WCI #103: Reduce Burnout with the Physician Philosopher

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 Dahli. Welcome to White Coat Investor podcast 103 reduce burnout with the Physician Philosopher. If you're finding our podcast informative and helpful, we would encourage you to sign up for our monthly newsletter. It is totally free and and includes useful, actionable information not available on the regular blog posts or this podcast. It's almost like being in a secret club. The kind of club that can boost your knowledge and enhance your wealth at the same time with no strings attached. Sign up today@whitecoatinvestor.com Newsletter. You can do this and the White Coat Investor can help. Welcome back to the podcast. It's good to have you here. I'm thankful that you're listening, that you're telling others about it. It's been growing and growing. It's been pretty incredible for something we saw as very much a side project to the blog that's really become pretty impressive in its reach. Actually, I think we're seeing 20 or 25,000 downloads an episode these days. Our quote of the day today comes from J.L. collins who said, those who live paycheck to paycheck are slaves. Those who carry debt are slaves with even stouter shackles. I think there's a lot of truth to that there. Just briefly, I wanted to talk a little bit about some of the differences between the three White Coat investor communities that we have online. The first one was the White Coat Investor forum and a forum is nice in that it's all on the White Coat Investor site. So we can actually have a little bit more control over what it looks like and you know, who's participating there, so on and so forth. It's been around for two years to almost two and a half years now and has a really great cohort of people, very knowledgeable people that'll help you with your financial questions. It's a good place to really dive deep into the details and have people be able to come back and help you with follow up questions as well. The second community is the White Coat Investors Facebook Group. This is a private Facebook group. You have to be a high income professional and you can't be a financial professional to be in there unless you're that month's sponsor. This is a much larger group. It's gotta be 17, 18,000 people by now and suffers from all the problems with Facebook. You know, anytime you have Facebook, things get very large, very quickly. Some people aren't putting a lot of thought into it. Sometimes they just put in quick answers because they're just on their phones. And sometimes, you know, it's a little bit difficult to find the signal for all the noise. But the benefit of it is, geez, it's 17,000 or 18,000 people on there willing to help you out. You know, it's just the sheer size of it and how quickly you can get questions answered and get multiple opinions and put up polls and those kinds of things that you can only do on Facebook. And because people are on it all the time, they can interact with you, you know, on their way at lunchtime or in between patients, or, you know, all these little chunks of time we have throughout the day where we're likely to pull our phone out and get onto it. And so it's got that benefit there of just being a very large, very responsive community. The third community is the subreddit for those who are into Reddit. It's a unique format. You know, you get a vote up and vote down the things you like. It's very little of any kind of promotion. You're just not allowed to promote much on Reddit. And that includes us, even though we started the subreddit. And so it's a great environment for those who are used to that and who like that. I would suggest checking out Reddit. There's a lot of great information across Reddit, so give yourself a chance to check those things out. I know you're on your way into work or maybe your way home from work or hopefully you're exercising, you're out on a run or a bike ride or well, maybe I hope you're not listening to this on a bike ride or even running if you're in a busy place. But it's good to, to listen to this stuff to improve your life with those moments of time that you have. But the rest of your life is difficult. It's hard to practice medicine. You see terrible things happen to people and that starts to weigh on you. It's a long training period. The hours are long. They're sometimes not at convenient times. You know, people are always amazed when I tell them as an emergency doc that only about 20% of the shifts that emergency docs work are actually during bankers hours. Most of them are in the evenings, you know, nights, weekends, holidays, etc. And so it's difficult what you do. And thanks for doing it today. We Have a very special guest that I want to introduce to you. James D. Turner, goes by Jimmy, has been blogging as the Physician Philosopher for the last year and a half. You can find the blog@the physicianphilosopher.com or in the links in the show notes. As of this month, his blog is the newest member of the WCI blogging network. So you're going to be hearing an awful lot about him in the coming months and years. And I thought it'd be good to get him on the podcast to introduce him. Jimmy is an academic anesthesiologist practicing in North Carolina and is not very far out of training at all. Only about 20 months. At this point in today's podcast, we're going to get to know him and his work a lot better. Welcome to the show, Jimmy.

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

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

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

I don't think you can drop a bomb like that in the introduction without expanding on a little bit. I mean, I don't know that, you know, a lot of us come from a not particularly well to do background, but. But I don't think a lot of us grew up in a family that went through bankruptcy. How do you think that affected you and your views on money?

