Doctor Money Matters

Im back. Sorry for the long gap between the last episodes and this one. Holidays and an extremely busy work schedule limited my ability to work on the podcast. I have a series of episodes ready to go and am excited to get back to it.

While finance and money are the main topics, I would also like to continue to address other issues that impact health care professionals including the burnout epidemic that has become a major topic amongst all of us.

My last episodes on private equity in medicine were very popular and well received. It is the continued erosion of physician ownership and employment that troubles me. (I don't blame anyone for taking a buyout if offered, I probably would go that route also, but the long term effects for the profession are probably not good.) When you are not an owner, you lose power, and when most of us are employees (myself included), we lose major negotiating power for healthcare policy decisions (You will hear about this in an episode with Dr. Marion Mass and an important organization she is a part of called Practicing Physicians of America.

I would also like to continue to highlight entrepreneurship and independent practice owners as I truly believe that ownership allows for a more fulfilling career. So if you are or know of any independent practice owners that I should spotlight, please shoot me an email at [email protected] , tweet me or FB message me.

Every year starts out with optimism and that is one of humanities great traits, to look arbitrarily at a calendar and decide that January is when you make a change. I am, just like most of you a working healthcare professional who puts in too many hours at work, tries to spend time with his family, and tries to take care of patients. I hope this is the year you make a commitment to your financial wellness.

So first basic goals I think everyone should try to get to as soon as they can this year.

1. Fund your 401k, 403b (esp if you get a match) (I want to make a quick tribute to Jack Bogle, the father of the index fund who recently passed away. He did more than anyone to help the average investor protect themselves from Wall St. Billions of dollars in investor accounts are there because pioneered low cost investing)
2. Fund your roth or reg IRA, (backdoor roth IRA for high income professionals)
3. If you have a HSA, fund that
4. Pay off high interest debt (if credit card or other very high interest, this may move up a few notches)
5. Take a moment to invest in yourself. This can be health, education, or just something that makes you feel better. Life is too short (as we all know) to not enjoy the journey.
6. Do something that makes you uncomfortable. For me that is going to include some public speaking. It's not too tough to sit behind the microphone on this podcast (though it was very scary to put it out there), but speaking in front of a group is nerve racking. I'm always impressed with those who do it so well and make it look effortless.

Finally I want to expand our investment mindset. While, I truly believe that equities and real estate should be core holdings (they are mine), I am always looking for other opportunities that are available (for diversification and non correlation) and educating myself and hopefully the audience about these. If you are interested in hearing about specific types please let me know and I can try to do shows about them. It has been a long bull market in most assets and no one knows where we are headed and I am certainly not a good forecaster. But there is a role for other investments and I do think that it's always good to explore these. Last year I joined an investment group of physicians looking at early stage healthcare companies. I will probably be talking more about this in the future, so keep a look out for that.

I want to thank all of you for listening to this podcast, sharing it with your colleagues, and your participation in the Doctor Money Matters FB group. While it may not be the biggest podcast or the biggest group, I hope they have been entertaining and useful, I hope we can continue to help educate and empower each other in our financial journeys.

I am thinking of putting on a webinar to discuss investing, taxes, and other financial topics. If you are interested let me know by email.

You can follow me on:

twitter @drmoneymatters

Instagram @doctormoneymatters

Facebook @doctormoneymatters

Please consider joining the Doctor Money Matters Facebook group.

Please share this podcast with your colleagues and join our email list.

Thanks for listening and please leave us positive reviews and continue to share this podcast with your colleagues.

Part 2. Private Equity buying medical groups -- What's the deal?

Ep 42 is part 2 (Ep 41 is part 1) of the episode talking about private equity buying medical groups.

There is an increasing amount of private equity purchasing/partnering of medical practices in the US. We are seeing in in a variety of fields such as radiology, anesthesiology, emergency medicine, dermatology, just to name a few. I wanted to explore why this is happening.

My guest on this episode is Kurt Schoppe, MD a radiologist in Dallas, TX. Kurt is part of the American College of Radiology Economics committee and has experience in the private equity world. On these episodes we talk about:

What is private equity?

Why would they be interested in medical practices?

1. Fragmentation of medical practices leads to market opportunities.
2. They are good at logistics, operations and can increase efficiencies to improve returns.
3. They can have access to capital to make discount purchases.
4. They see healthcare as a more predictable way to make money.

Why would a practice want to sell to these firms?

1. FOMO (Fear of Missing Out) Other groups have done so we probably should also.
2. Thinking that your group doesn't have the expertise to handle a changing healthcare reimbursement model
3. Money right now (particularly for senior partners)

What are they looking for when deciding to buy a practice?

What does this mean for medicine as a profession?

What does this mean for younger physicians?

Here is the article Dr. Schoppe referenced about corporate veterinary practices. https://www.bloomberg.com/news/features/2017-01-05/when-big-business-happens-to-your-pet

More episodes of this podcast are available at www.doctormoneymatters.com and Apple Podcasts, Google Play, Stitcher, etc. All episodes are also now on YouTube (Audio only) and Facebook.

You can find Dr. Schoppe on twitter @kurtschoppe

You can follow me on:

twitter @drmoneymatters

Instagram @doctormoneymatters

Facebook @doctormoneymatters

Please consider joining the Doctor Money Matters Facebook group.

