WCI #93: Being a Military Physician

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.

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Speaking of you, thanks for what you do, we have a great guest on today who's decided to serve his country, but in many ways you've decided to serve your country as well and you're providing a valuable service to your communities and to your family and to, you know, the other healthcare professionals in the hospital, helping them do their jobs and helping them to accomplish great things. So thank you for that. I know it's not always easy. Be sure to leave us any questions you may have that you'd like to get answered on the podcast@speakpipe.com White Coat Investor you basically just record like a 20 or 30 second question. We put it right into the podcast and we'll answer it on the podcast. So it makes for a really nice feature when we get to have a few more voices on the podcast. Our quote of the day today is from Morgan Housel who said the simple idea that most people wake up in the morning trying to make things a little better and more productive than wake up looking to cause trouble is the foundation of optimism. It's not complicated, it's not guaranteed either. It's just the most reasonable bet for most people. I agree with that. And we've got an optimistic person on the podcast today. Let's get into our interview today on the White Coat Investor Podcast. We've got a very special guest here. Commander Joel Schoeffer is a board certified emergency physician. He's got a lot of letters behind his name. He's got an M.D. he's got an MBA. He's a fellow of the American Academy of Emergency Medicine. He's currently serving as the Associate Director for Healthcare Business and the Executive Officer of the Expeditionary Medical Facility. He's a certified physician executive. He's published over 150 professional publications and held numerous national and state leadership positions. He's won tons of national academic and educational awards, and he has an academic appointment at the Uniformed Services Uniform of the Health Sciences. He's got numerous military decorations, including the Combat Action Ribbon, a Defense Meritorious Service Medal, a Meritorious Service Medal, and four Navy and Marine Corps Commendation Medals. Perhaps most impressively, he has served for three years as the Navy Emergency Medicine Specialty Leader. And for those who have been in the military, know that this is a rather prestigious position. You're basically in charge of all the other emergency docs in that service. So. Joel is also a prolific blogger where he blogs previously on a blog called Military Millions. And he has moved on to McCareer.org where he focuses on careers for military and, you know, medical Corps physicians. Joel, welcome to the podcast.

Hey, thanks, Jim. Thanks for having me. Sorry, that was a pretty long introduction.

That's okay. When you've done a lot, you get a long introduction. So I was so impressed with it. I felt like it was worth sharing with listeners. And I think those credentials are pretty important when we get into the subjects we're going to be talking about today. But you mentioned you have a disclaimer that you want to make sure everybody hears, so we're going to put it right up front at the beginning if you want to do that now.

Yeah. I'd just like listeners to note that the views I express in this podcast are mine and don't necessarily reflect the official policy or position of the Department of the Navy Department, Defense, or the United States government. Thanks.

You know, it's interesting, when you work for the government, or really any big institution, they have some strict rules about, you know, how you can make money and what you can do with your time off. And it's interesting we're recording this in the evening. We do most of our podcast interviews earlier in the day just because it's more convenient for Cindy. But we're actually doing this one in the evening just to make sure that everybody knows he's doing this on his time off. So let's start with learning a little bit about you. Tell us a little bit about your family and your background growing up.

Okay. Well, I grew up in southeastern Pennsylvania, had two brothers. Nobody in my family was involved in medicine. First one to go to medical school that I'm aware of did have a military connection. My uncle was in the Navy and both my grandparents were in the army, but none of my parents were and pretty much stayed in southeastern pa. Met my wife in college. We went to a small liberal arts college called Ursinus College that's notable for two things. Pre med, and both of us are physicians and graduates that marry each other. And interestingly, we both applied for the Navy HPSP scholarship, Health Profession Scholarship before we even started dating.

So that is a pretty interesting connection. So, speaking of which, tell us about your education and your career path so far.

Well, I did med school at what's now known as Drexel, but at the time was MCP Hahnemann, and then did a transitional year internship in San Diego Naval Medical Center, San Diego. Did some time as a general medical officer or GMO with the Marines and came back and did residency in San Diego and then did a tour in Okinawa for two years, Okinawa, Japan, as a staff attending, but then came back and did a civilian fellowship on the Navy's dime at Christiana Care in Delaware in emergency ultrasound. And I've been practicing ever since 2009 after fellowship, although I've moved around a couple of times, but still maintain my privileges and my practice there. So I've been there for nine years now.

So we have a really interesting almost connection here. You want to tell the listeners what our almost connection is?

Yeah. When I showed up after my fellowship, they gave me an office, and they told me it was the Air Force office. It was where the people that used to come down from Langley Air Force Base that practiced in the Navy Emergency Department, the room that they used in their office. I think there were three people, and I think you were one of them.

Yep, that's right. He got my office. So we were very nearly on the staff at the same time. But about the time the Air Force moved me out of there is when you showed up. So it's a. It was a great place. I really enjoyed my time there, surprisingly. And, you know, it was interesting because I looked forward to my shifts at and kind of dreaded my shifts at Langley while I was in the military. And so it was great to go down there and work with the residents and have that experience down there. But tell us now what you're doing, both clinically and non clinically.

Well, non clinically. I mean, my career has kind of transitioned. You mentioned I was the emergency medicine specialty leader, what they'd call the consultant in the Air Force or The army just turned that over actually. So it's a three year tour usually. So just turned that over about a week ago and moved into starting to move toward executive medicine. I still practice emergency medicine once a week, but spend most of my time, like you mentioned, in the healthcare business realm at the hospital.

So it sounds like almost a full time administrator now, is that right?

Yeah, I guess about 80%. I mean, four out of the five days of the week I'm doing administrative stuff, but, you know, that's, I think some of the things we may get into. That's one of the things that's unique about being in the military. I think it kind of really advances your career, just kind of forces you to move up or get out. So, you know, that's what I've been aiming for for probably the latter half of my career. So I'm happy to be where I am and I enjoy it. But I still like seeing patients once a week at least. So keep it real.

Now, some of our listeners know you from MilitaryMillions.com. what, what happened there? I understand you shut it down shortly after attending fincon last fall. Was, was that decision related to attending there or was it just the timing?