Yeah, so it absolutely had a profound impact on me. But the ironic thing was that that didn't really show itself until later when I became financially illiterate. I was financially illiterate for most of my life growing up until really just about fellowship. So my experience growing up was that one year in New Jersey, we got pretty much everything we wanted for Christmas. And as a 9 or 10 year old the next year we got very little. And we. We were all of a sudden living with my grandparents. And my parents were racking up six figures of credit card debt as they liquidated their 401ks and basically had no assets to their name. So they eventually filed bankruptcy. And my parents, despite being extremely hardworking people, were also not very financially literate. So I was very used to just using credit cards to buy anything growing up, which obviously had an impact on me later on, just kind of made sense to borrow money for medical school. And it didn't seem very. All of that had an impact on me. But I also, because of that experience, can relate to having much and having very little, which helps being able to find contentment in life because I recognize what it's like when we don't have much.

All right, let's move into the next phase of your life. Tell us about your schooling, your training, and your career up until this point.

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

All right, let's talk for a little bit about the physician philosopher. Why'd you start this blog? I mean, this couldn't have been in the first 40 or 50 physician financial blogs. You must have looked at those and said, there's something here that's missing and I can fill it. What do you think was missing?

Yeah, actually, I think when. When I joined, you know, Crispy Doc has a running list of personal financial bloggers. I know you do, too. And back when I joined, I think that I was probably number 40 or 50 like you said, maybe even 60. And you know, those. Some of those experiences growing up really shaped my view of money. And then I had. I had a couple of other experiences in medical school that were a very Rough introduction to the. To the financial industry. So when I was a third year medical student, I had, you know, we had our first kid, she's about to turn eight, actually, not soon after this podcast goes live. So I guess I should say happy birthday to my little girl. But when we had her, I thought that the appropriate thing to do, the fatherly thing to do, was to buy life insurance. And so I approached somebody who was the brother of one of my friends and basically said, hey, you know, I need term life insurance. And thankfully, I knew at least that much back then, but I knew very little else. And so he said, yeah, sure, we can get you life insurance, but you should probably also consider getting disability insurance because, you know, why not? You're otherwise healthy, right? And I said, well, you know, I have an essential tremor. I take propranolol for that. But yeah, for the most part, I'm pretty healthy and. But I just didn't see the reason to apply for disability insurance. I didn't have any income. I thought that I could do that. Later, I said no a few times and the insurance agent ended up talking me into it, which doesn't seem like a big deal, except for the fact that I got denied as a medical student in the very end of my third year. And then fast forward a few years to residency where they offer the guaranteed disability insurance policy and the really only stipulation for the guaranteed policy, which doesn't have any medical exam, no medical history taken, so they wouldn't have known about my tremor or the propranolol that I take. The only stipulation is that you can't have been denied personal disability insurance before. And since this insurance agent convinced me to apply as a third year medical student, I to this day cannot get personal disability insurance and have to rely on a group policy only. So that was a pretty rough introduction. And literally, not even 12 months later, I'm sitting in intern boot camp, which is this series of lectures or seminars where we're instructed about things that are related to medicine and outside of medicine that might help us prepare to be an intern or a resident physician. And they bring in this financial advisory firm. And it felt very slimy to me. Again, knowing nothing about money back then, I still, you know, hair on the back of my neck stood up. Didn't really trust it, but didn't really know why. And three or four years into residency, this firm that my medical school thought was trustworthy enough to give us advice on student loans and investment options, the CEO was sanctioned and charged by the sec. And thrown in jail for fraud for nine years. So, you know, I kind of had a rough introduction that taught me that if I was going to learn anything about this stuff, that I was probably going to need to do it on my own. And eventually that led me to, you know, your book, the why Coat Investor, you know, several blogs. And I started to become financially literate and became passionate about it and then started talking to everybody about it. And what I realized that was that despite all of the blogs out there, these 50 or 60 blogs, that there was still a huge need. There's a large number of people that don't know anything about this stuff, despite all of the really good material that's out there. And so I felt like I could really help fill part of that need and do it in a unique way where I connect topics that haven't really been previously connected, like burnout and financial independence and the psychology and philosophy behind money. So how our relationship with money shapes our decisions. And the third thing, I guess, is that most of the other blogs out there, it comes from a voice of expertise that people that have already done it, they've already accomplished it, they've already ascended the mountain. And mine is not the same voice. I'm a millennial. I'm young. I am a guide that's walking alongside these people and going through the same things that they're going through right now. For many of these people that are still figuring this stuff out, I felt that was a unique perspective and that could be more of a companion on the journey instead of coming from a, hey, I've done it. Let me tell you how to do it, too.

So what do you think? Does that give you more credibility or less credibility?

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

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

Yeah, yeah, that changed quickly.

It's definitely with the blog. That's a temporary condition, unfortunately. Yeah, that's better. For better or for worse. So if you had to sum up the message of your blog in one or two lines, what would you say it is?

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

Dedicated road. I like that.

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

You know, it's interesting. Every blogger has to sit there at the beginning and say, what am I going to call this? What am I going to put at the top of this blog? You ended up calling yours the Physician Philosopher. How come? Why'd you choose that name?

