In this episode, I am talking to Dr. Jimmy Turner. Jimmy is a practicing anesthesiologist at Wake Forest and a financial genius. He has helped many med students, residents, and fellows to manage their finances as a physician. In this episode, Jimmy is here to bring his knowledge to you all about what physicians need to pay close attention to financially during the COVID crisis.
This episode is going to be a little bit different and it is designed for a specific purpose. I’ve been having a lot of conversations lately with residents and fellows who were about to transition in the coming months to attending hood and I wanted to take one podcast segment and stuff as much value into it as possible as far as the things you need to know to succeed financially and career-wise as you transitioned to attending hood. There’s no one who I think can be a better sounding board for this discussion than Dr Jimmy Turner who joins me today.
So thanks for tuning in. In addition, embedded in this episode is an opportunity to get a couple of free resources from me. You’ll want to go to the show notes, anesthesia, success.com/ 46 for a lot of the things we’re going to discuss today. But in addition, I want to send a couple of copies of the one page financial plan, which is a great financial overview primmer for people who have questions about like what kind of paradigm should I even have for many basic financial questions. If you’re interested in that, we’d love for you to leave a review for anesthesia success. You want to go there and leave an honest review, screenshot it and send it to me. I would be glad to send you a book until I run out of them. I got a few of them here. As always, thanks for tuning into the anesthesia success podcast. Hello and welcome to episode 46 of the anesthesia success podcast. I’m your host Justin Harvey. I’m very pleased to be joined
Day by my friend, dr Jimmy Turner, also known as the physician philosopher. Jimmy is a friend of the show. This is probably his third or fourth episode. He is not only an attending anesthesiologist down at wake forest, but he is also a financial, I don’t want to call him a guru. He’s, he’s made a, a hobby and now has become, I mean he’s, he’s, we were just talking about, well I don’t know how much I want to share about what we were talking about, but Jimmy has a guy who’s developed significant financial acumen and he does a lot of work with regards to educating med students, residents, fellows about how to not make significant financial mistakes as a position. I’m really grateful for the work that Jimmy is doing and I’m really grateful that he’s joined us today on the show. Thanks Jeimmy.
Dr. Jimmy Turner (02:27)
Thanks for having me on Justin. I’m super excited about being here and kind of kicking it off again and I, I really enjoyed working with you. So I brought you down to teach my students at wake forest and that, that is a honorable position cause I, I would let very, very few people in front of my students. So I appreciate your friendship and I’m glad to be here.
Yeah, that’s right. That was a lot of fun. We were talking about how to, how to pick a financial planner and to do you need one. And that was a lot of content that I think is really helpful for a lot of different people inside and outside of the medical community, some of which we’re going to touch on today. So, yeah, that was, that was definitely a lot of fun. Right now I’m curious, you know, you are a mentor to many. You try to help people get oriented with regards to personal finances and a lot of that attaches to like career, job description, things like that. Right now with coronavirus, things are a little bit hectic. It’s a, it’s safe to say. So I’m curious, what kinds of things are you telling your residents and fellows who are getting ready to go take a job somewhere about how to approach a new role in the light of what’s going on?
Dr. Jimmy Turner (03:29)
Yeah, it’s, it’s, it’s been extremely challenging. So they’ve had lots of questions residents and fellows in terms of what’s coming up next and how to handle things. And I think that know by and large, it’s, it’s really driven home. A couple of things too, like the importance of an emergency fund. You know, there’s some people out there that say that hiring doctors don’t need one because we can cashflow a lot of money each month and who knew that a pandemic was coming that might put your job at risk? And so I think that that’s kind of naturally flowed downstream to the people that are about to start in the job market, are looking at their contracts and, you know, kind of wondering what’s in store for them, if the positions are still going to be available, you know, when they get there, what that, what’s that going to look like.
Dr. Jimmy Turner (04:08)
And it’s actually really interesting because some people are in these positions where they have guaranteed income for the first year or two, like they have a guaranteed salary, whereas the partners that they’re going to be working with make their money based on how much profit that the group has made. And so it’s actually for some of them a really great place to be because they’re starting off having a guaranteed salary when, when the partners who are normally in a better financial situation don’t have a guarantee cause they, you know, it’s RVU based or it’s, you know, based off of the profit generated by the group. And and so in some ways they’ve kind of seen this as not the worst thing in the world because they’re in a protected position. But of course they naturally have lots of other questions about, you know, well, I was thinking about buying a house and do you think that’s a good idea?
Dr. Jimmy Turner (04:52)
And I don’t know, I think it’s really just driven home the importance of having a plan. You know, it’s like the Mike Tyson quote, like everybody has a plan to get punched in the face. Like a lot of people just got punched in the face by the coronavirus pamphlets right. Financially and are finding out, Oh, I didn’t really have a solid foothold on what my financial plans were. And so a lot of it’s actually going back to, to questions that maybe should have already been answered. Yeah. Yeah. So I’m basically counseling people to, you know, first of all, make first things first. Try to figure out what the big plan is and some of the stuff we’re gonna talk about today. But then also this, this all requires so much flexibility on both the home front which, you know, I’m, I’m finding out about my fellows, my residents are finding out about, and it requires flexibility on the Workfront to, you know, like a lot of us are platooning in case some of our other colleagues get sick.
Dr. Jimmy Turner (05:43)
My fellows are doing the same thing. And so their week on week off, depending on what week they’re on, they may or may not be working. And so I think some other people being stuck at home were also finding out that they need a hobby. They need something outside of medicine because they’re going home and they’re like, I don’t have anything to do. The gym’s closed. Like, I can’t go out and be anywhere or you know, what am I going to do? And they’re like just sitting on their couch bored, you know, getting to the end of Netflix. Yeah. So yeah, that’s kind of the, some of the general themes I’ve been talking to them about.
