Podcast #150 Show Notes: Side Gigs, Women, and Demographic Changes in Medicine

Medical school classes now have slightly more women than men. In today’s episode, we talk a little bit about what that means, both for male and female doctors, for employers, and for patients. We cover some controversial topics that typically I only talk about with this week’s guest privately, but Dr. Nisha Mehta of Physician Side Gigs and I delve into the demographic changes that we are seeing in medicine and the issues women physicians are facing. Whether you are a male or female physician, you will finish this episode with the confidence to be an advocate for yourself and your family. You can have a life in medicine that works for you. Nothing is impossible. We talk about how to make that happen in this episode.

 

Have you ever considered a different way of practicing medicine? Whether you are burned out, need a change of pace, or want to see the world, locum tenens might be that option for you. Not sure where to start? Locumstory.com is the place where you can get real, unbiased answers to your questions. They answer basic questions like, “What is locum tenens?”, to more complex questions about pay ranges, taxes, various specialties, and how locum tenens works for PAs and NPs. Go to Locumstory.com and get the answers.

Quote of the Day

Our quote of the day today comes from William Bernstein, MD.

“You are engaged in a life-and-death struggle with the financial services industry. If you act on the assumption that every broker, insurance salesman, and financial advisor you encounter is a hardened criminal, you will do just fine.”

Side Gigs, Women, and Demographic Changes in Medicine

Women in Medicine

Medical school classes now have slightly more women than men. That is the way college has been for some time. So that trend is likely to grow at least a bit more going forward. 70-80% of female physicians are in dual high-income couples. That’s a much higher number than it is for men, although male physicians are also more likely to be married to high earners, or at least highly educated partners. I asked Dr. Mehta to talk about some of the financial and career considerations that that statistic has, or can impact, versus someone that’s married to a stay-at-home dad.

“I think it’s a fundamental shift in the demographics of the physician workforce that comes with a lot of implications. Every physician family is different. So, what applies to one female physician or one male physician, for that matter, isn’t uniform to everyone. So, certainly there are plenty of women physicians who are also the sole breadwinner in their families, or make significantly more than their spouses, or any other host of reasons why the overall statistics I’m citing might not be applicable in their particular situations.

But my point in stressing this particular statistic a lot in my talks is because when we see the implications that we have on the workforce as a whole, when we look at that number and how it really emphasizes a need to change the system.  I think we all have to create the life in medicine that works for us, and the fact is that most female physicians have a very different reality at home than whatever image it is that people have when they conjure up an image of a traditional physician. And that, obviously, for logical reasons and reasons that should happen, has implications on how we approach the job market and our careers. And so I think it’s so important for us to be able to acknowledge those differences because when you don’t, that’s when you really start seeing the impact that they have on career longevity.

The fact is that currently, 40% of female physicians go part-time or leave medicine entirely within six years of finishing their training. And that is a really crazy statistic if you think about it, especially when you think about the fact that half of the physician workforce is female, or will be female soon. So, as long as that is the right direction for themselves and their families, that is completely fine and definitely something that I would encourage. But on a larger level, it begs the question of what we as the physician workforce need to change to support or otherwise adjust so that we make sure that females aren’t leaving medicine for the wrong reasons, or because we don’t have a system that allows them to thrive.

We are getting closer and closer to a point where half of the physician workforce is going to be female. And when you take those statistics in combination with rising physician burnout and increasing physician shortage, they really raise real health policy issues in regards to the sustainability of the physician workforce. So I think, with my overall mission when I talk about the need for cultural change in medicine and emphasizing career longevity, it’s really that we need to create a system that’s more flexible and that allows women in medicine, males in dual-income families, millennials, later-career physicians, whatever other groups of physicians that don’t see themselves fitting into the mold of the “traditional doctor lifestyle” and everything that comes with it, to be able to create those careers that they want so that they can do it for the long haul.”

40% of women physicians go part-time or leave medicine altogether within six years of coming out of training. Now, I’m sure that number has increased for men over the last decade or two. Certainly, there’s more interest in part-time work among all people. But clearly women are more likely to go part-time, more likely to leave medicine completely, probably more likely to take a job that pays less but is more flexible.

70-80% of female physicians are in dual high-income couples, that leaves 20-30% that are not. Do their career tracks, going part-time, leaving medicine, etc, do they mirror that of men more commonly, particularly men that are the primary breadwinners? Is this a phenomenon more of being in a dual high-earner couple, or a phenomenon more of being women?

“Obviously there’s a lot of different pieces to that, but I think that female physicians who are sole breadwinners in their families are much more likely, and again, this is based on anecdotal, you know, me running around talking to people, not based on hard statistics but from what I see anecdotally, I think that female physicians who are sole breadwinners are much more likely to have careers that sort of mirror the more traditional physicians over the past few decades.

That being said, I still think that those female physicians, if they are part of families where they have children and they’re still wanting to be mothers, they still feel pulled in different ways. And that’s not to say that male physicians don’t also want more time with their families or any of those things, but I think there’s something about being a female physician where you’re still balancing that role of mother and society’s expectations of what mother means with your role as a physician.

And so even amongst the female physicians that I know that are primary breadwinners for their families, depending on what environment they are in in terms of private practice versus academic, a lot of them are still more likely to make some lifestyle decisions such that they can be at home with their families. Certainly, if you’re in a dual high-income family, you’ve got a lot more options available to you because you aren’t the one person that has to bring home the majority of your household income, and so that opens up a whole world of different options in there in terms of how much you work and how much you need to get paid and what kind of opportunity costs you’re able to place on flexibility.”

Nisha shared how in her family she took a job that paid less but had no responsibilities outside traditional work hours because that was important to her. But she was not paid less per unit of work she did in comparison to a colleague as that would have been a huge issue for her. Female physicians should never be in a position where they’re taking less money for doing the same amount of work. But she points out that there are certain situations in which female physicians have been offered less per RVU than their male counterparts and, therefore, even if they’re producing the same RVUs they’re making less money. There is a pay gap. Why do women who are offered less per RVU, or per whatever unit of work, accept it?

“I think that time and time again, there has been data out there that shows that females negotiate less. And you or anybody that follows me knows that I’m a big believer in negotiation and I negotiate hard. But I do think that there’s a lot of female physicians who worry about perceptions that are out there if they negotiate too hard. Or, if you’re given a lower starting point to negotiate from, then you’ve got a lot bigger of a hurdle to pass to the point where you could be on par with everyone else because if you’re offered $230,000 for a job where everybody else is being paid $250,000 and you’re trying to negotiate at that rate, whereas they gave your male counterpart an offer for $240,000, well he’s got $10,000 to negotiate up whereas you’ve got $20,000 to negotiate up.

And so a lot of times female physicians are offered less from the get-go. And a lot of times, at the end of the day people who are offering them jobs are running businesses and they are doing things based on strong business sense as they should; however, the problem becomes a lot of times they’ll make assumptions about female physicians and say, “Oh, well that person already has a spouse that’s working in this area so they need to be in this area, and therefore they’re probably more likely to take a job even if we offer them a little bit less, so let’s offer less and see where we end up.” And it’s not that they’re bad people; they’re also just trying to get the best deal for themselves. And I think that’s why it’s so important for female physicians to also step up to the plate, know their compensation data, know all of those things ahead of time so that they can come to the negotiating table as strongly as possible. So I think that that’s one thing.

I think the other thing is, is that there’s a lot of groups, whether they say it or not in person, and I’ve had plenty of these conversations confidentially amongst different physicians, where they’ll say, “Yeah, my group definitely will offer a female physician a little bit less because we’re accounting for the fact that there’s probably going to be a paid maternity leave in there,” or “There’s probably going to be decreased productivity at some point because of x, y, and z.” At the end of the day, these conversations are happening behind closed doors.”

This is completely illegal but Nisha can tell plenty of stories about it happening.

Dual High Income Couple’s Budget

With a dual high income earning couple how does the family budget become different? Nisha said they make a lot of decisions different than her parents did growing up with a stay at home mom. As a dual high income earning couple they pay a lot more for convenience and outsource a lot more.

“We definitely, as a dual high-income family, place a lot of budgetary resources into convenience and making our lives easier so that we can get more time with our children. So we’re trying to buy back some of that time. In terms of the things that are lower, it’s actually funny because our budget for almost everything, especially with both of us working the hours that we are, it’s actually lower than most of our friends’ because we’re so time-crunched. We just don’t have time to spend money. There’s less impulse purchases. I literally, when I go to the mall, I go in, I get what I want, I leave. I’m not walking around and being like, “Oh, that would be nice,” and “Maybe that would be nice,” and so I buy a lot less. There’s a lot less money spent on memberships that we don’t have time to utilize. We don’t have cable TV because we don’t have time to watch it. And so in a lot ways it’s funny because a lot of our fixed expenses are actually a lot lower than our friends who are not in dual high-income families because we just don’t have the time to do a lot of those things.”

Retirement Savings as a Dual High-Income Couple

What are the differences that you see when you’re a dual high-income versus a single high-income couple?

“When you max out two W-2 job retirement plans, that’s probably going to add up pretty quickly. That being said, of course, as a dual-physician sub-specialized couple, neither one of us really had real jobs until well into our thirties. So we started out way behind also. So I think you’re definitely on a delayed schedule in a lot of dual high-income families because people have, usually, additional degrees or things that kind of held off them being able to contribute a lot towards retirement, whether it was student loan burden or whether it was other things related to getting your life in gear.