You know, I still remember sitting down on the, on the couch next to my wife, trying to figure out what we're going to name this thing. And my wife's an elementary school teacher and so she appreciated the alliteration of the name. And you know, we went through a lot of, a lot of different things, but unfortunately we wound up with a bit of a tongue twister. You know, it's a little hard to say. I mean, I might as well have named it. You know, she sells seashells by the Seashore, you know, it's tough to type, too, for some people. So, you know. But all kidding aside, I'm an anesthesiologist, so, you know, I'm a physician. That part fit. And then I was a philosophy major in college who tends to think outside the box and think about, you know, traditional problems in a bit of a different light. And so I felt like it was an apt name for the blog.

What do you like best about blogging?

Yeah, you know, so I guess there's two things that I really like about blogging. The first is helping people. You know, I love getting that email that says, hey, you know, this post was really helpful for me, really helped me deal with some tough topics and put the things in right perspective, and that makes it all worth it in the end. And the second favorite part is writing. I love putting some headphones on, turning some music on and then writing. It's a bit of catharsis for me. It's honestly one of the ways I've dealt with my own burnout. But I will say that my least favorite part, and I'm ashamed to say this in front of you because I know what your thoughts are on it, but it's promotion and technical stuff. Something I've had to learn and I've had to learn to like because it's a necessary part of the job. But, you know, unfortunately, it's not something that I just. I just can't wait to do. So I really enjoy the writing and connecting with people much more.

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

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

Yeah, it's, it's unfortunate truth. If you don't promote yourself, you don't do nearly as much good as you could do. Speaking of which, this physician financial blogosphere has absolutely exploded in the last five years, particularly the last two or three years. Why do you think that is?

Well, you know, I think that what's happening in medicine is kind of an interesting phenomenon. I think that particularly for younger physicians and I think for many of the older ones too, that we're starting to see a shift towards work, life, balance and trying to find, you know, that right fit that allows us to accomplish our job and, you know, what we want to do with the rest of our life. And so I think there have been some bloggers that are younger that have come on the scene and trying to put a voice in that space. And some people attack that from like a minimalism perspective, like Dr. McFrugal, or from a burnout perspective. Crispy Docker, Reflections of Millennial Doctor, Several up and coming bloggers. And that said, I think that the obvious reason is that, you know, there are other bloggers that have done this, enjoyed what they did, and have done quite well with it. You know, for a while you were publishing your income reports on the white coat investor. And I'm not, I'd be lying if I said that I didn't read those and, you know, and didn't say, wow, that's, that's really something. I think that a lot of other people read that too. You've since taken them down, I understand. But, you know, that was absolutely a part of it, I think for many people that got started.

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

Yeah, that's fair.

Because it's super fun, right, to write about your net worth when your net worth is $10,000 or minus $200,000. Right. That's cool. It's cute. Everybody likes it. Everybody can rel but as you start hitting the seven figure numbers, all of a sudden, it's not generating the same feelings in a lot of the people that read it, unfortunately. Maybe it inspires some, but I think it inspires some less than worthy feelings in some other people, unfortunately.

Yeah.

So you have a book out this year, the Physician Philosopher's Guide to personal finance. The 20% of personal finance doctors need to know to get 80% of the results. I think that makes you just the fourth or fifth physician financial blogger who's also an author. And that's counting, you know, people like William Bernstein, who I don't know if he wrote any books while he was still practicing medicine. That was after he was done. I think that he started writing the books, but it's pretty select group there. Why'd you write the book?

Well, you know, I'm really excited about this book. Got a lot of really good feedback on it. But ultimately I wrote the book because it's the book that I would have wanted to read. You know, I felt like there was still a space to write in this topic. And it kind of flows in a chronological order after some introductory chapters on personal finance and conflicts of interest in the financial industry. And it basically tells you the 20% that you need to know at any given step along the way. And that's something that I wish I had. I found this stuff really late, and so I wanted to write a book that was targeting younger people, some medical students, residents, early career attending physicians to try to help them figure this stuff out. Because while you can fix things after you've kind of fallen off the road, you know, it is much easier if you prevent it from the get go. And so I'm very big on teaching financial literacy to medical students and residents and felt like this book could, you know, serve that purpose, you know. But I guess in the end there was an opportunity to write a book and, you know, it was written from my voice and my perspective and, you know, my thoughts on the topic and thought that might be helpful for some people.