Yeah. And with regards to that guaranteed salary, one of the things I’ve been sharing with people who are looking at these types of jobs is like, remember a guaranteed salary from a practice that may or may not be around in two or four or six months is actually not guaranteed. So it’s important to think about the financial viability of practices from whom you have job offer to make sure that it’s going to be there when you when it comes time to.
Dr. Jimmy Turner (06:32)
Yeah. I completely agree. And I actually, I, I posted a tweet on on Twitter the other day exactly about that because of the privileged position that I’m in working for a large academic hospital and we’re, you know, getting hit by this and losing lots of money. Cause the pandemic house didn’t hit us quite as hard. And we stopped elective cases. And so, you know, that said my, my salary in some ways is a lot more protected and a private practice doc who’s, you know, dependent on a small group of people. And so it’s been really, really interesting. And I, I found that out cause I was refinancing a house and they’re like, we need to make sure we need you to send a fifth or fourth month of, of paystubs just to make sure you haven’t lost your job yet. Yeah. And I basically email him and tell him like, I’m an anesthesiologist level one academic hospital. Like there’s not probably a more secure job right now. Yeah. I thought of emergency room doctors then in that. So yeah, it’s been interesting.
Yeah. Yeah. And I’ve been seeing these headlines. I just saw one today actually it was talking about permanent closure is a possibility for 25 location Wisconsin pain practice. This was just on Becker’s asc.com this morning. So there was that, there’s that big anesthesia practice out of Idaho and Boise that closed that had like 82 CRNs or something like that that they had to lay off. There’s, this is, anesthesia is not a specialty that’s insulated from this and we’re finding out a lot of these businesses actually are running on very little margin because they’re very quickly having to shutter their doors and, and furlough people just because the resources aren’t there.
Dr. Jimmy Turner (08:04)
Yeah. And it’s, it’s kind of an, I don’t have an MBA, you know, but I’ve often kind of wondered, having seen this so many times now since this has happened, how quickly businesses are having to fold up, and it makes me wonder, like if you encourage people in personal finance to have a three to six month emergency fund, why don’t businesses have a similar sort of setup where they can withstand things being shut down for three months? They’re leveraging so much of their position in debt that when the money stops coming in, now they’re, they’re closing their doors two weeks, four weeks later. I mean, that’s, that’s mind numbing.
Yeah. Especially when you think they’re still collecting money from procedures that they’ve done a month or two months ago. Cause the billing presumably takes a while to kind of trickle all the way through the system and to for collections to happen. Say yeah. But I want to pivot a little bit. That is certainly an important consideration for transitioning residents and fellows. But I want to take the next 30 to minutes and talk about five high value considerations for residents and fellows who are transitioning. And the Genesis of this discussion is I’ve had this conversation literally with three or four people this week alone and I wanted to produce a podcast with my friend Jimmy here to just talk about what are the, if we had to take the important things to say like here’s how we distill these key concepts and position you to succeed or not be taken advantage of.
Conversely, how do we package that up into one podcast segment? So that’s what we’re trying to do today. We obviously can’t hit everything but we don’t want to hit a few of the high points. And so number one is, and this is what I recommend and I know Jimmy who’s written about this, has the same recommendation, is get a literal piece of paper as a transitioning resident or fellow and write down your financial priorities for the next 12 months, your financial goals and the things that you want to make sure that are on the front burner for you. Because a written plan is one that is, in my anecdotal experience, I’m far more likely to get enacted, protected and followed.
Dr. Jimmy Turner (09:59)
Yeah, absolutely. I think that what people will get tripped up on later is that they start in the middle of a financial plan. A lot of times they just start, you know, haphazardly throwing money at their savings and spending a lot of it and not making really any plan at all. They just feel like, Oh, I’m supposed to save some money. So I guess I should just do that. And what’ll happen is, and this is a great example with the Corona virus and everything going on, is that something changes. And because you don’t know where you’re ultimately going, you haven’t designed that destination, you haven’t described it and know it in great detail. You can’t ever get there. I mean, you can’t expect to get in a car and just drive to a dream destination if you don’t know where that is. And so I think knowing the why behind money is infinitely more important than the how to or the steps to, to get it done.
Dr. Jimmy Turner (10:46)
And and that’s what this is about, right? Writing down your goals and I know that there are lots of tools out there, but the ones that is my favorite is the three kinder questions. You know, I teach something that was inspired by that and in my course. But either way, no matter what tool you use, the goal is to answer important questions. Where do you want to be? How long do you want to take to get there? I mean, because if you just save money haphazardly, you may not even save enough to retire by 65. What if you want to be done by 55? You got to figure out what that number is. That starts by knowing that 55 is when you were interested in potentially retiring.
Absolutely, and we’re going to talk about a lot of resources today. You’re going to be able to find them firstname.lastname@example.org slash 46 which is where all the show notes are going to be and a compendium of all the stuff we’re going to reference. So Jimmy just mentioned kinder, three questions. I know that’s something he’s written about. These are questions designed to help you evaluate as a person, what are my priorities in life, not even financially, but just as a human being. What kind of life do I want to build? And obviously financial priorities flow from there. I’m absolutely recommend giving that some intentional thought and you know, with regards to sort of the financial transition and how that relates to these goals, whenever you get a four or five X rays, all of that new resource needs to have an intentional place to go or else it will just fly out the window.
That’s just the nature of the entropy of personal finances. If you don’t give a dollar a job, that dollar will fly out the window. And if you have the goals and the priorities in front of you that your able to reflect on, maybe talk about with your spouse, if you have one or your significant other and keep yourself accountable, you’re going to be far more likely to experience a positive outcome and to make progress in the ways that are important to you. Then if you lack that plan, because if you make this transition and you go blind and you just say, we’ll see what happens, it’s going to be great when my checking accounts full of money. I mean that’s true, but easy come, easy go.
