WCI #150: Side Gigs, Women, and Demographic Changes in Medicine

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 Dali. This is White Coat Investor podcast 150 side gigs, women and demographic changes in medicine. I estimate that 80% of doctors need, want and should use a financial advisor and or an investment manager. Some investment gurus such as Dr. William Bernstein think my estimate is way too low. At any rate, if you want to use an advisor temporarily or for your entire life, there's no reason to feel guilty about it. Just make sure you are getting good advice at a fair price. If you need help updating your financial plan or just getting one in place, check out our list of recommended financial advisors@whitecoatinvestor.com financial advisors. You can do this and the White Coat Investor can help. 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, so I think the markets dropped 12% last week, which probably provided you a pretty stress test of your risk tolerance. I want to 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 youe 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 statement. Success. 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 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. 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. 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 is 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, you know, 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. Our quote of the day today comes From William Bernstein, M.D. 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. So I wanted 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. You know, 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. But that said, you know, it's a little bit like a TV show and nobody likes watching a movie on TV where there's hardly any ads at the beginning of the mo and then right when it gets good, they just stuff it so full of ads you almost can't stand it. So we're not trying to give you that kind of an 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. Now by the time you hear this, as we're recording it, it's before WC Icon. But by the time you hear this, we're going to be putting out the virtual version of WC icon 20. It's going to be an online. 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 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. So 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 WCICON Conference, the Physician, Wellness and Financial literacy conference of 2020. 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. 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 is some risk to ourselves and our families. So thank you for being willing to do that. 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. And so it's great to have you here on the White coat Investor podcast. Dr. Mehta.

Hi, Jim. Thanks for having me on the podcast. Excited to be here. You can totally call me Nisha, by the way.

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 would be fun. I'm looking forward to your talk at wcicon.

I'm definitely looking forward to it, too.

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 that way. But before we get into that, I don't know that all of my listeners know you. I know 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?

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. 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 Deb. So I don't think that we ever really wanted for anything. And 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 with our own money now, I think it really helps us to avoid a lot of the financial mistakes that a lot of physicians make early on.

So is there any way for you to pass those lessons that you learned onto your kids, or is it impossible?

Yeah, I mean, this is, I think, 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, my mom was a stay at home 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. And you know, unfortunately our kids, I mean, 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 payday that teach them to budget and all of those things, I mean, ultimately, at the end of the day, I think they see more wealth than we saw growing up. And we always wonder how that 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 as we can, but it's not easy.

Yeah, I can relate for sure. So tell us briefly about your education and training.

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. 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 Car 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 in attending for two years there until my husband finished his training.

So you mentioned you went into a little bit of your attending hood. Tell us about your career so far.

Yes, 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. 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 allowed 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 to me where I am today in terms of my non clinical 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 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.

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.

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 half time has become pretty complicated. But, you know, we dabble a little bit. And 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. I guess 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 in 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.

You know, it's interesting, A lot of the people that talk about burnout, and I include myself, you know, I give talks about burnout all the time, as do you. This fellow Dyke, I forget his last name for now, but he goes around and talks about, yeah, Dyke 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 halftime or less at this point.

Right.

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 know, you're only working halftime 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?

Yeah, so I think it's definitely one that's going to come up more often. So 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. But I'm not balancing a 45 hour work week with everything else that I'm.

Doing with, with another 45 hour work week or more.

Right. As you know. Yeah. I mean, I think that there were times with my fed stuff where I was putting in 60 hours there and I, you know, I didn't work that hard during residency. So I think that there were definitely weeks when I was doing both where it was a hundred hours plus. And you know, I've been there, I've done all the things, 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 it's, number one, it's still very fresh in my mind. And number two, I think, you know, we're still living that on a daily basis. My husband is full time, obviously. And by the same time, when I talk about burnout and I talk about solutions to burnout, it's not. Honestly, I don't think that I ever got 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, you know, 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. 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 on 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 tell me to have them double or I'd rather double cover, because for me 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. So I don't know. I mean, obviously do 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, you know, 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. Things change, but right now I feel pretty good that I still know what's going on.

Yeah, that's kind of the way I feel. And certainly, you know, 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, really do like doing this stuff, you know, 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. So. 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. 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. But first, let's get into a statistic that you've spent a lot of time thinking about. 70 to 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 a sort of 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.