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

Yeah, you know, I think that's tough. I mean, the easiest way to find that out is to buy the book, obviously. But it's different for everything, you know, for every step along the way. You don't probably need to know about, you know, complicated investing, you know, or algorithm based investing or anything that maybe any Point. But you know, there are certain topics along the way that are the 20% you need to know. I mean, student loans is going to be your 20% for quite some time. You know, and it's just like medicine, when you understand that 20%, that's gonna get you 80% of the results, you're gonna, you're gonna do a pretty good job. But I think it really boils down to this. Personal finance is honestly not that complicated. You know, you earn a good income, you have a plan for your debt, you save some money based on the fact that you're living below that income. You earn, and then you put money into the market so that it can work for you. That said, even though it's a very simple design, it's often very complicated. Just like a diet or exercising. You know, just because I know that I should eat well doesn't mean that I didn't eat cookies and cream ice cre, you know, it's just what humans do. And so I think the 20% is really understanding those basic topics and then setting up a plan and sticking to it so that you can find, you know, your success with your personal finances.

Now, your writings seem to focus a lot on contentment, longevity and burnout, yet you are admittedly working 1.3 FTEs, you have a significant side gig and you're planning to be financially independent before mid career. How do you reconcile all that?

Yeah, that's a good question. So, you know, I admittedly my first year picked up a few extra shifts because I was trying to pay down my student loans faster. I stopped doing that about a little less than a year ago when my wife started full time. But the other part of that is that my department, we have a really awesome anesthesia department awake. But that said, our services are continually being asked for by other places. So we're continually expanding to other hospitals, to other services like interventional radiology or gi. And because of that, we've had a hard time keeping up with hiring in that giant expansion that we've experienced in the last 15 months. So, you know, I'm working 1.3 FTE, I would prefer to be working one. And I'm steadily working my way to getting down there. But at the end of the day, you know, there's certain number of physicians that work in the anesthesia department and there's a certain number of shifts that need to be covered. As for the side gig stuff, really, you know, at the end of the day, I'm extremely passionate about this topic and about teaching people about Personal finance and how to find freedom through that and escape burnout. And so even if I wasn't getting paid to do this, even if I, you know, never made money on it, I would still probably be talking to people about this stuff, whether through a blog or, you know, a podcast or what have you. And it doesn't feel like work to me because I'm passionate about it. So while I am doing some other things on the side, you know, I'm trying to find balance in it all. And yeah, I do write about these topics, and it set me up for burning out myself, but I'd keep doing it anyway because of how passionate I am about it.

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

Yeah. So, you know, I think people focus on burnout, and rightly so, you know, mainly on the job. You know, there are lots of things about medicine that burn people out. That said, you know, I really think it's a matter of work, life, balance. And if either of those arenas, your work, you know, or life at home are off balance or are, you know, requiring more work than they used to, you're going to be in a situation where you're going to burn out. And I was doing all those things that we mentioned above. You know, my first years in attending was insane. I, you know, I published three randomized control trials. I won some teaching awards. I worked 1.3 FTE. Oh, I have three kids and a wife that started working full time in July. And so all of that combined really set me up to burn now, because my wife, who is a saint and is the best person I know, took care of so many things when I was in training. And my wife also happens to be a gifted educator. And while, you know, I'm no slouch at my job, it'd be unfair for me to, you know, to expect her to continue to do that because she is a gifted educator that really has the potential to help a ton of kindergarten teachers. She works with kindergarten teachers. And so she wanted to go back full time, and I completely supported that. What that resulted in is a need for me to help out more at home than I had been previously, because that's fair. And so I started doing that on top of everything else I was doing and realized that for the first time in my life, I do have a limit and that I had run up against it. And so I eventually had to start cutting back and asking if people wanted to take shifts that were interested in making more money. And fortunately, we have some of that balance where I work. But, yeah, that's also when I adopted, you know, what I've. I've affectionately called my hell yes policy, which basically, the purpose behind that is to say that when someone asks me for involvement in another commitment or committee or meeting or what have you, that unless I'm insanely passionate about it and it really makes me say hell yes for the opportunity, then I'm just going to say no. And so I started saying no to a lot of things and really defining some lines, drawing lines in the sand to help kind of fix that work life imbalance that I had because, you know, at the end of the day, I really wanted to support my wife and her dreams and passions in her career.

I love that you guys hear that. What are you saying here is if you can't say hell yes to it, say no. You know, that's basically the bottom line. Too many times we become yes men in medicine, and we keep getting asked to do these things, to serve in these committees, to do this project, to write this paper, to, you know, mentor this student, whatever. And at a certain point, you just can't do it all. And so look for those things you feel most passionate about. Say yes to those and say no to everything else. That's how you're going to reduce your burnout. Speaking of which, do you really think Dr. Burnout is any different from what people in other professions feel? I just got done recording an interview with Jonathan Clements. It's going to run a couple of weeks after this podcast, and he mentioned that at one point he was feeling a little bit burned out in his journalism career. Is Dr. Burnout really any different than other professions? And if so, how? I mean, is it just that doctors are whinier about it, or is there really a difference there?