Yeah, I think it was definitely related. I, I had had the other blog, the one I'm still doing, McCareer.org, which stands for Medical Corps, McCareer.org for about four years. But then, you know, I started to get the entrepreneurial bug and so I wanted to take what I was writing about personal finance and put it on a separate blog. And So I got MilitaryMillions.com started it, wrote, wrote on it pretty solidly for about a year. Always wanted to go to fincon. I know you've been there and I went there and it was all about building your business and building your brand and making sure you have a passion for what you're doing. And I'm sure you can relate to this. Running one blog is very time consuming and trying to run two is too much. So I was sitting there listening to all these lectures at fincon, everybody's inspired with all these, you know, all this incredible excitement for what they're doing. And I started to think, you know, I mean, really my passion and what I really like is with the Navy blog, it's what people know me for. It's what I've been doing for four years. And as we'll probably talk about, I mean, I'm financially independent now and I don't really need the money from military millions if it ever Got to the point where it was generating significant revenue. So I just decided to give it up and focus on the blog that is much more aligned with the things I like to do.

Did you get any pressure whatsoever from the Navy to not be, you know, have a for profit blog on the side or a money blog or anything or is this all just you?

No, no pressure, but it was very awkward. I mean, a lot of the things that I talk about at work are career related and personal finance related. I mean, I certainly do most of the personal finance lectures for not only my residents in emergency medicine, but also, you know, I've given them to the entire medical staff and I can't really. I couldn't talk about a for profit blog. So just imagine you're giving five finance talks but you can't mention the White Coat Investor. Not that Military Millions was anywhere near, you know, where your blog is. But I mean, people would ask me questions about investing in the Thrift Savings Plan or tsp, the military retirement program. And I couldn't say, oh yeah, I have a whole series on how to Invest in the TSP on MilitaryMillions.com Couldn't say it because I can't use my government position to benefit me personally. So it was, it was awkward. No one ever said anything to me about it. I did it kind of anonymously. It wasn't hard to figure out who I was. But you know, I never put my name just openly out there. Didn't have a picture on that blog or anything like that.

So tell us about McCareer.org I mean, is this you? Is this the military? Are they related and how much influence does the military have on what is written there?

It's mostly me. So I was. Another unique thing I've done is I was a detailer, which is, you know, the person that helps people get ready for promotion boards and moves people around in the Navy. Not just the emergency docs, but I had 23 specialties and subspecialties that I was in charge of about 1300 physicians. And I was in this job. And it makes me think about what you say, why you started the White Coat Investor. Because you got sick of typing the same old emails or the same old posts on all the online forums you were participating in. So I got sick of typing the same emails and I realized that all this great information was out there, but it was in 15 or 20 different places. So all I did was take all this information that people need to manage their career, put it all in one place and if you can Solve a problem and make people's lives easier. It just tends to take off. So it's unofficial. I don't do it like you mentioned in the beginning. I don't ever do it at work. I don't do it on a government computer. Do it on my own time. It's got a disclaimer. I'm following the military social media policy and they, I have, you know, I get probably about 80% of the content is just like job announcements, things that are open and that all comes from the military. But I, I have to be careful what I post on there. And I, I definitely realize that there may come the time, depending on where my career goes, where someone comes to me and says, hey, you can't really do this anymore, but haven't gotten there yet. And it's become so popular that I think if that ever happened, it would, there'd be a lot of Navy physicians and other medical people that would have a mini revolt.

So now that's not monetized at all. Correct?

No, I don't, I don't think I can do that because I would be using my government position to personally benefit. So it actually cost me $99 a year. Every year at the beginning of January, I put out the State of the Blog and I always put my revenue as negative $99, which people think is funny. But yeah, it gets enough traffic that it could definitely pay for itself, probably a couple hundred dollars a month, but it's just not worth the risk.

Right, right. Okay. Well, let's talk for a little bit about joining the military. What do you think should be the primary considerations for a student or a doc that's considering becoming a military doctor?

Well, I agree with things you've said in the past. It definitely shouldn't be finances. That's a huge part of it, especially with the cost of medical school nowadays. But I really think people should only join the military if they want to be in the military. I mean, if you go to UCs, you know, the Uniformed Services, University of the Health Sciences, the military Medical School, you're talking about a seven year commitment. And that can be a long time. I mean, most people who go there know they're just going to be sticking around for 20 when it comes to the HPSB scholarship like I used. I mean, you're talking about depending on how long your training is. 3, 4, 5, 5 year commitment. And I know you've, you've run the numbers on the finances of that and didn't feel like it was financially worth your, your time I think because you went to a. I think you went to a pretty cheap medical school, right? Am I wrong there?

Yeah. Basically the way the numbers worked out for me is, you know, I mean, I went to the University of Utah, tuition was 10 grand the year I started, and everyone came out with loans at 1%. And then I ended up in a relatively high paying specialty. And so the numbers didn't work out well for me. But, you know, that wasn't certainly the primary motivation of doing it. And so I certainly had a lot of great experiences I couldn't have had anywhere else while I was in the military. But number wise, I definitely came out behind having the military pay for my medical school.

Yeah, I don't know, I don't know why, but at the time, MCP Hanman was one of the most expensive schools in the country. And it was about $50,000 a year. And my, both my wife and I went there. So we got, she's a pediatrician, general pediatrician, you know, relatively lower paying specialty. So we got what probably would $500,000 of debt we avoided by both of us getting the Navy scholarship. And like you mentioned, got to do some cool stuff that we wouldn't otherwise have done. I'd do it again because it's worked out well for me and for my wife. But, you know, it's definitely not a decision anybody should take lightly.

I mean, let's talk about the reasons why people do go into the military. We mentioned the money, and I'm sure that's at least partially motivating to some people, but, but let's talk about some of the things that you can only do in the military that would cause somebody to go, yeah, I want to be a military doc.

Well, if you want to see the world on the taxpayer's dollar, I suppose that's a reasonable thing to do. I mean, you know, I've practiced for two years in Japan on Okinawa, you know, an island about a two hour flight south of mainland Japan. I've deployed three times. I've been to, Geez, you know, one deployment I've been to when I think I went to 10 countries, spent nine months in Guantanamo Bay, went to war, wore the same chemical suit for three and a half weeks. At the time I wouldn't, you know, thought we were gonna get gassed. At the time I didn't think it was very cool, and I don't think I would have given a very positive endorsement of the HPSP scholarship. But, you know, looking back now, I mean, it was definitely a life experience. I think a lot of people join because they're, you know, they have a lot of family history. I didn't, I didn't have a whole lot. But there's just legacy families, people who are in the military and they're just from military families. They're military brats and they join. They just want to serve their country. You know, there's just a lot of different things you can do in the military. It's very easy to change your career. You know, you have order come up every three or four years and it's very easy to bounce around. You can go with the Marines and then come back and do clinical medicine and then do something else and come back and do clinical medicine. So I think for people who tend to get, who wanted a variety in their career, the military can be, can really accommodate that.