But then once you start building it starts adding up pretty quickly because you do get to a point where you’re easily able to say, “Okay, what are all the things that I can do to max outmy tax advantaged account and, “Yeah, okay. Obviously, I’m going to fully fund my 401(k). If I have a 457, I’m going to put money in there also. If I’ve got a backdoor option, I’m going to do that.” You start having the ability to max out a lot of these things, and hopefully you get in at the right time and that stuff compounds quickly.

For us, especially with the business tax savings also, it’s been pretty easy to build a pretty substantial retirement nest egg because of the fact that we’ve got two of us actively contributing to multiple retirement plans and that’s been really good for us. But again, we also have family members who have been contributing to their 401(k) since they were 21 and they’re doing pretty well, too. So I don’t know you’ve got that lost opportunity cost of at least a decade when you’re coming into things as a physician in terms of those retirement accounts.”

Changing Demographics

We mentioned earlier that 40% of women physicians are likely to go part-time or punch out of medicine relatively early in their career, within six years of coming out of training. There are more women in medicine now. Doctors, male and female, want better lifestyles than the last generation had. Part-time work, side gigs, FIRE, seems to have more of a place than it used to. We talked about how this affects doctors, employers and patients. Very few of us are talking about practicing medicine into our 70s like many of the previous generation did. Older generations of physicians were a lot less worried about their income sources, didn’t have as much student debt, weren’t so worried about the future of their profession.

“I think nowadays so many of the physicians I talk to want a Plan B or a Plan C or even a Plan D, just so that they can make sure that they have the life that they want. And certainly in the context is that alternative income stream and I know for our family, it’s been really nice to know that if for some reason anything happened to one particular stream of income we would be okay. And that allows us to practice medicine happily on our own terms. When you’re tied to an employed position that you need, then your ability to walk away from a bad situation, of which it seems that there are increasingly more in medicine, that goes down. And so that’s why I advocate for a lot of these things, not because I want people to leave medicine, but because I want them to be able to do it on their own terms and be able to do it for longer.”

When the physician’s goals are to punch out of medicine as quickly as possible that does cause problems for sustainability of the physician workforce. That can be a huge deal for employers. Nisha reminds physicians that there’s a real physician shortage and if you understand your leverage in that particular position, where the demand for physicians is going to become greater than our ability to supply physicians, you will be able to negotiate the life you want in medicine.  They will have to change their job system to try to be able to retain physicians.

“I think when physicians and the public are looking at the problem of physician burnout they really need to be thinking about the sustainability of the healthcare workforce and what it means for them. And that’s what I always try to emphasize in my talks is, I understand you might not feel bad for us when we’re making six-figure salaries and doing all of these things. But this impacts you as well because you need access to physicians and you need access to this training and this healthcare.”

 

Top Side Gigs

We agree that not everyone needs a side gig to be financially successful. But Nisha did find that her side gigs gave her something new to be excited about, made her love her physician job more because she was excited and invigorated by some of the stuff that she was doing outside of it on her own terms. She feels side gigs have really enhanced her career longevity as a radiologist. I asked her what the top three side gigs are for physicians. From a financial perspective, she said it was hard to beat real estate investing. She finds the side gigs of owning other businesses very interesting like owning breweries or creating products.  She loves speaking and writing as it allows you to connect with so many people.

“There’s so many different options out there. I think you have to kind of figure out what your goal is for your side gig. Is it purely a monetary thing? Then I think it will take you down one pathway. But if it’s about exploring an interest that you have and then being able to reap some financial benefits from it on the back end, well, then that’s probably a different pathway for everyone.”

Building the Life You Want

Dr. Mehta wants to spread the message that you can create your life on your own terms.

“I think medicine, despite how amazing it is, shouldn’t be the only thing that defines you. I think a lot of us really need to take time to think about what it is that we want out of life, whether that’s professionally, personally, financially, etc. I always tell people that it’s amazing how many doctors can’t say what they want. A lot of people come to me talking to me about their burnout, or their professional struggles, or financial struggles, and the first thing I always ask them is, “What do you want?” and a lot of people have a really hard time answering that question. And it’s not surprising because, for a lot of us, the last time that we thought about that is probably when we checked off that pre-med box in college.

But I think it’s important that we go back regularly and sort of reassess that as our lives evolve. So I always tell people don’t assume anything is impossible. Be an advocate for yourself and your families. You have the right to have a life in medicine that works for you and so you should go after that. Don’t leave medicine because you think there’s no options. If you still love the heart of what you do, I think in this era of physician shortages you have more bargaining power than you think, there’s probably something out there that works for you. So just figure out your goals and then the rest in terms of learning about the how and the finances and all the other things that you need to do to make those things happen, that’s a lot less daunting once you can figure out what it is that you want.

Ending

Now go and create the life you want! For those who want to learn more about Dr Nisha Mehta, you can find her at nishamehtamd.com. Her Facebook group is Physician Side Gigs, a physician only private group.

Full Transcription

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. Here’s your host, Dr. Jim Dahle.
Dr. Jim Dahle:

This is White Coat Investor Podcast #150: Side Gigs, Women, and Demographic Changes in Medicine. Have you ever considered a different way of practicing medicine? Whether you are burned out, need a change of pace, or want to see the world, locum tenens might be that option for you. Not sure where to start? Locumstory.com is the place where you can get real, unbiased answers to your questions. They answer basic questions like, “What is locum tenens?” to more complex questions about pay ranges, taxes, various specialties, and how locum tenens work for PAs and NPs. Go to whitecoatinvestor.com/locumstory and get the answers.

Dr. Jim Dahle:
Welcome back to the podcast. I hope you are hanging in there. We’re having some turmoil in the markets and in medicine with the threat of the coronavirus burgeoning out of China, now in Italy, on the West Coast of the US, and by the time you hear this, it’s probably everywhere. Markets have fallen. As I record this, it’s after the big nasty week we had. I’m actually recording this, let’s see, what is today? Today is March 2nd. I think the markets dropped 12% last week, which probably provided you a pretty good stress test of your risk tolerance.

Dr. Jim Dahle:
I would encourage you to stay the course with your written financial plan. If you don’t have a written financial plan, I would encourage you to get one. If you don’t feel capable of writing it yourself, consider taking our online course. It’s titled Fire Your Financial Advisor! But it should be titled How To Write Your Own Financial Plan. If that’s not quite enough help for you, there are plenty of financial advisors out there who can help you come up with a reasonable financial plan that you can follow to your financial success.

Dr. Jim Dahle:
I don’t really know what the coronavirus is going to do. It certainly is not going to be containable, so we’re all going to be seeing it in our clinical practices. Probably a large number of us are going to get it. The good news is the virulence looks like the mortality is something around 1% on average, significantly higher for the elderly with comorbidities, and significantly lower for most of my audience, the relatively young and the relatively healthy. And so that’s somewhat reassuring, of course. But we all have grandparents with comorbidities, and so we don’t really know how this is going to take place. We don’t know exactly what’s going to happen. We don’t know how long it’s going to be until they develop a vaccine, if it can be developed. Maybe in a few years we’ll look at this kind of like we look at flu season now.

Dr. Jim Dahle:
But for now, the media is almost feeding a hysteria on it. If you have been to Costco this week it’s crazy, people are cleaning the place out. And I’m not just talking about face masks and hand sanitizer; I’m talking about toilet paper and bottled water. It’s almost as if people think the water isn’t safe to drink in their towns or something, or they don’t have any containers of water at home. So, before you get too crazy about it, sit back, use your physician brain, think about what’s probably likely to happen here, and what’s likely to happen is that millions and millions of people get this and approximately 1% of them die from it.

Dr. Jim Dahle:
I mean, we’re going to try to contain it as best we can, but I think that is going to be limited. Maybe the best example is the 1918 flu. It was a little bit more virulent than the coronavirus is. The mortality rate in the 1918 flu was 2.5%. So it sounds like the coronavirus is a little bit less than that. But about a third of the world got that flu. And so I would suspect that 10%, 20%, maybe 40% of the world is going to get this novel COVID-19 coronavirus. And that’s going to have both economic effects and health effects and effects on our jobs. So hang in there, we’ll get through it together, and we plan to keep podcasting.

Dr. Jim Dahle:
Our quote of the day today comes from William Bernstein, MD: “You are engaged in a life-and-death struggle with the financial services industry. If you act on the assumption that every broker, insurance salesman, and financial advisor you encounter is a hardened criminal, you will do just fine.”

Dr. Jim Dahle:
So I want to give a shout out to those of you who gave us feedback on a couple of episodes we had recently. I turned to Cindy one day as we were about to record a podcast and I said, “You know what? Maybe we should be like some of these radio shows, you know, like Planet Money or The Dave Ramsey Show, where between callers they have little 10-second ads, 10-second opportunities to promote some company or something they’re doing.” And I said, “Well let’s try putting some of those in throughout the show.” It doesn’t sound like you guys liked that based on the feedback we’re getting. And the truth of the matter is, is that we’re always trying to balance the value we deliver to you, which is our number one mission, to help you get a fair shake on Wall Street, with running a for-profit business. Obviously, we’re going to have ads on the podcast. If you call us up and say, “No more ads on the podcast!” I’m just going to dismiss you out of hand; we’re not going to do this for free.