Well, you know, I'll answer that last question. You know, about the whinier aspect of physicians with, you know, a resounding no, I don't. I don't think the doctors whine more. There's something different about our career. You know, when you match people in medicine to the general population, both residents and attending physicians have a disproportionately higher rate of burnout. That said, my wife is a teacher, and I can tell you that in her career, she's experienced lots and lots of burnout in education because teachers are underpaid and overworked and feel like they're undervalued. And so I don't think that it's a unique phenomenon just to medicine, but I do think that the burnout in medicine is probably different for other people because of that, you know, that road to burnout where we sacrifice those 20s and we miss all those things, and we just set ourselves up for this road that we really can't do anything about. Because if you think about it, you come out of medical school with the average student, 80% of students, having $200,000 in student loans, and they're forced into a job in residency where they basically can't pay that debt back. So it's just going to continue to accrue, and they're fine with that. In the meantime, while it's, you know, monopoly money, it's not real. They don't have to pay it back yet. But then they finish, they get to their job, and they don't have the autonomy or the, you know, the privileges that they thought they would have as a. As a working physician, an attending physician who's finished their career. It's been taken by emrs or, you know, administrators or insurance companies. And so, you know, it really is kind of a setup. And unfortunately, you know, many people find that autonomy stripped away from them. So they try to fix these problems with all the big purchases. And I think that's a very unique thing because a resident goes from making an average, you know, median income for the country to making four, five, six times that overnight. And despite all of that, we still have disproportionately higher rates of burnout. So something must be different.

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

Yeah, you know, I get pretty feisty about this subject because I think that what they're trying to say is they think that these people are weak. These people that are having difficulties with their work life balance that they're burning out, you know, that these people are too weak to take their job, you know, and the problems that come along with it. You know, there's a great video By Ed Ellison, Dr. Ed Ellison, that talks about studies where they look at medical students as graduate students coming into their graduate school, and they are compared to other medical or other graduate programs. They have the highest ratings of wellness and resilience coming into medical school compared to any other graduate program. Yet when they leave, they have the lowest. So something's happening in our training paradigm that results in this stuff. And I'd ask these people if they're really paying attention to the statistics. You know, Medscape, Mayo, Several other places have shown that burnout rates are around 40 to 50%. That's one in two doctors. And, you know, the suicide numbers are no better. Women physicians are 130% more likely than the general population to commit suicide, and men are 40% higher. So I don't know where these people are kind of getting the idea from, but a doctor a day kills themselves. And we have a problem in this country, and it's very real. Unfortunately, some people don't like to pay attention to these statistics and heap it on their backs of people and say that they just need to pick themselves up by their bootstraps. But really, at the end of the day, doctors are a perfect setup for this stuff. We're perfectionists, we're hardworking. We don't like to ask for help, you know, and all of that results in a situation where people can be struggling. And because of people like this that don't believe that burnout's real, there's a stigma, and they're afraid to ask for help. And so I think that not only are those people wrong, but I think they're actually harming others by thinking that.

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

That makes sense.

But I've kind of divided it into four issues that seem to affect docs. You know, the first of which is systemic issues. You know, these problems with abusive jobs, EMRs, all these, you know, problems that have particularly become acute in the last few years. You know, maintenance of certification stresses, those kinds of things. So that's the first category. The second is the stresses of the profession that simply can't be eliminated. You know, dealing with sick people, you know, things that just aren't going away, you know, watching people die, that kind of thing, it's a difficult job, etc. The third category is kind of financial stress, which often begins early in the career, you know, with the student loan debt, but can be exacerbated by poor financial decision making. Then the last one is the personal factor, you know, the amount of resiliency in the person. If you had to assign percentages to those four things, the systemic issues, the professional issues, the finances, and the individual person, what percentage would you assign to each of those for burnout?

What I think is a little bit differently about this subject, you know, where I think the burnout is a systematic or systemic problem. And so if you really look at the studies that have, you know, tried to determine what the causes of burnout are for physicians, whether you look at the Medscape study or other ones, really, you can clump a lot of the causes down into one major cause, which is autonomy. And that is something that makes sense because Ed Deci and Rich Ryan, two guys I've looked at work satisfaction and motivation at work, have come up with really three key components to be satisfied at work. Autonomy, meaning that you have the freedom to do your job how you wish. Competence, meaning you're good at it. And then relatedness, which is a fancy word saying that basically you get support from your workplace. And so I think that those three categories fit into the four that you mentioned in a way, because, you know, autonomy is something that most people feel like has been stripped away from them, whether it's an electronic medical record system, insurance companies or, you know, CMEs, or, you know, things. Things like you're mentioning before in your first category. I certainly think that most physicians are competent at their job, but many of them don't feel that way. They have massive imposter syndrome, particularly when they're young in their career. And a lot of doctors are. Are in a situation where they feel like they're not getting a lot of support. You know, they're. They're raising concerns and nothing's being done about them. And so they don't have a lot of that relatedness. But, you know, I guess at the end of the day, I'd. The majority of it is systematic or systemic, and that. That can be made substantially worse by the financial decisions that people make. So you can either find freedom through your financial decisions, or you can cause this burnout problem to be much worse. And so, you know, I don't know about exact percentages, but, you know, those certainly all contribute.