So there's a lot of different ways into the military, each of which has various, you know, financial and career benefits, pluses and minuses. You know, there's attending the Uniformed Services School. You can go through HPSP like you and I did, the Health Profession Scholarship Program where they basically pay for medical school. You can also do the FAP program where you join as a resident or even come in as an attending and often get some sort of a signing bonus. What do you think is the best way in and what are the pluses and minuses of each of the various methods?

I don't think there's necessarily a best way. Like we mentioned already. I think, you know, if you're, unless you're really committed to a career in the military, I think you, with its seven year obligation, I mean, it's great, right? You're wearing a uniform and you're going to military, to medical school, you're getting paid. Your time in medical school will count toward retirement at the end. So if you hit 20 and then you retire, you get credit for 24. When it comes to HPSP, you know, you're getting a stipend, you get a signing bonus. You're not getting full active duty ensign pay like somebody at ucious. But, you know, you're in a civilian med school, you're not wearing a uniform, your commitment's less. I mean, you're going to owe usually three or four years, depending on how long, how many years you get the scholarship for. But when the FAT program is interesting because you're, you know, if you do HPSP or eusis, you could train in the military. And that military time, if you're training full time in service, will count toward retirement. So it counts towards your 20 years. You need to get to. But if you do the FAT program, you're in a civilian residency already and that time's not going to count. So if you do, let's say you do a three year emergency medicine residency situation, we're both emergency physicians, and you sign up for the FAT program, you're going to get that extra pay while you're a resident, you're going to come on active duty, you're going to have only three years you owe, and you're going to hit your decision point that you can get out with only three years toward a 20 year military commitment. Whereas, you know, I did HPSP and because of my residency and my fellowship, I hit that decision point at 10. So I was already halfway toward a 20 year retirement. If you had, if I had done you, I wouldn't even, you know, I would have been so close to 20 before I even had that decision to get out. So I think it just depends on your commitment to the military. You know, you want to get your money and get your experience and you're leaning toward getting out that the fat program would be great. You think you're in for 20 years for sure, then you shush would be great. And the HPSP is probably a good compromise in between those two extremes.

Is it easy to join the military as an attending?

Ooh, tough. I honestly, it's hard question to answer because people contact me and they say, hey, I'm an ER doctor and I want, I want to come into the Navy. And you think that would be easy, but you have to pass the physical standards. You, you have to pass, you have to get a, you have to contact a recruiter. And it's just kind of a black hole. You know, I would direct people to the recruiters and, and it was very rare that I ever heard from anybody again. So it didn't seem to work out, you know, and a high percentage of the time when people would contact me and say they want to join and you don't ever get any feedback. Why, you know, the recruiters are kind of, there's a command called Navy Recruiting Command, and they're, you know, that's where you direct people. And the guys like me on active duty, even as a specialty leader, you don't really, you don't get a whole lot of information about what happens to those folks. But I do know a couple people that did. Just doesn't seem to, you know, the people that come to the ratio of people that are interested to the people that actually wind up Showing up one day, it definitely is not a high percentage of success there.

Yeah. You know, my take on these different routes into the military is that U Shoes seems to be the best route for somebody that wants to make a whole career of it. Not only do you get that extra payment at the end, but you also, you're in the military right from day one and getting paid like it. HPSP seems like a better way for somebody who kind of wants a taste of the military. They want to be in it for, you know, four years at the beginning of their career, have an adventure, and then go on and have kind of a civilian career, then FAP seemed like it was the best way to get in. If you were interested in avoiding going through the military match because you basically sign on with the military after the match is done. I don't know if that's the way you look at them or not, but that seems the way I've always kind of categorized them as far as why people pick one over the other. And part of it might just be when they decide they want to go into the military. If it's too late to apply to U Shoes, you can't go there. And if you're already out of med school, you can't do hbsp. But that was my take on it.

Yeah, I would agree with that. Honestly, I didn't even know ucious existed when I was a senior in college and applying to medical school with the HPSP program. I had already been accepted to HPSP when I even found out it existed. Yeah.

So let's talk about the military match for a minute. What's the secret to navigating the military match successfully?

Well, I've got a post on McCareer.org about tips to match in the military. And as the specialty leader, you kind of run the match for your specialty. So I've done that for a number of years. I've been involved in four military matches on the Navy side of things, and I think that you're in a much smaller applicant pool, and depending on the specialty you want to do, it can be potentially even harder to match. So I think the key is, number one, you have to be realistic about your chances of matching in the specialty you're trying to match in. It's actually harder to match in Navy emergency medicine than it is to match in general emergency medicine, even though general emergency medicine is extremely competitive. There were people every year that were applying to be emergency physicians, and even people that already had more than 10 interviews lined up with civilian programs. So they Were obviously very competitive, and I couldn't take them. I didn't have enough room. We just had such competitive applicants that it just, you know, it was just harder to match in the military. I think that the biggest downside to the military match is that if you wind up not getting what you want, the military is gonna find a job for you. So you could wind up being a transitional intern or an internal medicine intern or any kind of intern, even if it isn't the one you wanted, because, hey, guess what? You're on active duty and you need a job. So I think that can definitely. That. That uncertainty can definitely frustrate some people.

Yeah. I remember the year I applied in the air force. There were about 50 of us that wanted to do emergency medicine, and I think There were about 15 active duty spots and about 10 deferrals into the civilian match. So the match rate that year was literally 50% into emergency medicine in the air force, which was, I think emergency medicine that year was like 93% in the civilian match of people that wanted to do emergency medicine got to do it. So it was dramatically more competitive in the military. But on the flip side, I know of at least one doc who wanted to be a dermatologist, had spent some time as a family practice doc, and then came back and applied to do dermatology. And it was dramatically easier to match into dermatology in the military that year than it was in the civilian world. So I think it goes both ways.