Dr. Jim Dahle:
But, that said, you know, it’s a little bit like a TV show. Nobody likes watching a movie on TV where there’s hardly any ads at the beginning of the movie and then right when it gets good, they just stuff it so full of ads you almost can’t stand it. We’re not trying to give you that kind of experience either. So, keep giving us feedback, let us know when we cross that line and put in too much promotion, too much advertising, and we’ll dial it back a little bit. Because more than anything, we want to help you, and if you’re not here listening, we’re not helping you.

Dr. Jim Dahle:
Now, by the time you hear this, as we’re recording it, it’s before WCI CON. But by the time you hear this, we’re going to be putting out the virtual version of WCI CON ’20. It’s going to be an online course, it’s going to be great. We’ve got something like 27 hours of instruction from people like Rick Ferri and Harry Sit and Morgan Housel. We’ve got all the panels, all that is going to be added into the course. So basically, even if you weren’t able to go, you’ll be able to watch this is at your leisure or listen to it in your car, however you prefer to digest it, and actually enjoy the conference for a fraction of the price from the comfort of your own home or car. I don’t have a URL to send you to right now, but suffice to say it’s going to be all over the website as soon as we publish it. So go to whitecoatinvestor.com and check out that virtual version of the WCI CON Conference, the Physician Wellness and Financial Literacy Conference of 2020.

Dr. Jim Dahle:
Thanks so much for what you do. Medicine is not always a frequently-thanked profession, as are many of the high-income professions. In fact, if you listen to a lot of the political rhetoric out there, you might think that you were the devil incarnate for making anything more than $100,000. But I want to let you know that, you know what? Dumb people don’t make $200,000 a year very often, and it usually takes a fair amount of work and training and specialization and liability, frankly, to make the kind of money you make. So thanks for going through that. I appreciate that and I appreciate your ethics. When I start talking to colleagues about caring for patients with coronavirus, we all know that this is the duty we signed up for, even though there are some risks to ourselves and our families. So thank you for being willing to do that.

Dr. Jim Dahle:
We have a special guest on the podcast today. We have Dr. Nisha Mehta. She is a radiologist with subspecialty training in musculoskeletal and breast imaging. But you probably don’t know her from her radiology work. You probably know her from her speaking and writing work, and particularly from running the Physician Side Gigs Facebook group. There aren’t a lot of physician Facebook groups that are larger than mine, but this is one of them. She has over 52,000 doctors in her Facebook group where they talk about side gigs and side hustles and those sorts of things. It’s great to have you here on the White Coat Investor Podcast, Dr. Mehta.

Dr. Nisha Mehta:
Hi, Jim. Thanks for having me on the podcast. Excited to be here. You can totally call me Nisha, by the way.
Dr. Jim Dahle:
All right, I sure will. I’m excited to have you out. We’re recording this before the White Coat Investor Conference, but it will run after the conference. So, in between this time, I’ll actually get to see you in person, which will be fun. I’m looking forward to your talk at WCI CON.

Dr. Nisha Mehta:
I’m definitely looking forward to it, too.
Dr. Jim Dahle:
Yeah. Today I brought you on to talk about a few other things that maybe we won’t be touching on so much, either you or I, at the conference, so it’s a little bit of bonus material in that way. But before we get into that, I don’t know that all of my listeners know you. Some of them will but not all of them will, so tell us a little bit about your background, where are you from, and what did you learn about money growing up?

Dr. Nisha Mehta:
Sure. So I grew up in the suburbs of Pittsburgh. My dad is a cardiologist and I’m South Asian, so I grew up around a lot of medicine. I think the interesting thing, though, is that I never really felt like we had a ton of money growing up. In retrospect, I’m really pretty happy about that. My parents immigrated to the US in the 70s and I think that that mentality that just comes along with starting from scratch never really goes away. So my mom is one of five, my dad is one of six, and my parents were always supporting family back in India and helping family to come to the US, get them established, they paid for their education, et cetera. So there wasn’t really a lot of extra money floating around and there was this big emphasis on not wasting money, getting things on sale, a real aversion to debt.

Dr. Nisha Mehta:
So I don’t think that we ever really wanted for anything. We took plenty of vacations, and I don’t remember ever being told I couldn’t do something because it was too expensive. But I also never really asked for anything that cost a lot because, quite frankly, I didn’t think we could afford it. So it wasn’t really until I was filling out financial aid paperwork for college applications and my dad stopped me that I realized that we really could probably afford most things. And so I think a lot of that has rubbed off on me, and though we’re definitely a little bit more liberal our own money now, I think it really helped us to avoid a lot of the financial mistakes that a lot of physicians make early on.
Dr. Jim Dahle:
So is there any way for you to pass those lessons that you learned onto your kids? Or is it impossible?
Dr. Nisha Mehta:
Yeah. I mean, I think it’s a debate that a lot of physician families have and certainly one that my husband and I both have. My husband is a physician as well and so there’s a lot of things that come along with just practicalities and differences and having a dual-physician family and a dual-income family that my parents didn’t have. My mom was a stay-at-home mom and she took care of a lot of the things at home, and she had time to run around doing those things, like getting things on sale.

Dr. Nisha Mehta:
Unfortunately, our kids, while we try to be good about our money, and while we try to save and we try to emphasize the importance of money, and we try to teach them lessons and we play things like Pay Day that teach them to budget and all of those things, ultimately, at the end of the day, I think they see more wealth than we saw growing up and we always wonder how that’s going to affect them. I mean, ultimately, as much as we try, I think some of it is a little bit inevitable because we don’t have that same experience where we’re strapped for cash as much and we’re supporting a lot of other people. We’re really just supporting the four of us so things are a little bit different in that regard. So yeah, we’re trying as hard we can but it’s not easy.

Dr. Jim Dahle:
I can relate for sure. So tell us briefly about your education and training.
Dr. Nisha Mehta:
Yeah, so I went to public high school, and then in college, I went to Brown. I started at their eight-year medical program. I actually only ended up staying at Brown for the undergraduate portion because I actually found that I really wanted to be closer to home, so I ended up moving back to Pennsylvania and went to Penn for med school.
Dr. Nisha Mehta:
I got married at the beginning of my fourth year of medical school and my husband had already started residency in New York. So I actually then only applied to residency programs in the city and went to NYU for radiology residency. We then came to North Carolina after my husband matched at Duke for his plastic reconstructive fellowship. And I took a three-year role at UNC, first as a fellow and then that was followed by being an attending for two years there until my husband finished his training.

Dr. Jim Dahle:
So you mentioned, you went into a little bit of your attending-hood. Tell us about your career so far.
Dr. Nisha Mehta:
Yeah. It’s taken some unexpected turns but, as I said, I was on faculty at UNC until my husband finished training. And then we had both actually intended on taking… the plan was always for academic careers back in the Northeast. But by the time we finished with our years in the Triangle, I’d had my two sons, we had done the full balancing thing in academia, and I had spent three years with my husband really around very little while I juggled motherhood while being on faculty with grant funding, et cetera. And we ultimately decided to make some pretty big changes and decided to have my husband take a great private practice job in Charlotte so that we could have some semblance of work-life balance, which we really hadn’t had before.

Dr. Nisha Mehta:
And that threw me for a loop professionally because there were no academic institutions in Charlotte. So I ended up with about six months of downtime while I figured out what I wanted to do, found a job that fit, and got credentialed. So I ended up taking a radiologist position at the VA, which has been amazing, as it allows me to do what I love but not have the nights, the weekends, the holidays, et cetera. And so it was actually around that time that I started writing and that’s taken me to where I am today in terms of my nonclinical work. Because from the writing came speaking requests, and then I decided to start that online community that you referred to, and that group has now grown to, actually now it’s 54,000 physicians, and that’s become a part of my career as well. So, definitely a little bit more complex than what I had originally envisioned.

Dr. Jim Dahle:
Yeah. I think the people that know you that are listening to this podcast most likely know you from your side hustles rather than your radiology career. Tell us about your side hustles.
Dr. Nisha Mehta:
Yeah. So I do a lot of seemingly random things these days. I definitely still write, I speak, I run these online communities, and then I do a fair amount of investing and consulting. So tax time has become pretty complicated. But we dabble a little bit in real estate, we dabble a little bit in angel investing. I do a lot of consulting on the burnout side of things at places that I speak, and with individual physicians who are pursuing entrepreneurial things, and then with bigger companies and institutions. So I do a lot of different things at this point. My favorite thing is really just how much I get to connect with other physicians and talk about these things. And so, at the moment, speaking and PSG are probably my favorite side hustles and probably the two that take up the most time, but the other things are definitely also going on.