Yeah, absolutely. So I'm going to head off a little bit of what you said on the controversial side of things that I do realize 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. You know, 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 at home or anything like that. Right. I don't think that female careers should take a backbeat to their husband's careers or anything even remotely like that. So I don't want anything to be misconstrued in that sense. And I also know that every physician family is different. So what applies to one physician, 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 situation. But my point in stressing this particular statistic a lot in my talks is because 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 like, 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. So 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 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 a physician workforce needs 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. And so, as you just said, 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 an 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 and dual income families, millennials, later career physicians, whatever, other groups of physic that don't see themselves fitting into the mold of the quote, unquote, 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. 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 6pm after exhausting days at work. And those are all things that started coming up more and more as we got further along in the pathway. And consequently, we, like many high dual income families, whether in medicine or not, started making some decisions based on that. And I think that's what I see routinely when I'm going around the country and talking to female physicians is, you know, 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, you know, has been laid out for me. In terms of being this traditional physician, but it's not working for me. And 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, you know, 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 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?

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 stage 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 people's careers.

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 to 80% of female physicians are in dual high income couples. That leaves 20 to 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?

So I think 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 me running around talking to people not based on hard statistics, because we don't have those hard statistics. At least I'm 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 you know, 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 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, vers, academics, 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. So, you know, 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 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 that also said 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. You know, 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. But certainly if I'm proportionately decreasing my workload or decreasing the number of RPE's 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 to doing that maybe aren't as. You know, 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, you know, has a very high income.

I think that's a really important point to make because a lot of people, and I don't know the 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 or 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.

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 do 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, you know, in fields like you and I are in with emergency medicine 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 disparities, not that they don't exist, because there's 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. 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.

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?

So, okay, this may be more time than you have on one hour podcast.

Jim, but let's do the brief version.

Yes, the brief version of it. So, I mean, 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 do negotiate too hard or. 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, you know, 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 of 240, 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 positions are offered less from the get go. And a lot of times, and at the end of the day, people who are offering them jobs are running businesses and they're 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. Right? 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 there's 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 among different physicians where they'll say, yeah, you know, 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. Or, you know, at the end of the day, these conversations are happening behind.

Closed doors, which is completely illegal. Right, right. Completely illegal to even have that conversation.

Absolutely. It's totally illegal. But, you know, 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 stories 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. So, you know, I had a residency interview once where somebody asked me point blank if I was planning on having children during residency. And I mean, that's the 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 that stuff happens all the time. You know, 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 accessible 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, you know, their offers. And that's the reality of the situation right now.

Yeah, it's easy to see both sides. I mean, we have no doubt when we bring on a new doc at a 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 you really. It's not legal to even take that into consideration when you're choosing who you're going to hire.

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. You know, 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. So. 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 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, but 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 long term.

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 costs, 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 it works really, really important to him. What advice do you have to him?

I think it's the same both ways in both directions. You know, 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, 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. So I love What I do as a physician, I would never willingly give it up the way that our finances were with my husband being in private practice, plastic surgery, and me being in academics and government positions. And, you know, we're not a fancy family and our spending habits are not that high. And so honestly my income didn't make 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. Right. 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. And so I think for any female physician to feel, 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 gotta figure out what works out for your individual family. I mean, 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. Right. And if you talk about marriage dynamics, I mean, you want to create hostility within a 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, it's not a great grounds for decades of marriage.

Yeah. Let's go back to the dual high income couples.

Yeah.

How does the family budget become different? What expenses are higher or lower in that sort of a situation where you're two doc Family.

Yeah. So I mean, 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 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 struggle to balance more as the kids are older and my business grows. 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 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. My mom, on the other hand, you know, 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, right? 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 just is what it is. 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 things that are lower, it's actually funny. But 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. So we just don't have time.

You don't have time to go on vacation or buy the Tesla or any of that.

Right. And so it's kind of funny because there's less impulse purchases, right? I mean, 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, like 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 of ways it's funny because, you know, 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. 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?

Well, it's interesting because, you know, even when I follow your blog, for example, right. A lot of the things that applied to us five years ago no longer apply to us. Right. And things change. Right. 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, right when we were coming out of residency, when we were just learning about, you know, what is a 401k. 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, you know, masked 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. 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 that people are getting out there and getting those messages out. Because as you know, better than probably 99.999% of people in the world, we need it. Right? 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 mean, I think that there should be basic financial literacy in high school for everyone. That just doesn't exist. And so I think it's really good that a lot of this financial blogs exist. 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, with just that baseline level of knowledge. 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.

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 dual high income versus a single high income couple?

Yeah, I mean, so when you max out two W2 job retirement plans, that that's probably going to add up pretty quickly. That being said, of course, as a dual physician subspecialized couple, neither one of us really had real jobs until well into our 30s, so we started out way behind the eight ball 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 out my tax advantage to things. And yeah, okay, obviously I'm going to fully fund my 401k. 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, 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 401k 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.

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 of medicine relatively early in the 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?

