Jimmy: You can buy the book, “The Physician Philosopher's Guide to Personal Finance” and of course, you can join that Facebook group we just talked about or follow me on Twitter which is @physphilosophers, that's P-H-Y-S philosopher.

WCI: All right, Jimmy Turner, anesthesiologist and The Physician Philosopher, thank you for being on the podcast today. Thank you for joining the White Coat Investor Network. I'm sure that listeners will be hearing a whole lot more about you in the future.

Jimmy: Thanks Jim. I had a ton of fun, really appreciate the opportunity.

WCI: That was wonderful to have Jimmy on the podcast.

WCI: This podcast is sponsored by Pradeep Audho who's an independent insurance broker and the owner of PKA Insurance Group, Inc. He's based in Boston, but works with clients nationwide. His focus is on disability and life insurance. Pradeep has over 15 years of experience providing clients with disability life insurance. He represents all the major pure owned occupation disability insurance carriers. He's very laid back and approachable, is not a pushy salesperson. You can request life and disability quotes on his website at pkainsurance.com or you can reach Pradeep by phone at 978-314-7795.

WCI: Head up, shoulders back, check out The Physician Philosopher and his book. You've got this and we'll be here next time on the White Coat Investor Podcast.

Daughter: My dad, your host, Doctor Dahle is a practicing emergency physician, blogger, author, and podcaster. He is not a licensed accountant, attorney, or financial advisor, so this podcast is for your entertainment and information only, and should not be considered official personalized financial advice.