Yeah, it just depends on how many applicants there are. I mean, your ratio of 2 to 1 applicants to spots is pretty much what I've been dealing with in emergency medicine. But, you know, in some of the specialties where on the outside they'd be really competitive, there might not be a whole lot of training programs in the military, and there are one year. There might just not be a whole lot of applicants. So you may luck out.

So I know a lot of people wonder if they can get good training in the military. I mean, is that factor specialty dependent? Do you have any tips for maximizing the quality of your training if you have a military commitment?

Yeah. I personally think that the military programs across the board are excellent, but I'm also probably biased because I trained in them. There was an article today that. There was an article that recently came out this week that showed that they were looking at general surgery programs. And the one at Madigan, which is an army hospital, was ranked number one of more than 200 programs in general surgery. Of the percentage of their graduates that passed their boards the first time around, something like 97 or 98% first time pass rate. And the article was saying if you're in the 89th percentile on your in service training exam, you're at the bottom of their class. And what I usually would tell people, because a lot of the medical students and people that are applying for specialty would ask me as a specialty leader, you know, what's your take? And I would say, look, you know, I think in the military, you know, your program, you're going to be surrounded by people that are a little more regimented, oftentimes more older and more mature because a lot of people in the Navy at least wind up doing general medical officer or GMO flight surgery or undersea medical officer tours. So they're a little older and they just all, you know, it's just, it's just a, it's just a more motivated bunch, I think. And you know, you're still going to see the sick patients, you're still going to get all the training you need, all the programs are accredited, so it's still going to get you to the same place, board certified and whatever specialty you want to be. But you know, compared to the civilian, there's also some experiences in the civilian world you're just not going to get in the military. Mean, like just in our specialty, for instance, you know, if you want to crack chests every day, it's not happening. And I think you know that.

Yeah, for sure.

I mean, it'll happen in your, you know, 40 or 50% of your out service rotations that you're doing in civilian hospitals because you just got to do outside rotations to get the, the mix and the patient acuity that you need. So if you want to crack tests every day, hey, you're going to want to do a civilian deferment. But I think the academic programs and the teaching and the military programs are excellent. And I, you know, I did a fellowship in a very highly regarded civilian residency program and I just think the education and the quality of the residents was superb in the military when compared to the civilian world.

Yeah, that was kind of my take on it as well. I mean, obviously I have a bias as well. I was a faculty member for a military residency program. The residents were always very sharp academically. You know, there's a big focus for sure on doing well on board exams. You know, they like being able to say, hey, we are number one of, of all programs. I think there's a little bit of a chip on the shoulder of most military residency Programs. The problem came in. In that they were taking care of a very healthy population, particularly the active duty population is very, very healthy. You know, they don't have a lot of terrible diseases. And so in the specialty like general surgery or emergency medicine or critical care, you know, the pathology in the actual military medical center was going to be lower than what it might be in a comparable civilian center. And I think the way most programs deal with that issue, you know, lower numbers of procedures and a little bit less pathology, is by doing a lot of, you know, rotations outside the military. I guess my question for you is, do you think that's adequate to make up for that loss of pathology and procedures?

I do. I mean, like I said, though, if you want to be doing that stuff every day, every month, then, you know, you're probably going to want to get a civilian deferment. I mean, we all have to meet the ACGME requirements, whether you're a military program or civilian. I personally enjoyed it a lot. I thought it was. It was great to go out into a civilian hospital and take care of this sickest to the sick for two or three months and then come back and take a little breath and, you know, refocus on academics and then jump back into the fray a couple months later. So, I mean, I think this is. Again, maybe I'm biased, but I really think if you gave me one medical student and I had to make them the best physician in any specialty, and I had a choice, civilian or military. Go military. Because they're just gonna be. They're just gonna come out with, I just think they're gonna be better.

All right, let's move on to the end of residency here. Do you have any tips for a doc coming out of residency to get the assignment they want? I don't know if I've ever talked on this podcast about the horror story I had coming out, but what tips do you have for somebody having kind of been the specialty leader and been a detailer to get the assignment they'd like to have?

Well, what was your horror story? Was Langley, where you went, that wasn't very high on your list?

Well, I'll tell my story. It was interesting, right? I was in a civilian residency. I'd gotten a civilian deferment out of the match. I had no military experience whatsoever. And. And I find out from a letter or something that I need to submit some kind of a rank list of. Of all the places that Air Force emergency doctors can be sent. And so my wife and I stewed about it. And we went back and forth and we prayed about it, and we came up with this list, you know, in the order of where we'd like to go. And a couple of weeks later, after we sent that in, I get a call saying, hey, we've got you penciled in for Keesler. And this was a list of 15 places. Right. And Keesler was number 15.

Right.

And I think a hurricane had just gone through it and flattened the hospital or something. You know, I mean, it was not exactly a desirable place to go at the time. And. And I said, why'd I make the rank list? You know, I mean, what's the point of making it if I just go to number 15 on it? And I ended up at Langley because I was talking to Linda Lawrence, who was the special leader at the time. She was a future president of the American College of Emergency Physicians. But she said, well, we have one other spot. We're going to try to open back up at Langley. And I covered the phone and asked my wife, where's Langley? And she said, virginia. Take it, take it. And that's how I ended up at Langley. And it actually worked out pretty well. But, you know, I was the only emergency doc at Langley for a year, and there were only two of us for. For another year before we started getting more docs in there.

Yeah, well, I mean, as a detailer who assigned, you know, all sorts of specialties, and then especially later, I've been assigning people for four and a half, five years. So, I mean, I think across the board, you have to realize when you're a new grad out of residency, you're like you. Like you experienced, you're at the bottom of the barrel. I mean, people who are overseas and want to come back, people who have gone operational, deployed, people who are senior to you, you know, it takes a little while for you to rise up to the level where you are, you know, gonna get the pick of the litter. I would also encourage people to always just be honest. I mean, the military is filled with honest people, and we all talk. And if you try to play games, there are people who would try to play their specialty leader off of me when I was the detailer, you know, play dad against Mom. Well, dad and mom talk. And, you know, the military is about people, so you want to treat people nicely and don't play games. But, yeah, you're right. I mean, when you're. When you're junior, you're. Most of the time you're going to get what you want. I mean, you're going to get what nobody else wants. But to be honest with you, now, at least in the Navy emergency medicine, we do a match. So we use the ACGME matching algorithm. And it is literally an algorithm, like, so it's not really about seniority. Like, all the places that have spots submit a rank list. And then you submit your rank list just like you did, and it gets run through the algorithm, and that's where you go. So we found a transparent, fairly transparent and fair way to do it, at least in my specialty, that people seem to like.