Dr. Jim Dahle:
You know, it’s interesting. A lot of people that talk about burnout, and I include myself, I give talks about burnout all the time, as do you. This fellow Dike, I forget his last name for now, but he goes around and talks about burnout.
Dr. Nisha Mehta:
Dike Drummond.
Dr. Jim Dahle:
Yeah, Dike Drummond. And a criticism that is probably fairly leveled at some of us that are going around telling people how to not be burned out is that we’re only in medicine half-time or less at this point.
Dr. Nisha Mehta:
Right.
Dr. Jim Dahle:
Do you ever get that feedback? It’s like, “How can you tell me what to do? You’re married to another doctor and you’re only working half-time anyway,” or, “You’re only doing day shifts, you know? What credibility do you have to tell me how to manage burnout?” What’s your response to that?
Dr. Nisha Mehta:
Yeah. So I think it’s definitely one that’s going to come up more often. Until recently, I was doing all the things, so until about six months ago I was full-time as a radiologist and doing all of this other stuff on the side, and so I think I had a little bit more credibility in that realm. And since then I’ve actually switched to staying with my same group I was actually trying to go part-time with my same group and that wasn’t something that they could arrange for and so now I do per diem work with my same group and I’m only doing five to seven shifts a month with them, and that’s given me a lot more flexibility. But certainly, obviously, my work-life balance is better now that I’m not balancing a 45-hour work week with everything else that I’m doing.

Dr. Jim Dahle:
With another 45-hour work week?
Dr. Nisha Mehta:
Or more, as you know. Yeah. I think that were times where I was putting in 60 hours there and I didn’t work that hard during residency. So I think that there were definitely weeks when I was doing both where it was 100 hours plus. I’ve been there, I’ve done all that I’m glad to say that I’m in a place now where I don’t have to balance so much of that that authenticity is definitely still there because number one, it’s still very fresh in my mind and number two, I think we’re still living that on a daily basis, my husband is full-time obviously.

Dr. Nisha Mehta:
By the same token, when I talk about burnout and I talk about solutions to burnout, it’s not… honestly, I don’t think that I ever to a point where I was fully burnt out, clinically. If anything, if I was going to say that there was a period of time in my life where I was really burnt out, it would probably be more because of all the side hustle stuff I was increasing on the side at the same time that I was trying to do my clinical job. And so I think the big thing to talk about when we talk about burnout is really not just, “What are the things that cause burnout and what do you avoid?” but really what has to change on a systemic level and what has to change in terms of the culture of medicine to be able to get people to a point where they’re able to have that career longevity without burning out.

Dr. Nisha Mehta:
And so I think I can still speak to those things relatively from an informed sense. And I think that I’m really very much in tune with my audience because I’m talking to everybody on a daily basis in the community and I am still working a fair amount. It’s not as much as it was before. But when I go in now I actually almost always I’d rather double-cover because it’s more lucrative for me to work in that way. And so when I go in, those days are still very, very exhausting and I’m still living those days.
Dr. Nisha Mehta:
So, I don’t know. I mean, obviously you lose some authenticity when you’re out of it completely, yes, but I’m not out of it completely and neither are you. And I think we talk to so many physicians that we’re hearing these stories and in some ways are much more in touch with the overall sentiment of what is going on across the board than somebody who’s siloed within their one particular job and not hearing those stories. So, obviously always some plus and minus, but I wouldn’t say that I’m disconnected just yet. I’ll let you know in a year or so if things change. But right now I feel pretty good that I still know what’s going on.

Dr. Jim Dahle:
Yeah. That’s kind of the way I feel. And certainly I’ve had more burnout doing WCI stuff than I have ever doing clinical medicine. But I’ve really enjoyed half-time to three-quarter-time medicine. I just think it’s really enjoyable at that pace and I think a lot of docs, if they’re feeling burned out, the first thing to do is to cut back to full-time and see. You may realize, “Oh yeah, I really do like doing this stuff.” But so many of us are already working one and a quarter jobs or one and a half jobs, essentially, just with medicine that there’s no surprise you’re feeling a little bit burned out on it.

Dr. Jim Dahle:
But I didn’t really bring you on here to talk about burnout today. I brought you on to talk about some controversial stuff in medicine. They’re topics that you and I have talked about privately but that no one really talks about openly, particularly because it isn’t necessarily politically correct. Medical school classes are now split evenly between women and men, actually very slightly more women now, and that’s the way college has been for some time. So that trend is likely to grow at least a bit more going forward. So today we’re going to talk a little bit about what that means, both for male doctors and for female doctors, for employers, for patients.