You don't Sound like you would assign any amount of responsibility or percentage to a lack of resiliency in the practitioner.

You know, I just have a hard time finding, you know, believing that people that worked so hard to get through medical school, residency and fellowship decided to pursue a career in med, you know, medicine, and just what it takes to do that and get there. Who are the top 1 to 5% of, you know, intelligence in the country that these people are just all of a sudden going to be lazy and, you know, have a lack of ability to deal with difficult situations? I think that, you know, and I've gotten some flack for this before, actually, you know, from my military, you know, readers. But, you know, the most common thing to really compare this to is, you know, being in the military, you know, when you see things that are disturbing, traumatizing, you know, you mentioned those parts of the job that you can't change that causes secondary post traumatic stress disorder. There's studies on this, you know, and so I think that most of the problems that occur happen because of the system. And I'm slow to blame the physician for, for having burnout problems. Now, that said, I do think that there are things that individuals can do to, to make that problem better, but, you know, I'm not going to place a lot of blame on them. You know, I just, I think that when they finish, their reality is very different than what they expected during all of those long years of training.

Yeah, I think there's a big mismatch for a lot of people that, you know, it's difficult to decide what you're going to do the rest of your life when you're 22, 23 years old, and all of a sudden you come out at 35 or whatever, out of the other end of the medical training pipeline, and you're a very different person. You have very different life goals and very different interests. And it turns out that what you thought you wanted at 22 isn't what you want at 35. And then you have to reconcile that and yet add in $400,000 of student loans and the fact that you're not qualified to do anything else that could ever possibly pay those loans back. You know, just adds additional stress to it.

Sure, absolutely.

So the physician financial blogosphere has a prescribed solution to burnout, which is basically fire financial independence, retire early. Is that really the best solution to burnout?

No, I don't think that it is. And on my, on my site, you're not going to see me talk about early retirement very much. And part of that is because my target audience is younger. And I honestly think about, you know, that thinking about early retirement is not always a healthy thing, particularly young in your career. But, no, I don't think it's the best solution, honestly. It's a systemic problem, and so it's going to require a systemic or systematic solution. And the way that I look at this, you know, the way I explain it to people, is it's a bit like the aviation industry in the 1970s. And this analogy is coming up against a bit of a hard time with the Boeing incidents that have been happened. But, you know, in the 1970s, aviation, the airline industries, they had accidents all the time. People died all the time. And then not until March of 1977, basically, you know, on Tenerife island, there was an accident that killed about 600 people. And that led the aviation industry to look into things and say, what's. What's happening? Why is this. Why is this happening? Why are people continually dying on airplanes? What they found out is that there was a culture problem, right? They had a culture where the pilot was God. He got to decide what happened. When it happened, you couldn't question them. There were not checklists or safety systems put in place, and if they were bypassed by the pilot, no one could say anything. And people in that accident actually knew that something bad was about to happen, and yet they still didn't say anything and literally let the pilot drive them to their death because of how strong the culture was. And I think that that's the same as it is in medicine nowadays. In the aviation industry, Their response to this was they created something called crew resource management, where they basically started looking at the systematic ways they could fix these problems. And it led to the safety systems that we use in the aviation industry now that makes it much, much safer to fly. And honestly, that's the same thing that spawned, you know, the Atul Gwande's, you know, checklist manifesto and the checklists that are used there and that are used over, you know, in several hospitals in the country. So I think that the solution is not fire. It's not to escape it. It's a systematic problem. It's going to require systematic solutions. That said, I think that many, many people feel like the system's just not going to get fixed. You know, no one. No one seems to be doing anything about this, despite the problems that we're having. You know, the people in the trenches, the physicians in the trenches that are burning out in medicine feel like no one is coming to their rescue. And so I do think that there's some onus on the physician to say, well, you know, if the system's not going to fix itself, then I need to look for ways to provide freedom for myself. And in my opinion, that can be done through financial independence. So it provides us a way to win back that autonomy that led to our burnout or to, you know, cut back or to change things or to find the shift that we like or the aspects of the job that we really enjoy and cut back on the things that we don't. And ultimately, it's kind of like a support yourself fund. I think that people that are able to do that can fight against this problem even if the system isn't going to be willing to change, which is ultimately what needs to happen.

So how, I mean, everyone says the system has to change. It's a system problem. What has to change?