Dr. Jimmy Turner (12:42)
Yeah. And I think that, I think it’s important to mention too that you know, there are different strokes for different folks. So like I’m not a detail oriented person. I’ve never done a line by line $0 million budget where I had a job for every single dollar that came into my account. And I just, I wouldn’t be successful with that kind of plan. But I did have a very specific job for a lot of the dollars that came into my account. You know, I picked myself first, made it automatic, you know, followed sound financial principles to make sure that we were attacking our debt and we were investing enough to get to our goals. But at the end of the day, as long as my family spends less than what I bring in after those things are done, I don’t really care where it goes. And so you just, just in case I just don’t want to scare people off and make them feel like they have to have a job for every single dollar. Now if you can do that and you are detail oriented person, obviously that’s going to be mathematically a superior way of doing things. But for those of us that are, are not detail oriented or human or mortal or however you want to describe that, it’s okay if you don’t have a plan for every single dollar.
Yeah. And I’m glad you said that Jimmy, because I actually just did an episode a few weeks ago. It was slash 42 in a studio success.com/ 42 and I talked with Dr. Aaron Lewis about this very thing, what, what my wife and I do. And what I recommend for my clients is have a checking account and savings account and with a $0 million balance in the checking account of whatever your emergency fund is for your cash and say it’s $10,000 and then beginning of the month when it comes in, you pay your bills, money goes out at the end of the month. If you have $12,000 leftover and you’ve accomplished all your goals, you know, okay. This month I had $2,000 of net cashflow and everything that needed to get done got done. And that required zero budgeting. So for many people, including the Harvey household, that is more than adequate and it gets us where we need to go of it all about it. So that’s number one is write your goals and have them provide that accountability just from having them in black and white. Number two, number two of five is figuring out what, with your new paycheck, how to keep the money that you make. And obviously this is going to be subject to number one and how important that is to you with regards to savings. But Jimmy has a great rule that I really liked that he’s Jimmy. Talk a little bit about that and what that means in this kind of instance.
Dr. Jimmy Turner (14:54)
Yeah. So, so I really kind of tried to figure out, well how much money do most doctors need to be saving in order to have a reasonable shot at retiring at a typical age or just before. And so there, there are other rules out there, but I don’t think that they work for doctors. So this one’s the 50, 20, 30 rule. So 50%, 20% and 30% and that lasts 30% is really the important ones. That last 30% is your savings rate based on your take home pay. The 50 and 20 are the fixed and variable expenses. So fixed expenses are what you are going to consistently pay every single month. And they are kind of cycling payments such as your mortgage for example. Or maybe you have a car payment that’d be a fixed expense. A variable expense is something like a wedding or you, you know, you have Christmas coming up and you want to pay for presence or it could be something else at an emergency expense.
Dr. Jimmy Turner (15:50)
But those are things that you’re not gonna be paying every single month. So 50% should be going towards fixed 20% towards variable and 30% savings rate. And so I think that that’s really important because it in a big picture tells you where your dollars need to be going before you get them. Because otherwise what ends up happening is you bring home a paycheck and you spend every single dollar of it. Cause that’s what every human does. If they don’t have a plan for their money, no matter how much money you make, whether it’s, you know, a thousand dollars a month or a million dollars a month, you will spend it. So the 50, 20, 30 is, is built, a design is designed to help people figure out broadly speaking where their money should be going and about how much of it,
Yeah. And there’s a couple of reasons that I like this rule for physicians. The first is it takes sort of the traditional ratios, which there’s, there’s a, you could just Google like these three different numbers and different combinations budget and there’s like, you can find like, Oh, you know, 75, 25 15 or like different permutations. And I think having the 50 20, 30 fixed variable savings is a good ratio for physicians who are waiting until their early or mid thirties to start making significant financial progress. And it really, it compensates for that. It compensates for the fact that you’re, you know, 10 to 12 to 15 years behind your peers in saving and you’ve got to make up for lost time. So I think that’s really valuable. And secondly, I think the 30% some people might say, Oh, like, you know, my dad always said 10% 30 is like, really a lot.
You’re going to kind of cramp my style. But one of the things that you don’t realize is if you go from making 65,000 to $365,000 uncle Sam is going to take almost half of it right off the top. Right? And so if you think about your income as this really, really big number that as a lower earning resident or fellow, you just kind of think, well, it’s so big, I really can’t even conceive it. But I guess I’ll like see how much of that I can capture when I get there. If you’re not intentional about that, got to remember that taxes are going to be a much higher expense for you in the future than they are. Right? And that’s this whole new category that you’ve never had to deal with. So if you’re not intentionally building in after taxes a really meaty savings rate, then you’re just going to save money.
You’re going to accumulate money very slowly. And if you have a, you know, living expenses that increased significantly as you transitioned to attending hood and you have a very low savings rate, you’re just going to be working until you’re 85 and if that’s what you want, if that’s what you put wrote down on your goals is for item number one, it’s like I want to work until I’m 85 so I can live really, really awesomely then great, then great. If that’s cool, if that’s your plan, then great, but if it’s not your plan, then just be a little more circumspect at the outset and use this principle of 50 20, 30 rule. I just think it’s really a great ratio and one that I recommend.
Dr. Jimmy Turner (18:37)
Yeah, thanks. And I do want to mention too that that that is for your monthly your monthly pay that you can expect to be coming into your account regularly. And, and I recognize that not everybody gets paid like that. And so I do want to mention the other rule that I teach my students, which is the 10% rule. And so basically for any variable or bonus pay or you receive an inheritance or what have you, any unexpected pay that doesn’t isn’t your consistent monthly paycheck. The 10% rule would guide you to put 10% towards whatever your heart desires spending on whatever you want. And for me, I can tell you what that was in a second. And the other 90% of course is spent towards building wealth and that’s your take home. So if you bring home $10,000 as a bonus check, then you can spend, you know, a thousand dollars however you want and $9,000 needs to go towards building wealth.