Dr. Jim Dahle:
But first, let’s get into a statistic that you’ve spent a lot of time thinking about. 70-80% of female physicians, of women physicians, are in dual high-income couples. That’s a much higher number than it is for men, although male physicians are also more likely to be married to high earners, or at least highly educated partners due to assorted mating but can you talk about some of the financial and career considerations that that statistic has, or can impact, versus someone that’s married to a stay-at-home dad?
Dr. Nisha Mehta:
Yeah, absolutely. So I’m going to head off a little bit of what you said on the controversial side of things because I do realize that this is a really loaded topic. I do focus on that statistic a lot because I think it’s a fundamental shift in the demographics of the physician workforce that comes with a lot of implications. But I want to start by saying, and Jim, you know this from the course of our many conversations, but for those of you who don’t know me, I’m a pretty strong advocate for female physician empowerment. I went to Brown, I’m a female physician in a male-dominated field who’s also very active in the business world, I’m a pretty feminist person as far as female empowerment goes. So clearly, I’m not saying that female physicians want to be barefoot and pregnant and at home or anything like that. I don’t think that female careers should take a backseat to their husbands’ careers or anything even remotely like that, so I don’t want anything to be misconstrued in that sense.
Dr. Nisha Mehta:
And I also know that every physician family is different. So, what applies to one female physician or one male physician, for that matter, isn’t uniform to everyone. So, certainly there are plenty of women physicians who are also the sole breadwinner in their families, or make significantly more than their spouses, or any other host of reasons why the overall statistics I’m citing might not be applicable in their particular situations.
Dr. Nisha Mehta:
But my point in stressing this particular statistic a lot in my talks is because when we see the implications that we have on the workforce as a whole, when we look at that number and how it really emphasizes a need to change the system. So if you know anything about my work, I think we all have to create the life in medicine that works for us, and the fact is that most female physicians have a very different reality at home than whatever image it is that people have when they conjure up an image of a traditional physician. And that, obviously, for logical reasons and reasons that should happen, have implications on how we approach the job market and our careers. And so I think it’s so important for us to be able to acknowledge those differences because when you don’t, that’s when you really start seeing the impact that they have on career longevity.
Dr. Nisha Mehta:
The fact is that currently, 40% of female physicians go part-time or leave medicine entirely within six years of finishing their training. And that is a really crazy statistic if you think about it, especially when you think about the fact that half of the physician workforce is female, or will be female soon. So, as long as that is the right direction for themselves and their families, that is completely fine and definitely something that I would encourage. But on a larger level, it begs the question of what we as the physician workforce need to change to support or otherwise adjust so that we make sure that females aren’t leaving medicine for the wrong reasons, or because we don’t have a system that allows them to thrive.
Dr. Nisha Mehta:
And so, as you just said, we’re getting closer and closer to a point where half of the physician workforce is going to be female. And when you take those statistics in combination with rising physician burnout and increasing physician shortage, they really raise real health policy issues in regards to the sustainability of the physician workforce. So I think, with my overall mission when I talk about the need for cultural change in medicine and emphasizing career longevity, it’s really that we need to create a system that’s more flexible and that allows women in medicine, males in dual-income families, millennials, later-career physicians, whatever other groups of physicians that don’t see themselves fitting into the mold of the “traditional doctor lifestyle” and everything that comes with it, to be able to create those careers that they want so that they can do it for the long haul.
Dr. Nisha Mehta:
So, in my example, in my dual-physician family, both of us have had to make some significant changes in terms of how we approach our careers so that we can have the life that we want outside of medicine as well. So we have discussions regularly, or had discussions regularly, about how often we want to juggle two call schedules, and how are we going to spend the time with our children that we want to spend with them, and how are we going to get things like going to the Post Office done during hours when the Post Office is open, and how is our overall happiness and the ability to focus on the other things in our lives and our children and each other impacted when we both get home at 6:00 p.m. after exhausting days at work? And those are all things that started coming up more and more as we got further along in the pathwat and, consequently, we, like many high dual-income families, whether in medicine or not, started making some decisions based on that.
Dr. Nisha Mehta:
And I think that’s what I see routinely when I’m going around the country and talking to female physicians, is they get to this point where they say, “Okay. I’m doing all these things that I’m supposed to do and I’m following the path that has been laid out for me in terms of being the traditional physician, but it’s not working for me. So what are the changes I need to make so that I can make it work for me? Or do I just leave because the system just wasn’t… it’s not meshing with what I need from my life?” And I think that that’s where a lot of interesting things come up in regards to both finances and decisions about how you’re going to approach your career, and what you need versus what you want versus what things are practical and have to happen just so that you can run your lives. And those are all very interesting conversations that I think are happening routinely amongst female physicians now.
Dr. Jim Dahle:
Let’s go back to that statistic you shared. 40% of women physicians go part-time or leave medicine altogether within six years of coming out of training. Now, I’m sure that number has increased for men over the last decade or two. Certainly there’s more interest in part-time work among people of both genders, or of those two genders, I suppose I should be more inclusive with that statement. Do you know what that statistic is for men?
Dr. Nisha Mehta:
I don’t, actually. I could bring up some slides that have some of those numbers there. They’re closer to in the 20% range, but that’s also including later stage physicians who are cutting back towards the later stages of their careers. So, at the earlier stages of their careers, I imagine that those numbers are a lot lower for male physicians than they are for female physicians. It doesn’t look like as big of a discrepancy because of the number of males who are working part-time at later stages of their careers, so overall those numbers are actually not as different as they probably are if you just were to subset that into the first decade of peoples’ careers.
Dr. Jim Dahle:
But clearly more likely to go part-time, more likely to leave medicine completely, probably more likely to take a job that pays less but is more flexible. What differences do you see, I mean we mentioned that 70-80% of female physicians are in dual high-income couples, that leaves 20-30% that are not. Do their career tracks, going part-time, leaving medicine, et cetera, do they mirror that of men more commonly, particularly men that are the primary breadwinners, do you think? Is this a phenomenon more of being in a dual high-earner couple, or a phenomenon more of being women?
Dr. Nisha Mehta:
Obviously there’s a lot of different pieces to that, but I think that female physicians who are sole breadwinners in their families are much more likely, and again, this is based on anecdotal, you know, me running around talking to people, not based on hard statistics because we don’t have those hard statistics. At least I am not aware of them. And I look for them quite regularly, so if somebody knows of them I would love for you to email me and give me some of them. But from what I see anecdotally, I think that female physicians who are sole breadwinners are much more likely to have careers that sort of mirror the more traditional physicians over the past few decades.
Dr. Nisha Mehta:
That being said, I still think that those female physicians, if they are part of families where they have children and they’re still wanting to be mothers, they still feel pulled in different ways. And that’s not to say that male physicians don’t also want more time with their families or any of those things, but I think there’s something about being a female physician where you’re still balancing that role of mother and society’s expectations of what mother means with your role as a physician.
Dr. Nisha Mehta:
And so even amongst the female physicians that I know that are primary breadwinners for their families, depending on what environment they are in in terms of private practice versus academic, a lot of them are still more likely to make some lifestyle decisions such that they can be at home with their families. Certainly, if you’re in a dual high-income family, you’ve got a lot more options available to you because you aren’t the one person that has to bring home the majority of your household income, and so that opens up a whole world of different options in there in terms of how much you work and how much you need to get paid and what kind of opportunity costs you’re able to place on flexibility.
Dr. Nisha Mehta:
I know in my own family, for example, I took a job that paid less at the VA but, for me, the ability to not have responsibilities outside of the hours of 8:00 to 4:30 was priceless. And so I was willing to take that salary cut but I also had the luxury of being able to take that salary cut without worrying about how it was going to impact the other things that we wanted to do in our lives as a family. And if I was being paid less per unit of work I did in comparison to a colleague, that would have been a huge issue for me. I don’t think that female physicians should ever be in a position where they’re taking less money for doing the same amount of work.
Dr. Nisha Mehta:
But certainly, if I’m proportionately decreasing my work load or decreasing the number of RVUs that I’m producing, then I’m willing to say that’s okay. I don’t want to do those extra shifts that pay more, or I don’t want to do some of these other things that people don’t like doing that maybe aren’t as, for whatever reason, if I want to say no I have the ability to say no and make my own rules, which I think, obviously, in part, is tied back to the fact that I’ve got a spouse that has a very high income.
Dr. Jim Dahle:
I think that’s a really important point to make because a lot of people, and I don’t know they’re necessarily physicians, but I think the average person in the public hears this statistic that women make 60% or 70% or whatever it is of what men make, and a lot of times the statistics are not controlled for the fact that the women are working less or they’ve been out of the workforce more, all the other things that should be controlled for to actually determine how much of it is just pure discrimination. And certainly there’s a factor of that, and how big that factor is reasonable people can disagree about. But a lot of times you’re just not even having an honest conversation until you adjust for those factors.
Dr. Nisha Mehta:
Right. But it’s important to point out also in the context of that, even in studies that have controlled for those factors, female physicians still make less money. And so the fields where you see less of an income disparity are actually fields where people are reimbursed very highly based on their production in a very strict RVU formula. So in fields like you and I are in with emergency and radiology, actually those income disparities are less, in part because in a lot of environments you get paid per RVU that you produce, and since it’s relative to that and they’re bigger groups there’s a little bit more transparency about how that split happens. And so you don’t see as much in the way of income disparity. It’s not that they don’t exist because there are certainly situations in which female physicians have been offered less per RVU than their male counterpart and, therefore, even if they’re producing the same RVUs they’re making less money.
Dr. Nisha Mehta:
But in certain fields you see it less because people are being much more compensated based on their actual production, whereas in other environments when people say to you things like, “Oh, well if you work half-time then you also shouldn’t be getting X, Y, and Z.” And there’s a lot of situations in which you’re really working more than half-time, or more than whatever that amount is, but you’re getting paid less for that money. So I never want to sound like I’m saying that a pay gap doesn’t exist. I mean, all the good data out there that does control for those things shows that there’s a pay gap there, but do female physicians make certain decisions because of lifestyle? Absolutely. Do female physicians take jobs where they know that they’re being paid less per RVU or certain things because of their personal situations and knowing that a certain job works better for their lives? Obviously those things happen on a daily basis.
Dr. Jim Dahle:
So let’s dive into those statistics a little bit more. Why do you think women are offered less per RVU, or per whatever unit of work, and why do they accept it?
Dr. Nisha Mehta:
So, okay. This may be more time than you have on a one-hour podcast, Jim.
Dr. Jim Dahle:
Let’s do the brief version.
Dr. Nisha Mehta:
Yes, the brief version of it. So, I think that there’s a lot of things. I think that time and time again, there has been data out there that shows that females negotiate less. And you or anybody that follows me knows that I’m a big believer in negotiation and I negotiate hard. But I do think that there’s a lot of female physicians who worry about perceptions that are out there if they negotiate too hard. Or, if you’re given a lower starting point to negotiate from, then you’ve got a lot bigger of a hurdle to pass to the point where you could be on par with everyone else because if you’re offered $230,000 for a job where everybody else is being paid $250,000 and you’re trying to negotiate at that rate, whereas they gave your male counterpart an offer for $240,000, well he’s got $10,000 to negotiate up whereas you’ve got $20,000 to negotiate up.
Dr. Nisha Mehta:
And so a lot of times female physicians are offered less from the get-go. And a lot of times, at the end of the day people who are offering them jobs are running businesses and they are doing things based on strong business sense as they should; however, the problem becomes a lot of times they’ll make assumptions about female physicians and say, “Oh, well that person already has a spouse that’s working in this area so they need to be in this area, and therefore they’re probably more likely to take a job even if we offer them a little bit less, so let’s offer less and see where we end up.” And it’s not that they’re bad people; they’re also just trying to get the best deal for themselves. And I think that’s why it’s so important for female physicians to also step up to the plate, know their compensation data, know all of those things ahead of time so that they can come to the negotiating table as strongly as possible. So I think that that’s one thing.
Dr. Nisha Mehta:
I think the other thing is, is that there’s a lot of groups, whether they say it or not in person, and I’ve had plenty of these conversations confidentially amongst different physicians, where they’ll say, “Yeah, my group definitely will offer a female physician a little bit less because we’re accounting for the fact that there’s probably going to be a paid maternity leave in there,” or “There’s probably going to be decreased productivity at some point because of x, y, and z.” At the end of the day, these conversations are happening behind closed doors.
Dr. Jim Dahle:
Which is completely illegal, right?
Dr. Nisha Mehta:
Right.
Dr. Jim Dahle:
Completely illegal to even have that conversation.
Dr. Nisha Mehta:
Absolutely. It’s totally illegal. But I can tell you plenty of these stories and I feel like probably most female physicians who are listening to your podcast could tell you the same story where people will say things and they know that they’re illegal and they’re basically just counting on the fact that nobody’s going to call them out on it.
Dr. Nisha Mehta:
I had a residency interview once where somebody asked me point blank if I was planning on having children during residency. And, I mean, they don’t… that’s a completely illegal thing to ask them. And at the end of the day, I just didn’t rank them on my rank list. But by the same token, I didn’t go out and press charges and I think that stuff happens all the time. Hopefully we’re getting to a point where we as a society are making it more well-known that, really, you probably shouldn’t say things out there unless you want to open yourself up to a lawsuit and it’s becoming less and less acceptable to say those things. But currently, they still exist. People ask about those sorts of things all the time and they factor them into their decisions and they factor them into their offers, and that’s the reality of the situation right now.