You know, I don't have a great answer for that. You know, I think that there are obvious things that need to change. You know, the electronic medical record system is broken. It's a glorified billing system that is not meant for patient care, and yet it's sold to physicians as a patient care tool. And so that death by a million clicks, if you will, needs to be changed. And I think too, that a lot of physicians feel like administrators who don't do their job, can't do their job are telling them how to do their job, which really frustrates people. And the push here that's happened is that 75 to 80% of doctors are now employed, and so they're not their own bosses anymore like they used to be. I don't know how to fix that. You know, I mean, that's, that's going to have to come from administration and from hospitals or finding your own group that isn't owned.

Yeah, I think that's difficult in today's trend of consolidation. Even my small democratic group, you know, when I joined it, I think I was about the 10th Doctor. And even at that time, we'd consolidated with three other groups to, you know, negotiate with insurance companies and so on and so forth. But even in the eight years I've been here, this group has expanded from, I don't know, maybe it was 40 or 50 doctors at that point.

Point.

I think we're now 350 or 400 doctors, you know, in this small democratic group. It's just not a small group anymore.

No, it's not.

You know, and, and it's either that or be eaten by the contract management Groups out there. And so.

That's right.

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

That's right.

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

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

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

Sure.

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

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

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

Yeah, you know, I always think this is a funny conversation. So, you know, what I think is morally wrong is having a physician burnout and suicide problem in our country and watching very little get done with it. That's what's morally wrong to me. You know, there's a problem in the system and we need to fix it. But as for the morality of early retirement and whether that's a thing or not, I remember there was a Business Insider article that came out. It was highlighting Leaf, you know, physician on fire. And in that, you know, basically went through a week of his spending and it got posted on Doximity. And Leaf just took so much heat for that because people were like, this is incredulous. I can't believe that you're retiring early. You're a doctor, you put in so many years of work. It's a shame. They never should have let you in. I mean, he really got, you know, roasted pretty badly on that. And so I wrote a response to that called it's wrong for doctors to retire early, which is a bit click baity, but you know, where I basically went through all the arguments, the common arguments that people have for this sort of thing, and talk about the fact that, like, you know, the logical extension of these arguments don't make sense. Right? It's wrong to retire early. Okay, well, at what age is it okay? Is it okay at 60, 65, 70? Do you have to work until you're like, literally in the grave? I mean, at some point it becomes okay. Why is it okay in later years? How many years are required by these people that, you know, want to make these, these, these Kind of comments, you know, and is it really the physician's fault that there isn't as a physician shortage? Well, the ACGME slots are limited, so we have tons of doctors that graduate from medical school every single year. They have hundreds of thousands of dollars in student loans and they can't get into a residency that they'll allow, you know, will allow them to finish their career and to become board certified, you know, attending physicians. So that's morally wrong. I mean, we have a bottleneck that isn't getting fixed. And so, you know, I think that it's kind of funny because people focus on this thing, you know, and have very heated comments to make about it, but we don't want to talk about other things that are actual problems. Right. You know, the bottleneck or, you know, the fact that, you know, physicians are burning out at epidemic rates. So, you know, I don't think there's a lot of, a lot of truth to those arguments and obviously I don't put a lot of, a lot of weight into them.

Yeah, I can tell you feel strongly about them.

Yeah, I don't miss my words on that.

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

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

Now, your last update in February showed your net worth was barely six figures about 18 months out of training. Do you think that puts you ahead of or behind most of your peers?

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

Yeah, I would say getting into the positive in less than two years probably does put you ahead of most of your peers, based on the emails I get from people. But it's hard to say. You know, there's not really a great graph out there. The one I've seen, I think, is that Doctors in their 30s, something like 77 or 81% or something like that, have a net worth under 500,000. But that doesn't really tell you when people typically turn positive. You know, we tried to have a celebration this year, you know, in the, in the community, back to broke. You know, the doctors could celebrate when they got back to a net worth of zero. I don't know that it really caught on very well, but it really is a moment we're celebrating because it takes a lot of work just to get back to zero when you're a doctor.

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

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

Yeah. So, you know, really, really, in my mind, the reason that this doesn't happen for most people is because of that road that I talked about that, you know, we are kind of destined for where we finish. And then with all that delayed gratification, which physicians clearly need to be good at, because you did it for, you know, 7, 10, 12 years after, you know, high school. And so I think that what happens is people say, hey, you know, there's light at the end of the road. I really want to reward myself for all these tough years, long hours, and, you know, all the sacrifices that they made. And so they really inflate their lifestyle. And I think that some lifestyle creep to some extent is fine. And in fact, you know, what I talk to people about is something called the 10% rule, where basically you take your difference in your take home, post tax pay, and then whatever that difference is, say it's $10,000, then you take $1,000 of that or 10% and you spend it on whatever your heart wants. I really, I don't put people in a box on this one, like you can do whatever you want. And I actually did some pretty financially stupid things with my 10% and truth and transparency there. But, you know, I put the other 90% towards our student loans and towards maxing out some retirement vehicles and ended up paying $200,000 off in 19 months. So, you know, it required discipline. But this 10% rule, man, you know, when I finished, I got to inflate my lifestyle by $1,000 post tax a month. I felt like I was living like a king, you know, with the changes that we made. And so I felt like that allowed us to deal with that desire to improve your lifestyle, that you've earned that while still doing really the right and responsible financial thing at the end of the day.