Dr. Jimmy Turner (19:26)
And as you pay down your debt, when you get to the point where the mortgage is the only thing left to what my family has done with that, it started into the 25% rule. So we we basically now spend 25% of whatever bonus pay we take however we want. And the other set of 5% still goes towards building wealth. But the reason that that second rule of the 10% rule is important is because a lot of people get quarterly bonuses or an annual bonus or they get incentive pay based on how many procedures they performed. And so a lot of times that that paycheck comes in, you’re like, well, I didn’t know how big it would be and now I came in, but I wanted to buy that one TV. You know, and so like, because you haven’t already decided preemptively that you’re going to put 90% of that towards your student loans or whatever you’re paying off you often make mistakes.
Dr. Jimmy Turner (20:06)
And so what we did was and just to give an example that you can spend it on whatever you want. I financed a car, which I would personally recommend for nobody. You know, I don’t ever recommend financing anything. It was the last car last year. The car was getting made and truth be told, I ended up selling it later. So it just goes to show that things don’t buy you happiness. And I had to learn that lesson and I will continue to learn that lesson probably for the rest of my life. But we’ve got a golf club membership, but the other 90% were towards building wealth. And so we paid off $300,000 in debt in two years and increased our net worth by half a million dollars in about two and a half. And so it goes to show that when you have a early savings rate, which is the most thing in terms of math, you know, the why is most important.
Dr. Jimmy Turner (20:51)
But mathematically the most important thing early on as an attending is your savings rate. The amount of money that you’re putting towards building wealth because you don’t have a lot saved yet. And so the market can’t really earn you a lot. So your savings rebate matters more than just about anything. So that 30% using the 50, 20, 30, and then the 90% coming from the 10% rule allowed us to accomplish those goals. And just those two things by themselves. It a lot of the heavy lifting because we’d already thought about where the money was going to go.
Yeah, absolutely. I just wanted to give people an idea. You know, if you’re making a salary or your compensation is that the number I picked was 360,000 you can expect a big fat six figure tax bill and that’s something that people don’t always think about. So if you make three 60 we’re not talking about, you know, if we take this 50 2030 and we applied that to your situation, we’re not applying it to the three 60 right? We’re applying it to the net income. So you might think that 30% is a big number, but I just estimated maybe it’s $150,000 to go to taxes. It depends on if you’re married, where you live, what state you live in, a lot of other variables. But if that was the case, you’re netting $210,000 from a top line of 360 K if 210 is your number, that 50 2030 rule is getting applied to $210,000 and so that 30% savings rate is then going to be 63 K. Yeah. So that’s your number. So if your, if that’s your top line three 60 and we want it to say, what does this look like for you? It means 63 K needs to end up in your 401k four with Ruby, TSP savings account. And then all of the rest is what’s your money to do whatever you want with right, which is about 150 grand a year. Right. And if
Dr. Jimmy Turner (22:30)
Do you do that? That 30% is going to let you, assuming that you finished training in your early to mid thirties is going to let you be financially free or financially independent by your mid fifties to 60 yeah. That’s going to get you to your goal automatically. So now, now our savings rate by those numbers is substantially higher than that. But that’s because I want to be financially independent when I’m in my mid forties and so in order to do that, I have to save a lot more money. So you can craft this or manipulate this however you want based on your goals. But a 30% take home savings rate, I think is, is almost a minimum, you know, just because that’ll get you to 60.
Yeah. And you know, again, this is always in the context of two people who are interested in not only being financially independent, but helping others become financially independent. These are not everyone’s priorities, right? So you’ve got to tailor it to what’s comfortable for you. I think we’ve hit that enough. Let’s, let’s move on here. So number three, build your dream team. So no, no man is an Island. No one can accomplish big, ambitious goals for themselves personally, financially, professionally, or in any other way without a support network. People around them. So some of these are going to be professional services types of people, but others are going to be, you know, mentors and coaches and friends. And so in the context of building wealth, I wanted to talk through a couple people that it makes sense to have on your team or at least to describe the functions of these people to see if maybe you want to try to do some of that yourself.
But one of the benefits of being a physician is that in many cases you can hire experts to help with certain things. So the first thing I want to talk about, and we’re just going to breeze through these, we’ve got seven or eight of these and I want to just hit each of them briefly. Number one is a CPA. So I just said, you’re making a lot of money. All of a sudden you’re paying $150,000 a year, $150,000. That’s three times the U S median household income. That’s what you’re paying in taxes right off the top. So with a tax bill that significant it all, I mean 99 point, I always recommend just hire a CPA because you don’t know what you don’t know and you don’t want to blow up your own situation.
Dr. Jimmy Turner (24:41)
Yeah, I it’s funny cause I’m looking at the email that you sent me earlier and ass, please don’t use TurboTax. And it’s so funny because up until a year ago I did use TurboTax and and I finally had a complicated enough financial situation that it just didn’t make sense anymore. So I hired a CPA for the first time this year and it was worth every penny. And I would say that that this is going to be true for a lot of these things that one mindset piece that you have to wrap your mind around as a doctor is that your time is highly valuable. And so if you can outsource something to someone else to help provide a function or service that you need to be performed and that will save you time so that you can do other things that are more valuable to you, whether that’s financially, emotionally, family-wise, or however that is often money well spent.
Dr. Jimmy Turner (25:29)
And so the money that I gave to my CPA saved me from having to do K one paperwork from, you know, sending out 10 99 or your w nine forms. And you know, I collected those. They sent out the stuff to my independent contractors that I paid. And and so it saved me a ton of time by having an excellent CPA. And so it did cost me, you know, I think it was like maybe five or $700 for my personal and then like another 1200 bucks for my business. But I plan on doing it again next year because it was such a good experience and I know that it was done right. And and I was sick of correcting TurboTax when they did my 86 Oh six wrong. And you know, like I just, it made all the sense in the world, so I completely agree.