Dr. Jim Dahle:
Yeah, it’s easy to see both sides. I mean we have no doubt when we bring on a new doc out of residency, we bring on a new PA, typically there is a maternity leave or two in the first few years. So you can see why people think about that. But, really, it’s not legal to even take that into consideration when you’re choosing who you’re going to hire.
Dr. Nisha Mehta:
It’s not legal to take that into consideration, but the other thing to keep in mind, you know, the things that I kind of laugh about, is it’s also more likely that a male is going to have a heart attack at some point during his career and you’re going to have to pay for short-term disability or whatever, they’re going to be out of the workforce at some point for some health issue than a female is. I mean, all of those things happen. Certainly if you have a higher elderly male population in your physician workforce, there’s not a small number of things that take those guys out of the workforce at some point either.
Dr. Nisha Mehta:
So I think you just got to believe that all of this stuff is going to even itself out in the long run. And if you’re going to structure a physician workforce where half of the members are female, you’ve got to believe that at the end of the day it’s all going to work itself out. In the large scheme of the number of healthcare dollars that are being put out there, if you really want to emphasize career longevity and you want people to stay at the same job for the next 20, 30 years, at some point you’re going to have to do a little bit of give and take at that beginning stage of practice in hopes that that person will then have that loyalty and know that you did right by them and therefore will try to stay with that job longterm.
Dr. Jim Dahle:
Agreed. Now let’s turn the page just a little bit and talk about women that are the primary bread-earner. Tell me what you think about someone that’s married to someone that makes much less money, perhaps even less than their childcare cost, but like many men, derives a significant part of his identity from his work. What advice do you have to that family, to that couple, where she’s making all kinds of bucks in medicine, he doesn’t make very much at all but work’s really, really important to him? What advice do you have to him?
Dr. Nisha Mehta:
I think it’s the same both ways in both directions. I think female physicians who are making less than their male husband counterparts are probably also having those same discussions with their families. I think the math is going to be different for every family, every individual physician is going to feel different about that. But ultimately I think it’s very insulting to be told that you don’t make enough money and therefore you should drop x, y, and z no matter what, right?
Dr. Nisha Mehta:
So, I love what I do as a physician, I would never willingly give it up. The way that our finances work with my husband being in private practice plastic surgery and me being in academic and government positions, and we’re not a fancy family and our spending habits are not that high, and so honestly, my income didn’t make too huge of an impact on our family’s finances. But the number of times that I got asked when I was going to quit my job by those who knew our situation was incredibly frustrating because I love what I do; it’s a part of me. I’ve worked really hard to become a radiologist and I wasn’t going to give that up just because my husband made more than I did.
Dr. Nisha Mehta:
And so I think for any female physician, if they were the primary breadwinner, to feel as though their husband should then give up what they do that they love, that they find fulfilling, is the same thing as asking a female physician to give up their situation just because their husband might make more. So I think, ultimately, you just got to figure out what works out for your individual family. If the childcare costs are adding up to more than what that person is bringing home post-taxes, that’s a discussion that you need to have, but I don’t think it’s a slam-dunk decision for that person to leave, no matter what, because ultimately they still like what they do, and I think that that has value.
Dr. Nisha Mehta:
If you talk about marriage dynamics, I mean, you want to create hostility within the marriage, that’s a pretty good way to create hostility within a marriage, is by forcing somebody to take on a role that they don’t want to take on and give up something that they love doing. So I would say ultimately, you run those numbers, you figure out what works and what doesn’t work, but to tell somebody that their income is not as valuable as somebody else’s income just because it’s less or whatever is not great grounds for decades of marriage.
Dr. Jim Dahle:
Yeah. Let’s go back to the dual high-income couples. How does the family budget become different? What expenses are higher or lower in that sort of a situation where you’re a two-doc family?
Dr. Nisha Mehta:
Yeah. So as a dual high-income family, we definitely make a lot of decisions that are different than, for example, my parents did when I was growing up. So I think I had said earlier but my dad’s a cardiologist, my mom’s a stay-at-home mom, and we manage our money very differently. For one, we pay a lot more for convenience. We outsource a lot more and that has definitely increased over the years as we’ve struggled to balance more, as the kids are older, and my business grows.
Dr. Nisha Mehta:
For example, I used to cook every day. But as the business grew, we actually had a year where I was working that full-time job and working on the business, and I hired somebody to cook for us because at the end of the day, it cost a lot less than what I was making during that hour on the business side of things to pay somebody to cook for us. And it took some responsibility off my plate and gave me more time with the kids.
Dr. Nisha Mehta:
My mom, on the other hand, she still to this day goes to three different grocery stores depending on what’s on sale at each grocery store, and she will clip coupons, and she will point out to me endlessly the differences between our grocery expenses and hers, and ultimately the opportunity cost of our time is different. And so it’s the same thing with things like buying the kids shoes when they need them. They come home with a hole in their shoes, I get online and I order what option will get shoes to me ASAP, and I can’t drop everything to look for a sale at that moment. So if there happens to be one that’s a bonus, and if it’s not, I don’t cry over it because it is just what it is.
Dr. Nisha Mehta:
So I think we definitely, as a dual high-income family, place a lot of budgetary resources into convenience and making our lives easier so that we can get more time with our children. So we’re trying to buy back some of that time. In terms of the things that are lower, it’s actually funny because our budget for almost everything, especially with both of us working the hours that we are, it’s actually lower than most of our friends’ because we’re so time-crunched. We just don’t have time to spend money.
Dr. Jim Dahle:
You don’t have time to go on vacation or buy the Tesla or any of that, huh?
Dr. Nisha Mehta:
Right. And so it’s kind of funny because there’s less impulse purchases. I literally, when I go to the mall, I go in, I get what I want, I leave. I’m not walking around and being like, “Oh, that would be nice,” and “Maybe that would be nice,” and so I buy a lot less. There’s a lot less money spent on memberships that we don’t have time to utilize. We don’t have cable TV because we don’t have time to watch it. And so in a lot ways it’s funny because a lot of our fixed expenses are actually a lot lower than our friends who are not in dual high-income families because we just don’t have the time to do a lot of those things.
Dr. Jim Dahle:
Now there are a lot of financial blogs out there and podcasts that talk about ways to save money and how to do this and how to do that. Do you ever feel bad when you’re reading those and you’re like, “Man, we don’t have time to do any of that stuff,” or “That just doesn’t apply to me. It’s not relevant to me because I’m doing something different. Even though I’m spending more money, we’re coming out way ahead financially”? What’s your thought on kind of the common messages you’re seeing in financial blogs and books, et cetera?
Dr. Nisha Mehta:
Well, it’s interesting because even when I follow your blog, for example, a lot of the things that applied to us five years ago no longer apply to us. Things change, and everybody’s lives are at different situations, and a lot of the financial blogs are really aimed at establishing basic financial literacy. And so they were really good for a certain stage in our lives, when we were coming out of residency, when we were just learning about what is a 401(k). All of those things I think that they’re really, really good for, but at some point you do get to a point where you’ve kind of maxed out that knowledge and you kind of need to start focusing on maybe some more tax-savvy techniques, or maybe you’re focusing on investing, and investing is a whole different realm in terms of what the opportunity cost of that money is and where you can get the biggest bang for your buck, depending on what your resources are.
Dr. Nisha Mehta:
And so I think I read all of that stuff and I’m really, really happy that it’s out there because I know how much it helped me at an earlier stage in my career, and I’m glad that people are out there and getting those messages out because as you know, better than probably 99.999% of people in the world, we need it. There’s not a whole lot of financial education very early on. Regardless of whether you’re a physician or whether you’re in healthcare or not, I think that there should be basic financial literacy in high school for everyone. That just doesn’t exist. And so I think that it’s really good that a lot of those financial blogs exist.
Dr. Nisha Mehta:
But at the end of the day, at some point you’ve learned to create a budget, you’ve learned to balance a checkbook, you’ve learned that you need to max out your retirement accounts, and those things are all very valuable. But then you start asking, “Well, what’s the next step in terms of being smart about my finances? And how do I start looking into some of these more complicated things that might be better for my particular situation right now?” So I think it’s basically, I feel like everything has a season and while you’re in that season that information is really, really good for you, but you also have to not be complacent with that. If you really want to although you would be more than set to retire if you followed all those basic principles. But then if you really want to start talking about what more can you do, there’s a whole other layer of all of that.
Dr. Jim Dahle:
Let’s talk a little bit about retirement savings as a dual high-income couple. What are the differences that you see when you’re a dual high-income versus a single high-income couple?
Dr. Nisha Mehta:
When you max out two W-2 job retirement plans, that’s probably going to add up pretty quickly. That being said, of course, as a dual-physician sub-specialized couple, neither one of us really had real jobs until well into our thirties. So we started out way behind also. So I think you’re definitely on a delayed schedule in a lot of dual high-income families because people have, usually, additional degrees or things that kind of held off them being able to contribute a lot towards retirement, whether it was student loan burden or whether it was other things related to getting your life in gear.
Dr. Nisha Mehta:
But then once you start building it starts adding up pretty quickly because you do get to a point where you’re easily able to say, “Okay, what are all the things that I can do to max outmy tax advantaged account and, “Yeah, okay. Obviously, I’m going to fully fund my 401(k). If I have a 457, I’m going to put money in there also. If I’ve got a backdoor option, I’m going to do that.” You start having the ability to max out a lot of these things, and hopefully you get in at the right time and that stuff compounds quickly.
Dr. Nisha Mehta:
For us, especially with the business tax savings also, it’s been pretty easy to build a pretty substantial retirement nest egg because of the fact that we’ve got two of us actively contributing to multiple retirement plans and that’s been really good for us. But again, we also have family members who have been contributing to their 401(k) since they were 21 and they’re doing pretty well, too. So I don’t know you’ve got that lost opportunity cost of at least a decade when you’re coming into things as a physician in terms of those retirement accounts.
Dr. Jim Dahle:
Let’s turn the page a little bit here and talk about demographics. We mentioned earlier that 40% of women physicians are likely to go part-time or punch out medicine relatively early in their career, within six years of coming out of training. There are more women in medicine now. Doctors, male and female, want better lifestyles than the last generation had. Part-time work, side gigs, FIRE, seems to have more of a place than it used to. Can you talk for a minute about how this affects men who are docs, women who are docs, employers and patients?
Dr. Nisha Mehta:
Yeah. I think that it affects all of us a ton. I think about my dad’s generation of physicians and how so many of them are still working the same hours well into their 70s. And the truth is I see very few of my colleagues or friends thinking about doing that same thing. But I also think that they practiced medicine at a different time. Older generations of physicians were a lot less worried about their income sources, they didn’t have as much student debt, they weren’t so worried about some of these things in terms of the future of their profession. And so I think that they were facing a very different outlook when they thought about what was going to pay their bills in the longterm.
Dr. Nisha Mehta:
I think nowadays so many of the physicians I talk to want a Plan B or a Plan C or even a Plan D, just so that they can make sure that they have the life that they want. And certainly in the context is that alternative income stream and I know for our family, it’s been really nice to know that if for some reason anything happened to one particular stream of income we would be okay. And that allows us to practice medicine happily on our own terms. When you’re tied to an employed position that you need, then your ability to walk away from a bad situation, of which it seems that there are increasingly more of in medicine, that goes down. And so that’s why I advocate for a lot of these things, not because I want people to leave medicine, but because I want them to be able to do it on their own terms and be able to do it for longer.
Dr. Nisha Mehta:
But I think the problem, of course, with that is that if your goal is, “I’m going to retire as early as humanly possible,” or “My side gig should eventually become my main gig,” well then you start with all of these sorts of problems in terms of the sustainability of the physician workforce. And I think that that’s a huge deal for employers. And a lot of times when I talk to physicians who feel like they can’t do anything or they have no power, I keep trying to remind them, “Well, there’s a real physician shortage,” and if you understand your leverage in that particular position, there’s going to come a time where the demand for physicians, if we’re not already there already, is going to become greater than our ability to supply physicians.
Dr. Nisha Mehta:
And so that, I think, becomes very concerning on the employer side of things. If they can’t keep people in medicine and therefore… that’s usually, when I’m talking to groups like the C-suite and things like that and in consulting, what I try to remind everybody is that it doesn’t matter what you think about burnout, and it doesn’t matter what you think about millennials in medicine or women in medicine. At the end of the day, there’s some real supply and demand economics at force here and you’re going to have to change your job system to try to be able to retain some of these people whether you like it or not, or whether you believe in it or not, because otherwise you’re going to have people leave.
Dr. Nisha Mehta:
So there’s plenty of people that I talk to who say, “Well, if I could work x, y, and z, I would stay in this forever. But since I can’t, I’m leaving medicine.” Well, I think the employers are going to have to start thinking a lot more about, “Okay. I’m going to have to ask them what it is going to take for them to stay and I’m going to have to be more flexible about what it is that I’m giving up.” Obviously, on the patient side of things, I think it’s the scariest thing because I think a lot about who’s going to provide medicine to me in 20, 30 years when I need the healthcare system more, and what is that going to look like if I can’t see a physician for many, many months, for example?
Dr. Nisha Mehta:
I think that those things are a really big deal. I think that it’s a shame because we don’t talk about these things a lot in medicine, up until very recently, but a lot of the issue behind that is that none of us want to seem less committed to our careers, or be scared about making assumptions about what one person would assume versus another person would assume. But if we don’t talk about those things it becomes very hard to create a path going forward that’s sustainable for physicians longterm. And so I think all of us are having these thoughts.
Dr. Nisha Mehta:
I remember when I first started out most of my writing was tailored towards female physicians because obviously I could relate to that concept and I knew that demographic. But actually for the first time that I really realized I had to broaden my scope was actually speaking at your first conference, because I remember after I gave my talk I had at least twenty-something male physicians either seek me out to speak to me about their particular situations or email me with their related issues. And I think that that is becoming more and more widespread regardless of what your particular demographic in medicine is.
Dr. Nisha Mehta:
So I think when physicians and the public are looking at the problem of physician burnout they really need to be thinking about the sustainability of the healthcare workforce and what it means for them. And that’s what I always try to emphasize in my talks is, I understand you might not feel bad for us when we’re making six-figure salaries and doing all of these things. But this impacts you as well because you need access to physicians and you need access to this training and this healthcare. And if you don’t understand that there’s a real health policy issue here, or a real issue for your particular organization’s ability to be profitable, then you’re doing a lot of short-term…
Dr. Nisha Mehta:
Whenever these articles come out in the press talking about how much physicians make and physicians’ salaries and calling them cartels or any of these things, I always laugh because I’m like, “You don’t understand.” I understand that there’s a lot of sex appeal to these articles and these headlines, but at the end of the day you’re pitting patients against physicians and you’re not giving the patients the ability to understand that if you don’t compensate physicians fairly, or if you don’t recognize the opportunity cost of their training, you’re not going to have very many physicians down the line to be able to serve an essential, basic human right and basic need of a society and I think that that’s really, really important.
Dr. Jim Dahle:
So let’s talk for a minute about society. I mean, how do we adjust for this fact? Doctors are working less, whether they’re women, whether they’re men. Certainly, the fact that there are more women increases that. Should there be more medical schools and residencies to make up for this fact?
Dr. Nisha Mehta:
So I don’t think that medical schools are currently the issue. I think medical schools are pretty profitable and so there’s plenty of spots. And I feel like every other month or two I hear about a new medical school popping up at different institutions. So the problem, I don’t think, is the number of medical students. And certainly there’s a lot of physicians from other parts of the world who are very excited by the idea of coming to the United States and practicing medicine.
Dr. Nisha Mehta:
So the problem in the pipeline is not the number of medical students; the problem in the pipeline is really the number of residency programs that we have and the number of residency spots that we have. And that, I think, is a really big issue because we haven’t significantly increased the number of residency spots, and therefore we have a very large physician shortage that’s pending. I always try to remind people that we’ve had a projected significant physician shortage prior to any of these things being an issue in terms of burnout or any of these other things in relation to the pressures of the healthcare system and changing demographics in medicine, just by virtue of the fact that people are living longer with chronic disease and increasing utilization of the healthcare system.
Dr. Nisha Mehta:
So now we face a situation where, in combination with the changing demographics and increasing physician burnout, the sustainability of the physician workforce is becoming increasingly threatened. And honestly, it’s really scary when you look at things from a policy standpoint. So, a lot of my background from college is in policy, and when I look at those numbers from a policy standpoint they are terrifying. So the first thing I think we really need to do is to be able to increase the number of training spots for people who have come out of medical school and then want to match into a residency spot. And there’s just not enough residency spots out there.
Dr. Jim Dahle:
What about APCs? Do you see an increased role for APCs, the PAs and NPs out there, because of doctors working less?
Dr. Nisha Mehta:
That’s another loaded question.
Dr. Jim Dahle:
We’re going to try to hit all the controversial topics in medicine in one podcast.
Dr. Nisha Mehta:
I know! You’re really trying to put me in a hard place here. I’m not sure that we have enough time to do that topic justice either. I think the fact is, is that we certainly need all the people that we can get in healthcare. We need strong teamwork. That part is absolutely, for sure, the case. I think that we’ve got an aging population, we’ve got increasing healthcare needs, I think we’ve got a society where people expect to be seen relatively expeditiously. We’re not in one of these other countries in the world where people are okay with wait times of six months and where people are okay following algorithms that don’t necessitate them getting an MRI two minutes after they say that they have a headache.
Dr. Nisha Mehta:
So I think that all of those things require, in the US, that we get creative about how we can best utilize the respective strengths of every member of the healthcare team to really be able to deliver the healthcare that we need to patients. I think that that part is absolutely 100%. There are scope of practice issues that definitely need to be sorted out. I think that as long as patient safety is emphasized, and we put that at the forefront of everything, I have confidence that we’ll get there. I think it might be a little bit tumultuous in the meantime, but I think we’re going to have to figure it out. We don’t really have a choice.
Dr. Jim Dahle:
Very diplomatically stated. All right. I got into a Twitter spat the other day with a few people that thought it was ridiculous that I said, “Any physician should be able to take care of a $100,000 student loan debt relatively easily.” Their argument was basically that some doctor jobs don’t pay very much and are located in high cost of living areas, and thus not everyone can afford to pay back student loans of any amount. What’s your take on that? Should doctors be able to take any job they please, no matter what their financial situation? Do they get a pass on math?
Dr. Nisha Mehta:
I don’t think that any of us gets a pass on math. I think we all make choices that we have to live with and those choices are different for everyone. And so for some, living near family or near a certain cultural scene, or near a particular resource are essential to either their wellbeing or their happiness and I think that that’s just a fact of life. I travel frequently for my speaking and not every place I go to is the right place for me to live in. Obviously when you make the decision to live in a high cost of living area, that money has to come out of another bucket somewhere.
Dr. Nisha Mehta:
So in our family, for example, living literally two miles south of where we live would have significantly decreased the price of our home. But also with traffic in our area being what it is, it also meant that it would have taken an extra 30 minutes for each of us to get home every day. And for us, those extra 30 minutes at a time where we have young kids that go to bed relatively early is a huge deal. So we were willing to pay that price to have that on a daily basis, but it did mean that we carried a mortgage for longer.
Dr. Nisha Mehta:
I think as long as people understand that they’re in charge of their choices and they have to live with the consequences, they can do whatever they want. It’s not really anybody else’s position to judge them on that. I think if you start saying that there’s no choice, well, there’s always a choice, right? We all know that. We’re all adults and we understand that there’s always a choice. We just have to make the best one for our families and then deal with the rest, good or bad.
Dr. Jim Dahle:
Now there was a scam recently involving a cryptocurrency trading algorithm where doctors ended up losing about $34 million, an average of $220,000 per doc. Investors were recruited in and from a physician Facebook group, a physician dad’s group. Now you run a Facebook group like I do. What can we do as group administrators and group users to prevent that from happening in our groups?
Dr. Nisha Mehta:
So I heard all about that. Like I said, we have about 54,000 people in our Facebook group, our numbers are similar to yours. Ultimately, there’s no way to control everything that happens. We do have some very strict policies in place to try to prevent those things. They’re not always popular, they’re not always foolproof, but we stick with them for that reason.
Dr. Nisha Mehta:
So, for example, we don’t allow any solicitation or lead marketing on our group. We don’t allow anybody to say things like, “PM me for more information.” Either they share the information on the group or they don’t share it. That gives us an opportunity to at least have some control over anybody who’s trying to take advantage of anybody in the group. Not to say that that physician in that group was trying to take advantage of other people, I don’t know exactly what his involvement in all of that was, but just in general we have a pretty strict policy that says if somebody wants to advertise something they have to go through a vetting process. Then they have to pay for my time to go through all their stuff and do that vetting process and so I try my best to vet things. Is it perfect? No, obviously it can’t be. I hear you say all the time about how you’re not licensed to do anything but practice medicine or drive a car and I’m in the same boat. I’m not a licensed real estate professional or a licensed investment professional or anything. I try my best.
Dr. Nisha Mehta:
We all obviously have all these legal disclaimers on the group about everybody needing to do their own due diligence and that ultimately every decision is theirs and that we don’t endorse any particular opportunities. But I think, at the end of the day, common sense is what’s going to dictate what people get involved in and if somebody is selling something that sounds too good to be true, it probably isn’t a great idea to get in on that without doing your own research and feeling comfortable with the risk that you’re taking. But yeah, on our end of things we really try really hard to prevent solicitation to the best of our ability. Can we monitor every single comment that happens? No. Are there ways for people who are really determined to get around things? Yeah. We block them as quickly as we can if we find out that they’re doing it. We regularly try to remind people on our group that if they’ve been solicited they should let us know so we can take care of it that is really all that you can do.
Dr. Jim Dahle:
Yeah. We’re running out of time here but I wanted to talk briefly about side gigs. I’m going to ask you to defend the concept of a physician side gig. Why should a doctor, who already has a busy, top 2-3% job, need or even want a side gig? Why can’t they be content with their already challenging job and their relatively high income?
Dr. Nisha Mehta:
So, for the record, I don’t think that anybody needs a side gig. I really don’t. I think that there is value in side gigs, but I don’t think that it’s necessary. I think you could certainly work every day at work in a full-time physician job and have plenty of money to meet your financial goals and do really well in life and have a good, happy, fulfilled life. I don’t think everyone needs a side gig.
Dr. Nisha Mehta:
I think the value in side gigs that I see is really what it’s contributed to my life. It’s having multiple streams of income because with that comes options, and I think having options is priceless. I love being able to say no to anything that I don’t want to do. I love being able to work the hours that I want. I love being able to take the vacation that I want. That’s a pretty amazing thing for a physician to be able to say, and most physicians can’t say stuff like that because they are bound by the confines of what their W-2 jobs are. So I think that that’s something that’s a really big deal for me in terms of why I think it’s been so positive to have side gigs in my life. I think there’s also the tax benefits that we don’t get through our W-2 jobs, which are great in terms of extra retirement accounts, deductions, all of those things.
Dr. Nisha Mehta:
And then I think there’s this whole other part of it that is, for me, really the best part, which is that I get to use a different part of my brain, I get to learn about different things, I get to meet different types of people. And for me, my side gigs really exploded right around that same time that that seven-year itch happened for me professionally. So it really gave me something new to be excited about, and it’s actually made me love my physician job even more because I’m so overall excited and invigorated by some of the stuff that I’m doing outside and I’m able to do it on my own terms. So for me, I would say that it’s really enhanced my career longevity, being a radiologist. And so for all of those reasons I think that having side gigs is great. But I never would go on the record saying, “Everybody needs a side gig.” They don’t.
Dr. Jim Dahle:
Now you’ve had exposure to lots and lots of side gigs. What are the top three side gigs? What are the best physician side gigs, do you think?
Dr. Nisha Mehta:
Hmm. So that depends on how you define “best,” obviously. From a financial perspective, I think it’s really hard to beat real estate or other investing unless, of course, like you do with WCI or I do with my work, you have a substantial business. But then in those cases, I would argue that in many of those cases they’re no longer side gigs when they take up at least the same or more of your working effort. So I don’t know that they’re necessarily side gigs if you’ve got a full out other business. So I think real estate and investing, from a financial perspective, definitely for most physicians is going to be your most lucrative.
Dr. Nisha Mehta:
That being said, I think some of the most interesting side gigs are owning other businesses. We have people who own breweries or who have created really great products that they’ve gotten out there. And some of those things can obviously really take off, some of the more creative things in the arts and music realm, people who have their own bands or who are just doing some really great stuff artistically. I love speaking and writing. I think it allows me to connect with so many people and it allows me a context with which to process my own life, so that’s been really, really great. Advocacy, anything where you can add value to the world in a different way is pretty cool, obviously.
Dr. Nisha Mehta:
There’s so many different options out there. I think you have to kind of figure out what your goal is for your side gig. Is it purely a monetary thing? Then I think it will take you down one pathway. But if it’s about exploring an interest that you have and then being able to reap some financial benefits from it on the back end, well, then that’s probably a different pathway for everyone.
Dr. Jim Dahle:
All right, we’ve got to wrap up here. But you have the ear of tens of thousands of doctors and similar high-income professionals, is there anything we haven’t talked about today that you want to tell them, specifically?
Dr. Nisha Mehta:
Mostly just the message that I like to spread is that you create life on your own terms. I think medicine, despite how amazing it is, shouldn’t be the only thing that defines you. I think a lot of us really need to take time to think about what it is that we want out of life, whether that’s professionally, personally, financially, et cetera. I always tell people that it’s amazing how many doctors can’t say what they want. A lot of people come to me talking to me about their burnout, or their professional struggles, or financial struggles, and the first thing I always ask them is, “What do you want?” and a lot of people have a really hard time answering that question. And it’s not surprising because for a lot of us, the last time that we thought about that is probably when we checked off that pre-med box in college.
Dr. Nisha Mehta:
But I think it’s important that we go back regularly and sort of reassess that as our lives evolve. So I always tell people don’t assume anything is impossible. Be an advocate for yourself and your families. You have the right to have a life in medicine that works for you and so you should go after that. Don’t leave medicine because you think there’s no options. If you still love the heart of what you do, I think in this era of physician shortages you have more bargaining power than you think, there’s probably something out there that works for you. So just figure out your goals and then the rest in terms of learning about the how and the finances and all the other things that you need to do to make those things happen, that’s a lot less daunting once you can figure out what it is that you want.