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

Exactly.

So as long as you are making progress toward what you want to accomplish, you're winning the game in that respect. It's. It's solitaire, really.

Sure. Exactly.

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

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

Yeah, for sure. That's definitely when I started the White Coat Investor. It was with a bunch of weekday mornings that I didn't know what to do with. No doubt about it, this would not exist if I had been, you know, a classic internist in clinic every Monday during bankers hours, you know, it would not have happened. So no doubt about that. So you decided pretty early on really not to blog anonymously. That was not the case for the Physician on Fire or Passive Income md. They eventually kind of came out of the anonymous blogging closet, but that was never really seemed to be much of a thought for you. Why? Why was that?

Yeah, so the site started in November of 2017 and ended up becoming, which was anonymous at the time and ended up becoming non anonymous in February when I published my book. But you know, really the background to that is that, and this is, you know, maybe helpful for some people that are considering doing side gigs. I'm an employed physician and so I didn't know what my hospital would think about my blog, particularly given my, you know, open, transparent nature. And so I didn't know what to do with it. You know, I thought that it might be safer if I, if I just kept it anonymous. And then, you know, I spent nine months writing, you know, the Physician Philosopher's Guide to Personal Finance. And so I had to make a decision because I was really proud of that book. I took, I put a lot of work in it. I really tried to whittle it down to what people need to know so they could read it pretty quickly and not waste a whole lot of time. But when I did that, I wanted to put my name on it. You know, I was proud of the book. And so I approached my chair about the book, about the blog and said, hey, I just want you to know that these things exist. And I was extremely nervous going into that meeting actually, and my chair was unbelievably supportive. And so, you know, we talked about that relatedness, you know, feeling like you have support from your, from your workplace. And so when that happened, my work satisfaction was maybe at an all time peak. And just because I felt like he was really supporting me in my ambitions. And when they have their thinking cap on, this really is something that makes them look good. And so I think that he recognized that. But the hesitancy was just, I didn't know what my employer would think about it, to be honest with you. And then when the book came out, I had to make a decision.

Now, going back to the beginning of your blog, your very first post was how to choose a medical specialty. Why did you choose that for your first post?

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

Yeah, don't go back and read any of my stuff in the first, you know, year or so. There's plenty of stuff in there I'm not super proud of. Exactly. You know, I mean, I think I got the message out pretty early on in the first few months, but I've tried a lot of things that just didn't work, you know, over the years. And it's funny because you don't realize that's okay because nobody's reading, you know, that's right. There's nobody out there reading this stuff. And occasionally I have someone call or write me and say, hey, I've gone back to the beginning. I've read everything. And I'm like, wow, you've read some terrible stuff. You know, but it's interesting. Kind of the progression of a blogger.

Yeah, for sure.

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

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

What does it take to get into that group? Do you have to be a philosophy major?

So you have to be. No, you don't. You have to tell me your favorite philosopher. No. Yeah, so it's, it is a physician group. So it's for MDs and DOs, and that's basically it. So as long as you're on the, on that road that I've been talking about, you're. You're welcome to join. I want, I wanted people to have a safe place to, you know, really say what they thought, you know, from, from their perspective.

So how can listeners follow you and learn more about the Physician Philosopher?

Well, you can visit the site, the physicianphilosopher.com and you know, I put out posts three times a week. You can also subscribe to email lists which you can find on the, on the front page of the. Of the site where you can choose to get weekly updates either. Well, I guess updates either weekly or as soon as the post comes out. And you have two different options there based on the number of emails you want because, you know, I'm not any bigger fan than anyone else on emails, but you can buy the book the Physician Philosopher's Guide to Personal Finance. And of course you can join that Facebook group we just talked about or follow me on Twitter, which is Phys Philosophers as P H Y S Philosopher.

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

Thanks, Jim. I had a ton of fun. Really appreciate the opportunity.

That was wonderful to have Jimmy on the podcast. If you're finding our podcast informative and helpful, we would encourage you to sign up for our monthly newsletter. It is totally free and includes useful, actionable information not available on the regular blog posts or this podcast. It's almost like being in a secret club. The kind of club that can boost your knowledge and enhance your wealth at the same time, with no strings attached. Sign up today@whitecoatinvestor.com newsletter. You can do this and the White Coat investor can help. Head up. Shoulders back. Check out the Physician Philosopher in his book, you've got this. And we'll be here next time on the White Coat Investor Podcast.

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