Yeah. And you know this, this is an area of transition for physicians professionally when they’re going from resident and fellow where you work 80 hours a week and you get one W2 and you have a very simple plain Jane situation in most cases and all of a sudden it’s different because your income is way higher. Maybe you have a family, maybe you are a business owner, maybe you have outside income. And it just, the complexity, just exponents from there and it’s just, it’s so much worth it for the peace of mind to get a CPA. Okay. financial is the next one I have on my list. This is somebody who can wrangle your personal financial situation for you. So this is sort of a broad term. Obviously I am a financial advisor. Jimmy knows a lot about financial advisors and financial planners. I would use those terms interchangeably.
When your complexity and the number of zeros in your paycheck increases, this is another time to consider hiring a financial planner to help you answer these questions around financial transition. It’s not right for everyone, but I think it’s right for most doctors. And I think that there should be no shame for you as a physician to say, my time is valuable. I don’t want to spend every Saturday morning cruising around on personal finance blogs and I want to find a trusted partner that I can shovel financial tasks onto and have them help me get my ducks in a row.
Dr. Jimmy Turner (27:31)
Yeah, absolutely. So the way that I explain this to people is that I break up doctors into one of three groups. So the first group is the do it yourself group. So that’s where I land. And so I don’t have a financial planner that said I also recognize that the do it yourself group is a very, very small proportion of people. A lot. Most doctors are not going to end up there. The second and third group are much larger. Sets the dot your I’s and cross the T’s groups. That’s the group that they probably know a good bit about money and they may be able to do things themselves, but they want a professional to make sure that they’re dotting the I’s and crossing the T’s not doing anything stupid. And the third group is the outsource group, which is where most doctors unfortunately fall.
Dr. Jimmy Turner (28:10)
I wish everybody was in group one or two, but that’s just not reality. So the outsource group is, they view their financial life just like they view childcare or lawn care or you know, their laundry, you know, for taking it to the dry cleaner. Like they want someone else just to handle those things. They want to pay them for it and they do everything. So for that second and third group, a financial planner, which is by far and away the vast majority of doctors fit in the second and third group of financial planners is well worth it warranted and, and honestly the right thing to do. You know, and, and hopefully as people learn more, they get shifted into groups two and one. But I also recognize that’s not the case. And so that’s why, I mean there are just so few advisors out there though that, that I personally recommend, you know, Justin, you’re one of them.
Dr. Jimmy Turner (28:55)
And the reason why is because you do have to be careful. And so as you go down that list from group one to group three, you have more and more risk in terms of getting screwed by the industry. And you also have more and more need for a financial planner. And unfortunately as you go down that list, you have less and less knowledge to figure out what a good planner looks like. And so, you know, Justin’s a great example, flat fee only fiduciary. I know you don’t like that term, but fiduciary planner that has experienced work with doctors. And so, you know, I think it’s important to get a planner for the vascular doctors, but please do your research, please ask somebody for a recommendation. And you know, Justin’s a great place to start there. But I mean just just do your, do your due diligence is awesome
And you want to, the biggest thing is to just make sure that they’re qualified to answer the questions that you have and that you understand how they’re getting. And we’ve talked about this extensively another episode, so I don’t want to hammer on it now, but one of the nice things about the financial planner in your bullpen is that they can get all the rest of the people that you need. They can get the attorney and the CPA and the property and casualty person and others who are going to be part of your financial and professional journey. They can read their own Rolodex on your behalf, which is a really nice benefit. Another one that I’ll sort of lump a few of these together as you’re transitioning is you have legal complexity as you move from resident and fellow to attending hood. Now this can be with regard to estate planning.
So an estate planning attorney or like a business and entity formation type of function for an attorney or asset protection. These are all things that a lawyer is going to do for you. Maybe even taxes, depending on how complex your situation is. So integrating legal help when you need can be really beneficial. Now again, having the financial planner kind of quarterback that to say, yes, you need a lawyer. No you don’t. That can be really beneficial because the lawyers are gonna, you know, I hired an attorney recently, he said, here’s the $1,500 retainer, send that to me and then I’ll start hearing what your questions are. So it’s a, it’s a very, you know, time-based. That’s just how they bill and that’s how the world works. But you’re, you need their expertise in many cases. So having legal help is something that can be really, really important. Especially, you know, if you have little kids, please get a will. Please have a, you know, healthcare proxy, financial powers of attorney, things like that. Don’t delay on that type of thing. And having an estate planning attorney look at your situation and give you a customized recommendation can be really beneficial.
Dr. Jimmy Turner (31:18)
Yeah. And I think that that, that last piece is so important. Just organizing things because God forbid you die in a car accident or something like that and your family’s grieving and having to figure out where you keep all your files and who takes care of what and how, you know, one kid goes, you know, like you don’t want, you don’t want your whole family situation going through probate and taking months and months and months, you know, to, to allow a process to happen that could take much less time if you just had these documents in place. And so if you have children and, or are married, please do those things. It’s just, I mean, that should be number one on your list, I think, you know, quickly followed by asset protection stuff. You know, with disability and life insurance if you don’t have that yet. But I, it’s just, it’s something people far too often put on the back burner. And so I, I completely agree.