Let's talk about what people like anyway. In your experience, what percentage of docs are happy in the military and what percentage of the docs there just can't wait to get out?

Well, I don't know. It's probably the rule of thirds. There's probably a third that can't wait to get out, a third that are, you know, vacillating between, you know, are pretty. Pretty neutral, and then a third that love it. But I don't really have. I don't really have a sense across the services, especially the army and the Air Force, how unhappy or happy people are. I think probably the most unhappy people are the people that pick a service that doesn't align with what they like. You know, they don't like to camp and they join the Army. I don't. I don't understand that. They can't swim and they join the Navy. I mean, this stuff happens all the time. It just doesn't make a whole lot of sense. Or they sign up like. Like we've already talked about, they sign up for the military just purely for the money, and they don't want anything to do with the military. And as you know, when you're in the military, there's a whole lot of stuff that comes with it that has nothing to do with being a doctor.

Yeah, for sure. In my experience, I think the Air Force attracted a higher percentage of docs who kind of did it for the money. And so I found, as a general rule, you know, having worked basically in the Navy and in the Air Force, that the Navy docs were happier with their choice to join the military. And I never really understood exactly why that was. I think it was not necessarily that the Air Force was treating people particularly badly while they were in. I think it was that the people selected themselves that way. And people who are more likely to be happy as military docs join the Navy or the army and not the Air Force. But I don't know that that experience is Generalizable.

Yeah. I don't know. I don't interact with the Air Force very much. You know, the best thing about it is they always have nice golf courses, as, you know, pretty nice one up at Langley. Their deployments tend to be shorter. You know, the armies tend to be really long and ours tend to be in between. We're obviously usually clustered around the water. So you want to live on the beach, you want to join the Navy. But I don't interact with the Air Force very much. I really don't. I interact more with the army than I do with the Air Force.

You know, I hear lots of. I don't know if it's complaining, but lots of discussion and worrying among medical students and residents about GMO tours. What's your take on a GMO tour?

Well, they've been. I mean, I've been in the Navy 17 and a half years, and I think for 17 and a half years, they've been getting rid of the GMO tour. So people probably don't even know what it is. But you basically do your internship and then you go spend some time as a general, as a gp, you know, you're basically a primary care physician for a bunch of healthy people on a ship or with the Marines or in whatever setting. You know, sometimes you're even in a clinic and, you know, you get a little extra pay. You definitely get a lot of experience. You oftentimes feel like you're over your head because you've only had internship. But very rarely do people complain about it. Once they get into it, many get the pay. Their life's pretty good. They get experience. They get a little bonus when they come back and apply through the GME match. You know, the military match rewards those who have gone out and done their time. So it's very rare that people complain about it. I mean, there's a lot of people that just want to do the straight through training, and then they, like I said the Navy talking about getting rid of that forever because the army and the Air Force don't do a lot of this. We're a little unique in the Navy with respect to that. It's. It's very rare that people complain about it. It's usually a pretty. Pretty good experience for folks. It really kind of, you know, you get to go out there and grow your clinical skills and come back and refocus on your doing your residency program with a little extra experience in your bag.

What do you like best about being a military doc?

You know, it means something to me to Serve my country. You know, I think that we get to take care of some of the best patients in the world. I mean, there's great people out there, but I think that the people I get to take care of, although like you mentioned, they're oftentimes not as sick as some of us would like potentially, I think they're just great people. I mean, they're, they're part of the 1% or less that have worn the uniform and it's an honor to take care of them.

What do you dislike the most about being a military document?

Online training? That is not even a question. I mean, the solution to every problem in the military is to create online training and make you do it. And it just drives you crazy. I mean, you, you know, you're a board certified emergency physician and you have to do online training about the flu shot. Really? I mean, I have to learn about the flu shot and I have to go through 20 PowerPoint slides about the flu shot. But, but you do. And you, I'm sure you experience these things. There's things you have to do. And so at some point your, your brain shifts and you know, you're in for 20. And then you start to realize, you know, this, this, this online training that I used to hate, well, I mean, at least they're paying me $100 or more an hour to do it. So I suppose there's worse things in life, but yeah, online training, that is absolutely the worst. And I'll tell you, Secretary Mattis, Secretary of Defense, he's trying to reduce the training burden and trying to get rid of training that does not have anything to do with your primary job. But man, we still have. It drives crazy.

So how long do you expect to stay in the military?

Well, I'm in 17 and a half years. And so I got, I got picked up for, oh, six.

So congratulations.

Thanks. So I'm, I've got, you know, I aligned my bonus to. I have to stay into 21 now to retire as an 06. So I've got three and a half more years and I'm planning a 30 year 06 career. But I honestly don't think you really know what you want to do until you're faced with the decision. So you'd have to ask me 9 to 12 months ahead of my 21 year mark when I could get out because you got to submit your retirement paperwork 9 to 12 months ahead of time plan in 30 years. But as you've experienced, things change so rapidly in the military. I mean, what it is now compared to what it's going to be like two and a half years from now when I'm actually facing that decision that I could actually retire, it could be drastically different.

You know, it's interesting. I. When I was in the. I was a captain, and in the Air Force, a Captain is an O3, and in the Navy, a captain is an 06. You know, I mean, it's basically the guy in charge of an aircraft carrier. And so when I'd call the lab and say, this is Captain Dolly and I'm wondering where my CBC is, I sure got a lot of attention. And so it was kind of a fun thing.

I know every now and then somebody will do that, and then they'll show up and they'll be wearing the Air Force uniform because we have a lot of joints, you know, residency programs, and you'll pull them aside and go, you know, I don't think you should be doing that in the Navy. Maybe you ought to call yourself doctor.

All right, let's get to some more hardcore financial topics here. Let's talk about disability insurance for military physicians. What do they need to know about disability insurance?