Yeah. So I think that it affects all of us a ton. Right. 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. Right. But I also think that they practice 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 long term. 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 of that, alternative income streams become something that come up. 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, well 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 a lot 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. 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. I think that that's a huge 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, I mean, there's going to become 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. 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 I'm 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. 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 fore, but since I can't, I'm leaving medicine. Well, I think the employers are going to be. They're 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, right, Because I think a lot about who's going to provide medicine to me in 20, 30 years when I need, you know, the healthcare system more. And what is that going to look like? I keep, you can't see a physician for many, many months, for example. I think that those things are a really big deal. So, I mean, I think that it's a shame because we don't talk about these things a lot in medicine right 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 long term. And so I think all of us are having these thoughts. I remember when I first started out in this space, 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 a at least 20 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. 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, you know, I understand you might not feel bad for us when we're making six figure salaries and you know, 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 negligence. Like whenever these are articles come out in the press talking about how much physicians make and slamming physicians salaries and calling them cartels or any of these things. I always laugh because I'm like, you don't understand. Like I understand 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.

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.

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. 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. 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 health care 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. So now we face a situation where, in combination with 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 and policy, and when I look at those numbers from a policy standpoint, they're 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 residency spots. And there's just not enough residency spots out there.

What about APCs, do you see an increased role for APCs, the PAs and NPs out there there because of doctors working less?

That's another loaded question.

We're going to try to hit all the controversial topics in medicine in one podcast.

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 that we certainly need all the people that we can get in on healthcare. We need strong teamwork. That part is absolutely for sure the case. I think that, you know, we've got an aging population, we've got increasing health care needs. I think we've got a society where people expect to be seen relatively expeditiously. Right. 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've asked, you know, say that they have a headache. 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 ch.

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 $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 Medicare?

I don't think that any of us get to 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, you know, a certain cultural scene or near a particular resource are essential to either their well being or their happiness. And I think that that's just a fact of life. Right. 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. So. 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 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. So, I mean, 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 ones for our families and then deal with the rest, good or bad.

Now, there was a scam recently involving a cryptocurrency trading algorithm where doctors ended up losing about 34 million bucks, an average of $220,000 per doc. Investors were recruited in and from a physician Facebook group, the Physician Dads 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?

Yeah, so I heard all about that. You know, like I said, we have about 54,000 people on 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. 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. Least have some control over, you know, anybody who's trying to take advantage of anybody in the group. Not to say that that position in that group was trying to take advantage of other people. I don't know, you 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, and 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'm not. You know, I hear you say all the time about how you're not licensed to do anything but practice medicine or drive a car. I'm in the same boat. Right. I'm not a licensed Real estate professional or a licensed investment professional or anything. I try my best. 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 opportunity. 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, I mean, 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. I think 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. All that you can do?

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 to 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?

So for the record, I don't think that anybody needs a side gig. I really don't. I think that there is value inside gigs, but I don't think that it's necessary. I think you could certainly work every day at work in a full time position 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. I think the value inside gig that I see is really what has contributed to my life. Right. It's having multiple streams of income because with that comes options. And I think having options is priceless. Right. 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, you know, by the confines of what their WT jobs are. So I Think 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 W2 jobs, which are great in terms of extra retirement accounts, deductions, all of those things. 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 of the reading room 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.

Now, you've had exposure to lots and lots of side gigs. What are the top three side gigs? What are the best position side gigs, do you think?

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 WCIA 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 and to 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 positions is going to be your most lucrative. That being said, I think some of the most interesting side gigs are owning other businesses. You know, we have people who own breweries or who've 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 great advocacy. Anything where you can add value to the world in a different way is pretty cool, obviously. So, I mean, 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? I think it'll 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, that's probably a different pathway for everyone.

All right, we better wrap up here. But you have the year 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?

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 change, take time to think about what it is that we want out of life, whether that's professionally, personally, financially, etc. So, I mean, I always tell people that it's amazing how many doctors can't say what they want. A lot of people will come to me talking to me about their burnout or, you know, 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 evolved. 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 the life of 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.

Awesome. Well, thank you so much, Neisha. For coming on the podcast. For those who want to learn more about Nisha, you can find her@nishamahtamd.com Her Facebook group is Physician side Gigs. It's a private group group position only that you can get into. And if, of course, if you come to wcicon, 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.

Thanks so much, Jim. I'll see you in a few weeks.

All right. That's always great to have Dr. Mehta on. She spoke at the first WC icon. 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 you're listening to this, it should be out within a few days. I estimate that 80% of doctors need, want and should use a financial advisor and or an investment manager. Some investment gurus, such as Dr. William Bernstein, think my estimate is way too low. At any rate, if you want to use an advisor temporarily or for your entire life, there's no reason to feel guilty about it. Just make sure you are getting good advice at a fair price. If you need help updating your financial plan or just getting one in place, check out our list of recommended financial advisors@whitecoatinvestor.com financial advisors. You can do this and the White Coat Investor can help. 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.

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