Yeah. And I want to lump a couple of these other ones together cause I want to get to some of these other points. So I think this is a good time during this transition if you don’t already have one to find a mentor in health care in medicine who can help you. You know, somebody who’s somebody like Jimmy who this transition is very fresh for him. He’s made some mistakes, he’s made some great decisions and he can tell you which is which. Find somebody like that in your life who can help you navigate these changes outside of the normal professionals. This is an informal relationship, but one that is nonetheless intentional and this is an ideal time to S to go to somebody and say, Hey, like I want you to be my go to resource. I, I need help. And I respect and value the experience that you have as a physician. And I would love to get coffee every couple months or talk on the phone just to tell you about what I’m thinking and how I’m feeling and have your wisdom manifest in it with what I’m going through.
Dr. Jimmy Turner (33:06)
Yeah. And you’re going to have, like you kind of alluded to multiple different kinds of people for these roles. And it can be formal and it can be informal. So, you know, I have formal advisees. You know, I’ve got three residents that are advisees of mine. I meet with them every three to six months, take them out to lunch, dinner, check in, make sure things are going well, and see if I need to advocate for them or represent them in any way or if there’s anything I can be doing for them. And then I have a, you know, more informal relationships where people pick my brain all the time and, you know, awake. If someone has a financial question, like they’re going to come and find me and they’re going to ask me. And that’s just how it’s become. And so, and then I can refer them to the appropriate people for the needs that they have you know, to, to, to make that dream team.
Dr. Jimmy Turner (33:48)
And so I, I’ve also found it really important for myself, you know, like doing research. I have a question. I know that I can go talk to a couple of my senior colleagues who are much more experienced in the, in the research realm and in publishing and you know, writing manuscripts and, and kind of pick their brain about stuff. And I do that all the time. And that’s actually how I got started in that I pitched a research idea on studying how long nerve blocks last. Right? So we’re doing a, I guess this is a anesthesia related podcast, one of the few times I can actually go into this. So we were looking at a systemic and paranormal DECA drawn and whether it prolongs blocks or not. And so we did two different studies and Justin, like, I can’t believe people actually signed up for this study, but they did it.
Dr. Jimmy Turner (34:29)
We got through the IRB and patients actually completed this study. So it was kind of widely accepted that DECA drawn prolonged blocks. Just lots of bad definitions. Like, you know, we’re out there. And so I had never really been objectively studied. So I poked people with a, with a needle every two hours until the block wore off around the clock. And I didn’t know that when we put DECA drawn into one of the blocks is an adductor canal block that was going to last a really long time. And so I had to, I didn’t do it, my research assistants did it, but we poke people with the needle every two hours for like, I mean up to 50, 55 hours sometimes. And so that’s like through the night, every two hours for two months. So but like what I described this study, cause I wanted to like actually answer the question.
Dr. Jimmy Turner (35:14)
I didn’t feel like anyone had ever done that. I approached a couple, my now partners Darryl Henshaw and Rob Weller and about the idea and they’re like, you’re crazy like that. But I was young and naive and I feel full of full of zeal and charisma. And so we we embarked on the journey and and ended up becoming my, you know, my first two randomized control trials that got published. And so, but it was so much work and they were so right that I will never do a study like that ever again. But having the mentors there to let me know before I got started that this was going to be extremely hard was really helpful. Set expectations early.
Yeah. Yeah, absolutely. And, and one that is related to this that I think bears mentioning is having a coach like a personal or career coach. This is something that can be a little bit weird and not everybody would probably be a fit for. But I think I have benefited from this. I know my wife has benefited from this. Having somebody that you pay them money, and this obviously looks very different for my wife and I, cause I have a business coach who I, I say, Hey, here’s everything happening in my financial planning business. Here’s what I’m the, all the efforts, I’m, here’s the, the stated goal, here’s the 17 things I’m doing to try to get to the stated goal. How does this look from an objective third party standpoint? And I think a career in medicine, it’s very, very demanding. And personal life takes up obviously all the rest of your time.
And so having an objective third party to say, what are your career goals? What are your goals for your marriage and your family and your kids and other personal pursuits and how do you feel, what kind of time are you putting on on each of these? And somebody to just hold up the mirror and provide that touch point every few weeks, every month to have a conversation about how are you doing, take the temperature and see what kind of adjustments you can make to just thrive as a human. I am a huge, huge believer in that type of relationship. And it could be a coach, it could be even like a therapist or there’s different sort of titles depending on the expertise of the person to whom you’re speaking. But I think that’s really, really, I think the more like high functioning, the more driven you are, the more beneficial that can be. And the irony is people who are very high functioning and smart, they don’t think they need the help. But we do. We do.
Dr. Jimmy Turner (37:29)
Yeah. And I want to mention one specific thing there, whether it’s a mentor or a coach, I think it’s really important to realize that these, these relationships are driven by the person who is getting the advice. So, so exact. It’s exactly what you’re saying. You know, you have to know that you need it. And honestly, the reason why is because you can, you can go ask people for their advice all day, but if they’re not someone that you respect someone that you trust, someone that you know, you admire or want to in some way become, you’re not going to listen to what they say. And so if it’s not driven by you and someone just walks up and he says, Hey, you know, I want to give you some advice on such and such, like nobody ever listens to that. So I think it does require a certain you know, introspection and amount of knowledge about yourself that, that it is actually really helpful for high functioning, intelligent people to, to get coaches and planners and all sorts of mentors and, you know, places of advice. But it has to be driven by the person that needs the advice, I think. Because otherwise it’s just, it may not be followed through at all.
Yeah. And I know there are professionals out there who specialize actually in like physician life and career coaching. I want to get a couple of them or maybe one of them on the show sometime in the future to just ask them all the questions that I’m so curious about how this, how this really functions in the life of a physician. But I’ve seen the good effects that it has had in the lives of some clients and friends and I’m just, and, and myself and I’m just so convinced that it can be really, really valuable. And during this time of transition you’re taking on a whole new model, a new job responsibility, but your, your the last line of defense in ways that you haven’t been before as an attending physician. Plus you have whatever your personal you know, relational stresses and strains are that are all sort of hitting at the same time.