Dr. Jim Dahle:
Awesome. Well thank you so much, Nisha, for coming on the podcast. For those who want to learn more about Nisha, you can find her at nishamehtamd.com. Her Facebook group is Physician Side Gigs, it’s a private group, physician only, that you can get into. And of course, if you come to WCI CON, you can hear her speak, but by the time you hear this she will have already spoken. That doesn’t mean you can’t see it on the virtual, e-version of the conference, and so if you want to pick up more of what she has to say you can check that out as well. Thank you so much, Nisha.
Dr. Nisha Mehta:
Thanks so much, Jim. I’ll see you in a few weeks.

Dr. Jim Dahle:
All right. That’s always great to have Dr. Mehta on. She spoke at the first WCI CON, she’s speaking at this one. If you want to get more from her, obviously you can do that with the e-version of it. That should be out, if it’s not out at the time that you’re listening to this, it should be out within a few days.
Dr. Jim Dahle:
And this podcast has been sponsored by CHG Healthcare, who is the founder of locumstory. If you’ve ever considered a different way of practicing medicine, whether you’re burned out, need a change of pace, or want to see the world, locum tenens might be that option for you. If you’re not sure where to start, locumstory.com is the place where you can get real, unbiased answers to your questions. They answer basic questions like, “What is locum tenens?” to more complex questions about pay ranges, taxes, various specialties, and how locum tenens works for PAs and NPs. Go to whitecoatinvestor.com/locumstory and get the answers.

Dr. Jim Dahle:
Thanks for leaving us a five-star review and telling your friends about the podcast. Keep your head up, your shoulders back, you’ve got this and we can help. We’ll see you next time on the White Coat Investor Podcast.
Disclaimer:
My dad, your host, Dr. Dahle is a practicing emergency physician, blogger, author, and podcaster. He is not a licensed accountant, attorney, or financial advisor. So this podcast is for your entertainment and information only. It should not be considered official, personalized financial advice.