Well, I think, you know, as you know, I've written that article for disability insurance for military physicians on your site. And I think the bottom line is you got to realize that if you're a highly paid professional in the military, that the military's disability insurance coverage, if something would happen to you, is not going to compensate you. Like, you're a physician. But it's very hard to get disability insurance as an active duty, you know, physician or officer or whatever you do. Attorney, dentist. You know it. For some reason, insurance companies don't want to insure people that go to war. And it took me like half my career to find any policy that would give me a supplemental coverage. And that was the American Medical association group coverage. They'll give you up to $2,500 extra disability insurance a month. And then, you know, if that's not an. If you. If you really want to get into an individual policy, the best you can get, you go to one of your people that you recommend in your site, and they will. You're really stuck with nowadays Lloyd's of London, which. Which is pretty expensive. I mean, I was able to get back when I did it, I was able to get Northwestern Mutual and Lloyd's of London cobbled together, and I was able to get an extra $6,000 of coverage a month if I was disabled on top of the military. And then if after five years I was still 100% disabled. I got a lump sum payment of $500,000. And, you know, that was certainly better than what I would have gotten in the Navy if I was disabled and couldn't practice. But you can get the disability insurance, but it's. Man, it's expensive. I don't know what it's like to get it as a civilian, but it's expensive and extremely hard to get for somebody in the military.

Now you can still get a mass mutual policy as well. Can't you forget for military docs?

Actually, yeah, now that I think about it, it wasn't Northwestern, it was MassMutual.

Yeah.

You know, so I think you're stuck with MassMutual and Lloyd's, but there may be other options out there.

But I think that's right. Basically the big five or six disability insurance companies, you got one of them. You know, I mean, I mean, the Lloyd's policy is not an awesome policy, you know, compared to what a typical civilian doc gets.

Yeah, I was able to get 2000 through MassMutual. I think my payment was approximately $100 a month for that. And then, yeah, the Lloyds I paid, I saved 20% by paying. It was a five year policy, so I bought it in a lump sum and I think it was gonna cost me about $12,000. I paid 10 because. And I saved $2,000 by just paying it all up front. It's pretty pricey, especially, you know, with the military salary, depending on where you are in your career.

Yeah, there's not a lot of extra, extra money there to be buying expensive disability insurance, that's for sure. Let's talk a little bit about the blended retirement system now. We're recording this in December of 2018. I think there are some people that have to make this decision by the end of the year, but they won't hear this podcast for another six weeks or so. And so we'll just assume that we're talking about the system as it will be in place as of the start of 2019. But can you explain what military doctors have been doing about retirement savings for the last year or two since they've been hearing about this new blended retirement system?

Sure. So the old, the old legacy system, which is what I have, you know, you. It was, it was a cliff vest. So you had to stay in 20 years or you got nothing. If you got out at 19 years and 11 months, not that anyone would do that, but if you did, you left with nothing, no DoD contribution to your retirement. And all you would have is whatever you of your money you put into the thrift savings plan, which is our, you know, 401k equivalent. And now under the blended retirement system, you'll get a DoD match. So if you contribute 5%, they'll match up to 5%. And that way, you know, if people leave, they actually leave with some DOD money in their retirement account that they can take with them. So I think it's much more modern system. But if you do the BRS or you're under the BRS and you stay till 20, your pension gets cut by 20%. Because the multiplier under the old system is they take the average of your top three years of your highest pay and then they Multiply it by 2.5% times the number of years you've stayed in. So if you stay in 20 times two and a half, you basically get 50% of your highest, your average of your highest three years of pay. Well under the BRS, instead of the multiplier being two and a half percent, it's cut by 20%. So it's two, so you get 40%. So you still get a pension, but all along the way you got a match, you know, of up to 5%. So in the end you could work out, depending on how your investments do, you could obviously make out even better. You just don't know. So I think it's a much more modern system. The math, I don't have physician specific numbers, but among officers, 57% get out before 20 years, only 43% stay in. And the percentage among enlisted is less than 20% stay in to 20. So the overwhelming majority of people under the old system got nothing toward retirement. It was just whatever they saved.

Now as of 2019, there's no decision to make anymore. You're just in this new program, Correct?

Correct. Now the, from what I understand, anyone that signed like, like for instance, if you signed an HPSB scholarship under the old system, you're just not on active duty yet because you haven't graduated from medical school. What we've been told is that anybody in that situation, once they come on active duty, even if it's in 2019 or 2020, they're going to have a one time chance to either go with the old system or come under the new brs.

So what do you think? Somebody that plans to make a career out of it, which one should they choose?

Well, I think if they, I think it's, I don't think it's that simple. I mean, I think anyone. Life changes, right? And I Think if you plan to make a career out of it, there's a ton of people that plan to make a career out of it that didn't. So I think if you know you're just going to do your time and you're just going to get out, you've got to take the blended retirement because that's the only way you're going to leave with any DoD money toward your retirement accounts. If you're not sure, just like we just talked about the odds, say you're not going to do it. So you should go brs. If you're 100% positive you're going to stay 20 years, my personal opinion is you should stick with the traditional if you had that choice. But like you said, by the time they've listened to this, most people won't have a choice anymore. They'll either already made the choice or they came in under the brs.

Yeah, I certainly would have had more money if I'd been under the BRS rather than the old system. I imagine if it's 57% for a typical officer, it's got to be higher than that for docs. I think most docs probably get out, don't they? Maybe not so much in the Navy, but certainly in the Air Force. It's a higher percentage than that.

Yeah, that's always been my guess. I just don't have physician specific data to back it up. But because of the job market and the money you can make, I would suspect you're right.

Let's talk a little bit about a reserve pension. A lot of times a doc decides I'm going to get out of active duty, but I'm going to go on reserve so that I can get, you know, this, this different pension. It's not the same pension, but it's a pension that starts at age 60. What's your take on that? What do you think about that as an option?

I think it's a great option. Not necessarily because of the pension, but because of, like you and I have talked before, the online, the, the value of Tricare, you know, that's the part of it that a lot of this fire community, their biggest worry is trying. What are they going to do about health insurance? And while there are other options out there, you know, reserve pension, while it won't have the same pension that I would have, you know, it doesn't start till 60 versus I could retire at age 46 and my pension would start immediately. That the reserve pension would be probably lower. It doesn't start till 60 but it's still government pension, inflation adjusted. But then it, you know, it gets you that Tricare. So to me, I think if you can, if you get out and you can work, earn your normal wage as a civilian physician, it's probably gonna get, be more money than you'd make in the military unless you're in like a primary care setting. Because honestly they get paid pretty well in the military. And then you combine that with a reserve pension that kicks in when you're 60 and gets you access to Tricare. That's, that's pretty, it might be the most, you know, financially lucrative way to do it. You just kind of get the benefit of both worlds.