Having somebody to help you walk through that can be really valuable. Okay, so we said number one, write down your goals. Number two 50 2030 rule number three, build your dream team. We’ve got two more. Number four as far as how do you optimize this transition from residency slash fellowship to attending hood is for yourself. Get informed on the basics of your personal finances and even just the broad categories. What are the things that I need to know in order to not accidentally step on a landmine? And I know this is a particular passion of yours, Jimmy. So how are you counseling people who maybe come to you and say, Oh my gosh, like I know there’s this big transition. I know I’m about to start getting paid a lot more and I don’t even know where to begin. I know I ought to know more and I don’t. What should I do?
Dr. Jimmy Turner (40:03)
Yeah, so this is tough because I think this is a fundamental problem in, in medical education. And so, so I do want to mention I’m attacking this from a more formal perspective. You know, creating that the fourth year med student curriculum that you came and spoke at Justin. And, and I think that that’s really important. So for, for the attendings out there or you know, faculty or staff or CRNs that are in practice, like I highly encourage you, if you were financially literate to consider starting a curriculum for your students and, and making this something that’s little more natural that happens as part of their education. Unfortunately the vast majority of people, that’s just not the case. So, so they come and they say, Hey, you know, I’m looking to get started. I have no sort of exposure to this stuff at all.
Dr. Jimmy Turner (40:43)
And so if you’re coming from that situation, what I normally do is I recommend that they get a base knowledge from somewhere. So this could be from a book and ones that I commonly recommend are how to think about money by Jonathan [inaudible]. I love that book. For investments. I often talk about bill Bernstein’s book, the investor’s manifesto. And then, you know, they can kind of, you know, go down the rabbit hole in terms of where their interest is after that. You obviously can’t cover everything. I mean, I’m not going to send people to read about an estate planning for example, like I’m going to refer you to an estate attorney to have that conversation. But in terms of personal finance you know, I wrote a book too, so I guess I have to plug that right. The position philosophers could guide to personal finance, which is written chronologically what you need to know at various points.
Dr. Jimmy Turner (41:25)
And so I think that however you do that, you need to get a basis. It could also be an online course, right? It could be you know, a meeting with a planner. But the part that really I, I don’t want to say meeting with the planner yet though, because what I want you to do is have enough personal finance knowledge that you can sit down with a planner, understand what they’re saying, be financially literate or enough to know whether what they’re saying is a good fit for you or not before you even meet with them. So the idea is to get everybody again into that dot the I’s, cross the T’s group. You cannot just go into a planner and trust that they’re going to, you know, know everything that there is possibly to know about you and enact a plan and do everything for you.
Dr. Jimmy Turner (42:03)
Like you have to take some ownership of it. So I start people off the burst, the personal finance basis which is usually a book, a course, something to that regard. And then they need to continue their financial education, right? Just like you continue your medical education when you get done, which I recommend through blogs, podcasts, things of that nature. You know, podcasts like this, you know, listen to it once a week and dig into the little nitty gritty details or you know, interests that you have just to keep you up to snuff. And you might still read a book occasionally, but after that you’re just trying to maintain your knowledge and make sure that you’re staying familiar with terms and sticking to the plan. And of course after you’re financially literate, I think is a great time to engage a financial planner to help you put all this stuff together into a cohesive plan.
Yeah, absolutely. And sitting here on my desk, I have several copies of the one page financial plan by Carl Richards, which is a great primmer and introduction to these important financial concepts. Just to give you again, the big box is the categories that you’ve got to sort of fill up or hire an advisor to help you fill up. So for anybody listening who wants to leave a review on iTunes right now, if you wanted to find us anesthesia success, get on there, lever and honest review, copy and paste that and drop it in an email to me. I’d love to send you a copy of the one page financial plan. So I’ll do that to the first three people who email me. So thanks for obviously always leaving those honest reviews. We appreciate that to help raise the profile of this show. And I also want to couple that with an effort to just help you, physicians who are transitioning right now to have these constructs that are going to be helpful in helping you ask the right question. So thanks for doing that. If anybody’s interested, anything else you would add on that, Jimmy, before we move on?
Dr. Jimmy Turner (43:44)
Well, you know, I think that after you start to have that basis for your your, your knowledge base, you need to start enacting some stuff in terms of like cashflow planning and that sort of thing. And so it does need to become a bit of action. But typically I’m gonna say that you can either fall into that, do it yourself group, right. And cause there’s gonna be a certain proportion out there and you’ve got to figure out how to do that. Or you’re going to lean on someone else to help you figure out how to make that plan for you. So, so that knowledge does eventually turn into action. You have to start with knowledge first.
Yeah, I agree. I think that’s a good formula here. So like first read a book about it and then either do it yourself or hire somebody to help you there. There is no third option. Right?
Dr. Jimmy Turner (44:24)
Okay. And the fifth and final item, this is a little bit more tactical but it is time sensitive. So I wanted to make sure I mentioned it is understanding disability coverage. So this is one of the things that would be in this book is insurance and the way that it functions in the life of a physician. One of the most important, if not the most important insurance for a physician is disability insurance. And what that is is you’re protecting all of your future income that is as yet unearned. But if you’re making 300 K plus a year, that’s millions and millions cumulatively over your career and because you’ve invested a lot of money in your brain and in your training to be able to earn that money, we want to make sure that it’s protected appropriately. And as a resident or fellow, there’s a unique opportunity to get special discounts in many cases from reputable carriers to be able to get this coverage in place before you transition.
There’s a lot of reasons that are a little bit more technical that that is the case. But suffice it to say, if you’re ready to transition to attending hood and you don’t have a personal disability policy, make sure that you research that and consider putting something in place because it’s a, it’s a time sensitive item that you may, depending on the employer benefits package of the place you go to work, you may not be able to get it in a few months or it may, the options available may be different and the discounts are going to be less, meaning they’re going to cost more, the policies are going to cost more. So it’s something that makes sense to address in training definitely before you transition.