Of course, it's not a, it's not a free benefit. You got to put in your time as a reservist as well. And so those folks are, I think, earning that pension as well.

So, yeah, there's no doubt about that. And your, and your pension will start before 60 if you've deployed or been activated. So it depends on how much time you've done that. But it'll start, you know, let's say you did that for a year. It'll start a year earlier than 60.

I didn't realize that that's, that's a nice benefit, I think for people that got deployed a lot. That could add up to several years.

Yeah.

Let's talk a little bit about financial independence in the military. You said you were either becoming financially independent relatively soon or you already are. Do you think it's easier, harder, or about the same for a military doc to become financially independent?

I think it's easier because, you know, I'm definitely financially independent just because I can't get out of the military for another three and a half years. But then when you combine what I have and, you know, the, the pension and Mike's what I live off of. Yeah, I'm financially independent as long as I stay in another three and a half years. I think it's easier because of the health care, the access to Tricare. I think it's easy because people really underestimate the value of the inflation adjusted pension for the rest of your life. You know, every year the Department of Defense has to report to Congress basically a whole accounting of the retirement system and the net present value, you know, how much money you have to have now in order to equal a 20 year 05 commander or lieutenant colonel retirement, which really isn't hard for most physicians to get, is $1.3 million. And for a 21 year 06, which is a pretty. Pretty common, you know, Navy captain or colonel, pretty common decision point to get out. That would be my decision point point. It's 1.6 million. And you can't spend it. I mean, you can't screw it up. I mean, as you experience, certainly there's just tons of ways that doctors, whether it's buying the doctor house or the doctor car or getting the doctor divorce, can screw up their finances. And you just can't spend or screw up your military pension. Although I will admit that, you know, if you're married long enough and you get divorced, they're entitled to some of it, but it's just hard to mess up.

Yeah, I think that's one big advantage of it. Another big advantage, of course, is that you don't start out in this huge hole. You know, you don't have that debt at the beginning of your career. I got an email this week from somebody who was DOC 50 years old, owes $300,000 in student loans and has $300,000 toward retirement, you know, at 50 years old. And so I think starting at zero is. Is in some ways a big, huge advantage. I think another advantage in the military is that there's not this expectation of spending that's quite so high as it is in the civilian world. You know, people know you're in the military, and they know military docs don't necessarily get paid that much. And I think there's not quite the expectation to have the fancy doctor house and the fancy doctor car and the fancy doctor vacations. And I wonder if that doesn't contribute as well.

Yeah, you get a lot of things provided for you. You get a lot of tax benefits. You know, you get allowances, you get free services on base, reduced cost, things like commissaries. The daycare was cheaper when. Was cheaper when we needed it. I mean, there's a whole host of benefits. I don't have to think about what I'm going to wear to work every day.

Yeah, certainly save some money on. Save some money on scrubs there. I'm not sure an emergency doc is going to save a lot, but fire is really one of those things that people talk about a lot and they talk about all the changes they're going to make when they're financially independent, how they're going to work less, how they're going to quit their job, how they're going to do an encore career, how they're going to drop their night shifts or whatever. But in the military, you can't necessarily change your job just because you're financially independent. What's the point of financial independence in the military if you really can't cut back on work or dictate how you work or avoid deployments, etc.

Well, I think that you can do some of that. I mean, if you stay in and you promote and you become a senior leader now, you don't want to be some kind of like dirtbag that never works, you know, doesn't deploy and deploys everybody else. And you know, you have to keep yourself honest. But I think you do have a lot of say in how things go in your career if it progresses and goes the way you want. And you just know that when you hit that 20 or 21 year mark that you have that option, you know, just like I do. I mean, I could get out and do whatever I want. So yeah, maybe I can't fire at 10 or 12 years like some of these fire folks can, but I mean, I'll be what, 46 years old. I mean, that's still retire early. I don't know that I'll be retired, but I mean, you're right. I mean, you're not. Like I said, you can, you can't do a 12 year career and fire because you're not going to get a pension. But 20, that's still pretty early.

Yeah. You know, I think one of the most underestimated ways to fire is to join the military at 18, have them put you through college, finish at 38 with an officer's retirement, you know, and collecting Tricare and this pension for the rest of your life. You know, I mean, that's 38 years old that someone who joined at 18 could, could get out at. And that's really a pretty quick route to fire. Yeah, I don't know, leave a lot of people, you know, envious.

I don't know that your four years in college would count. So you probably have to do it till 42. But I mean, same, same thing. You're right. Yeah, it's, you know, and then you've, and you've got access to Tricare, which takes care of that. One of the biggest worries for people that are in the fire community now.

A lot of military docs moonlight talk about that. What tips do you have about how moonlighting should be done in the military?

So I used to have to approve people's moonlighting applications and you know, they would come to me requesting permission to moonlight. And I think one of the most common mistakes they would make, which you certainly are very familiar with, is they already signed the contract to moonlight and they're going to be an employee. And they didn't understand that if they were an independent contractor, again paid on a 1099 instead of the W2, they'd have the options to open up a additional space in tax advantage accounts like in a SEP IRA preferably, as you're well aware of a Solo 401K over the SEP and, and they've made that mistake because, you know, in the military that's the one thing I actually, I don't moonlight and I don't, I don't have very much tax protected space. I've got my backdoor Roth, my wife's backdoor Roth, and then the TSP after that, everything's in taxable accounts. But you know, if you're a 1099 moonlighter in the military, you can open up that solo 401k and you probably can't moonlight enough to fill it up because there's limitations on how much you can moonlight. But it definitely, you know, you could put another 10 or $20,000 in there potentially depending on how much you're working.

What are the limitations on moonlighting in the military?