Dr. Jimmy Turner (45:54)
Yeah, and I would add that it’s time sensitive for another reason too, which is that you can get diagnosed with something at any point. So if you leave training when you should have gotten in, I’m gonna get into the weeds a little bit here. This is, this is a personal pet peeve and topic of interest. So so I, I guess let me back up and just tell people why then it might make sense what my perspective is. But so anyone that knows my origin story knows that I, I basically got hosed out of disability insurance as a fourth year medical student who shouldn’t have applied for it. And so I had at the time and essential tremor Virta propranolol and agent B I talked to him and ended up getting denied. That’s right. And he basically was trying to earn a commission from me.
Dr. Jimmy Turner (46:41)
But there’s something called the guaranteed standard issue, which only exists in training. As far as I know, Justin, correct me if I’m not, if that’s not true, but the GSI policy that was at wake, the only stipulation in that policy, which doesn’t have a medical exam, there’s no medical underwriting is a little more expensive, but it’s a guaranteed policy is that you can’t have been denied before. So since I got denied as a fourth year medical student, I couldn’t get it and I still can’t get it. And so that’s my background where, you know, disability insurance is just paramount to your financial plan because you have a lot of cashflow coming in. And if you can’t protect that, should you become disabled, that’s a big, big problem. And group policies don’t work the same way. So a group policy is not sufficient. You need a private policy on top of that because they don’t work the same.
Dr. Jimmy Turner (47:27)
And without getting in the weeds, they’re all, I’ll just say that GSI policy is, is time-based, right? So you have to get it while you’re in training. I think you may have six months afterwards to get something like that. But GSI policy if you have medical problems, may be the best route for you. And the other reason is time-based is because if you don’t have anything and then you graduate and you become an attending and then you get diagnosed with something that may prevent you from getting disability insurance at that point. So really, if you’re at any point training, this isn’t the 60 days before you leave, this is the moment that you start earning a paycheck. As a resident, you need to get a disability insurance policy with a future purchase option or a benefits rider that allows you to increase the value later. And, and that has to happen as early as you possibly can because you never know. You could be in your third year of residency and get diagnosed with graves’ disease like I did at the age of 33. So like stuff happens, right? Yeah. So it is time sensitive from a, from a rider perspective and the benefits and the cost as well as from a life perspective that you may get a diagnosis you didn’t know you had. Yeah.
Yeah. And the nitty gritty of the types of insurance and the types of riders is beyond the scope of this discussion. But suffice it to say, have this discussion with someone who can speak intelligibly into your situation about it, financial planner or a trusted insurance professional and get the coverage you need before you leave training. This is time sensitive and you can get it done. If you start right now, this will be released in may. If you’re wrapping up June 30, we’ve got time, but it’s time to do it right now, so please get that taken care of. Okay. Those are the five items that I think are most important for transitioning residents and fellows. I want to, Jimmy, you have talked to way more residents and fellows than I have, so I want to give you an opportunity to do a little grab bag at the end. Like what else are you telling people who are transitioning to try to prepare them for all that lies ahead?
Dr. Jimmy Turner (49:21)
Well, you know, just, I give them a little more concrete advice too. And so, you know, oftentimes they’ll, they’ll ask, Hey, should I start paying down my student loans? Should I start investing? You know, like, what should I be doing? And and I always try to ask them questions instead of giving them advice cause my residents and all the people that I talk to are super, super smart. I don’t need to tell them what to do. They just need the information. And so you know, I’ll say, well, what are you gonna do if like you you buy a house in your, your AC unit goes out, it cost you $5,000. How are you gonna pay for that? And I’d be like, well, I don’t know. They put on a credit card and I’m like, that’s a terrible idea. You know, and so, and then like, Oh, I guess I need to save some money in case something like that happens.
Dr. Jimmy Turner (50:05)
I was like, yeah, it’s called emergency fund. And so I’ll talk to them about that, you know, and, and just plug that early because it’s something that as you transition, it’s actually pretty easy to get a pretty sizable emergency fund going quickly because you just live your same lifestyle. I would not even use that 90 10 rule until you have an emergency fund in place. I’m just hammer away at creating a three to six emergency fund. And then, you know, the other piece of advice that I kind of give to people is about working backwards from the Y. So like, you design the Y great. You figure out that you want to be able to be financially dependent by 55 great. And then you can whittle that down into a backwards monthly goal, basically. Like, this is how much I need to be saving to get to X, you know, age and have Y money.
Dr. Jimmy Turner (50:52)
But you know, those are the kinds of the big pieces that I tell you just cause like I feel like they, they get stuck in the transition and you know, I’m moving to such and such and I’m, I’m thinking about renting or buying a house. And I normally encourage people to rent as well because more than 50% of doctors will change their jobs with their first job in the first, I think three to four years. So there’s a really good chance that you’re going to get to your job and for whatever reason you don’t like it. You need to move family reasons. You have to leave. And so if you want to buy a house that’s going to cost you a lot more money. And so there’s lots of other things too, but I think it highlights you know, it’s a dimension.
Yeah, I agree. I think we’ll, we’ll end it there. Dr Jimmy Turner. It’s been a pleasure speaking with you. Thank you for all the work that you’re doing through your course, through the flare course that you’ve created for med students at wake forest through your blog and all the writing that you do and the podcasts. You’re putting out a lot of content for the betterment of the medical community and I’m glad we’re friends and I’m glad that you have joined me today on the anesthesia success podcast. Thank you.
Dr. Jimmy Turner (51:49)
Yeah, thanks for having me Justin, and thanks for being part of flair. I’m so glad my students got there.
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