Well, I know that in the Navy you're not allowed to do more than 16 hours a week. You can do more than that if you're on, you know, on leave, on vacation. I'm not sure if, though I'm not sure how they limited in the army or the Air Force. You also, in the Navy at least you have to be on leave if you're more than two hours away from your home station. So you know, I'm in, I can't, you know, I can't fly to San Diego to moonlight over a weekend. I mean, I gotta take leave. So they, they kind of have a two hour radius around where you are and they, they meet. You can't do it more than 16 hours a week without, without requesting special permission.

Now let's talk a little bit about. You've mentioned several times that you have the TSP, the Thrift Savings Plan or the Military 401k system. I get a lot of questions about whether an attending physician in the military should be using the Roth option there or the traditional tax deferred option. What's your take on that?

Well, I think probably the Roth option because like we've already talked about, most people are going to get out, their income is probably going to go up. And so when they're in the military, especially with all the tax advantages you have with some of your allowances, you're probably in a lower tax bracket. So it probably makes more sense to pay the Roth version. My personal opinion on it is that I can afford the taxes now, so I put every dollar I can in the Roth. I have no idea what the future holds when it comes to tax rates or law changes in law. And for the first half of my career we didn't have a Roth option. So I'm shooting for a 5050 ratio, you know, just to have that variability. But I can't catch my traditional TSP just because of all the compounding and all the years I had it early in my career or there wasn't even a Roth option. So I'm a huge fan of filling any Roth space you have, but I'd be interested in hearing your thoughts about it.

Yeah, I'm totally jealous. Right. I got out in 2010, there was no Roth option available to me. But I think a military doc ought to be going all Roth all the time, kind of like a resident for a couple of reasons. One, you're in a low tax bracket. I mean, a quarter or a third of your incomes tax free, it's an allowance, you know, it's your bah and your base. Plus you're probably a resident of a tax free state if you're like most people in the military, so you're not paying any state income taxes. And then when you get out, even if you, you know, if you, if you get out, you know, without a retirement, you're going to be making more and in a higher tax bracket. And if you get out with the retirement, you're going to have a pension that fills up all those lower tax brackets. So either way, I think you're better off with a Roth. I see very little reason for, for any military doc to not be doing the Roth tsp. It would really have to be a pretty unique situation to make sense, I think.

Right.

All right, let's talk about tax loss harvesting. You made this comment in an email you sent me this week that you don't tax last harvest. Let's tell the listeners why you don't.

I don't because I don't care anymore. I mean, are you not there yet? I mean, are you only doing it because you have a financial blog? I mean, seriously, I'm asking you.

There's no doubt that it's not going to move the needle for us for sure, you know, I mean, what are we talking about? It's $3,000 a year against your ordinary income. Maybe that knocks, you know, a thousand or fifteen hundred dollars off your Tax bill in a given year.

Yeah. And I don't have near the income you do because of your blog. But I, I choose life, you know, I mean, I don't know. I just don't do it. And I just read, I just read all that. You know, a lot of people like position on Fire and you, they, you know, they talk about tax loss, harvesting, and I just sit there and think, man, these guys would think I was a total moron, but I just don't. I just can't get myself motivated to do it. It's like the financial equivalent of online training in the military. I just can't do it. So I don't know, I just don't care. But I just always thought you would find that you would just, you know, maybe you would tell me I was stupid for. For not doing it.

You know, it reminds me of a post that the physician on fire did recently where he. Where he tried to calculate the actual benefit of doing a backdoor Roth IRA versus just investing in taxable. And I think his conclusion was that it was worth a lot less than a lot of people think it is. And at a certain point, at a certain level of wealth, it's true that all these little financial tips that we talk about on, you know, blogs and podcasts don't make a huge difference. And the reason why is because you got the big rocks right. You know, you got your income up, you saved a big percentage of it, you invested in some reasonable way, you kept at it for a couple of decades, and now you're wealthy. You know, it's really not about the little tricks and tips and, and, you know, a few bucks here and a few bucks there, sure, that might speed the process up a little bit. But in reality, getting rich is pretty straightforward. You know, you make a lot of money, you save a big chunk of it, you invest it in some reasonable way and you protect it with, with some insurance policies, and that's really all there is to it.

Yeah, my father's pretty wealthy. He owned a couple businesses and he's, you know, retired when he was about 50. And I wonder if I'm going to get to his point. Point. He's at the point where he can't stand his retirement accounts now. I don't think I'll ever get there. He can't stand them because they limit what he wants to do and he's going to have to do RMDs, and it just drives him crazy, you know, so maybe, hopefully we'll both get there one day too.

Yeah. Hopefully. So we're going to wrap up here soon. I think we're pushing about 50 minutes or so. But you've got the ear of 20,000 docks and similar high income products professionals. What do you think they should know that we haven't covered yet today?

I think it's, it's kind of like you just said, it's real simple. It's the big stuff. I'm, I'm at where I am today on a military salary because I saved 30% of my gross income for the majority of my career. And the other half of that equation was I didn't drive the doctor car, I don't live in the doctor house, and I haven't had the doctor divorce. And when it comes to the military, just people just don't, can't they just don't underestimate the value of that inflation adjusted government guaranteed pension. If you can stay in for 20.

Dr. Schoeffer, thank you for your time and for coming on the podcast and congratulations on your selection for captain.

Hey, thanks. Thanks for having me, Jim.

That was great having Dr. Schoeffer on. You know, one of the things I miss about the military is the high quality of the people in it. And I just love seeing people that have this desire to serve. It's wonderful. So thank you to him for being willing to come on. I think we were about six months trying to get him on the podcast. But what I'm finding as I get further and further away from my own military service now, eight and a half years ago, is that I'm starting to not know the answers to the military financial questions. You know, people started asking me about this new blended retirement system and I have no idea because it wasn't in there when I was on active duty and remembering details like when the reserve pension starts and that sort of stuff. So it's nice to have somebody watching me and correcting me when I make the inevitable errors. And Dr. Schoeffer has been doing that for me over the last year or two. Every time I screw something up with the military, he shoots me an email and I'm able to correct it. So I appreciate that getting quality disability.

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If you haven't checked out our Facebook group or our subreddit, be sure to do that. Please leave us a five star review if you can, on itunes and also if you'd like to get your questions on the episode, leave them@speakpipe.com whitecoatinvestor and we'll get your voice on the White Coat Investor Podcast. Until then, head up, 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. Dahl, 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.