Please share this podcast with your colleagues and join our email list.

Thanks for listening and please leave us positive reviews and continue to share this podcast with your colleagues.

Welcome to the Doctor Money Matters Podcast. This is a podcast about financial topics related to the healthcare professional. I am your host Dr. Tarang Patel, a diagnostic radiologist in Arizona.

The topic on this episode is the increasing amount of private equity purchasing/partnering of medical practices in the US. We are seeing in in a variety of fields such as radiology, anesthesiology, emergency medicine, dermatology, just to name a few. I wanted to explore why this is happening.

My guest on this episode is Kurt Schoppe, MD a radiologist in Dallas, TX. Kurt is part of the American College of Radiology Economics committee and has experience in the private equity world. On this episode we talk about:

What is private equity?

Why would they be interested in medical practices?

1. Fragmentation of medical practices leads to market opportunities.
2. They are good at logistics, operations and can increase efficiencies to improve returns.
3. They can have access to capital to make discount purchases.
4. They see healthcare as a more predictable way to make money.

Why would a practice want to sell to these firms?

1. FOMO (Fear of Missing Out) Other groups have done so we probably should also.
2. Thinking that your group doesn't have the expertise to handle a changing healthcare reimbursement model
3. Money right now (particularly for senior partners)

What are they looking for when deciding to buy a practice?

What does this mean for medicine as a profession?

What does this mean for younger physicians?

More episodes of this podcast are available at www.doctormoneymatters.com and Apple Podcasts, Google Play, Stitcher, etc. All episodes are also now on YouTube (Audio only) and Facebook.

You can find Dr. Schoppe on twitter @kurtschoppe

You can follow me on:

twitter @drmoneymatters

Instagram @doctormoneymatters

Facebook @doctormoneymatters

Please consider joining the Doctor Money Matters Facebook group.

Please share this podcast with your colleagues and join our email list.

Thanks for listening and please leave us positive reviews and continue to share this podcast with your colleagues.

The 2018 Medscape Salary and Wealth/Net Worth Survey

Your income is the biggest contributor to your overall financial health for most people. As physicians we don't always know what we are worth. It is important to look at the market data.

My guest on this podcast is Lesley Kane of Medscape business of medicine who is in charge of the annual physician salary and net worth surveys.

We talk about trends in physician salaries. What are the highest paid fields? We look into primary care vs specialty fields. We also look at the persistent gender gap in salaries and what are some possible causes vs misconceptions.

We talk about why there are so many physicians with relatively low net worth by age 65 despite relatively high incomes. This is a problem and I am critical of the number of physicians who are in this situation. While some may have valid reasons, 25% of physicians with net worth less than $1M by age 65 is too much.

Also we discuss whether physician salaries should be discussed publicly and whether its a good thing or not. Will patients or other non physicians use it against us?

Here are links to the surveys. (You will may need to login or subscribe to Medscape (Free))

Salary and Compensation report

Net Worth and Debt report

Let's continue the discussion over at the Doctor Money Matters private FB group (you need to request membership).

Follow me:

Twitter @drmoneymatters

Instagram @doctormoneymatters

Facebook @doctormoneymatters

Negotiation for MDs

How are your negotiation skills? Do you love bargaining or do you cringe at the thought of trying to make a deal.

Negotiation is a critical tool in our careers and can literally make or break our financial and professional futures. My guest Robert Felberg, MD talks about important topics in negotiation as they relate to physicians.

What is a matrix?

What are the models of negotiation

What can you do to improve your negotiation skills?

This episode is vital for early career and mid career physicians. Listen to Dr. Felberg talk about the types of tactics that you can use to improve your bargaining position, who you are actually negotiating with, and how to do without seeming selfish.

We talk about negotiations for compensation and also with insurance companies and even your family.

Finally he recommends a book for negotiation that I had not heard of called Bargaining for Advantage by Robert Shell. (Note if you buy through this link, I get a small referral fee)

You can find out more about Dr. Felberg and his negotiation course at NegotiationMD.com

as follow his blog where he also delves into some financial topics.

Let's continue the discussion over at the Doctor Money Matters private FB group (you need to request membership).

Follow me:

Twitter @drmoneymatters

Instagram @doctormoneymatters

Facebook @doctormoneymatters

Doc G This is a 2 part episode, so make sure you also listened to episode 37 (part 1) first

How did this internal medicine physician achieve a high net worth ($6M) at a young age? How was he able to 5X his income from the time he started practicing to now as a primary care physician in a large metro area?

Many physicians are resigned to the work, work, work mentality but don't have a plan to increase their professional income. Investing is great and passive income is fantastic, but why not get paid appropriately for what you trained all these years for? Doc G talks about how he learned to optimize his workflow at all stages in his career and was constantly assessing what brought him income and joy and tried to remove those parts of his practice that didn't.

While we are constantly learning about medicine via journals, conferences, presentations, etc, how many of you are consistently optimizing your own practice? It's important because it will bring you greater job satisfaction and decrease burnout. The corporate practices do this but not for your benefit, so its vital that you assess how you practice.

It's also great to see that primary care physicians can become very successful financially in this era of medicine.

Let's continue the discussion over at the Doctor Money Matters private FB group (you need to request membership).

You can follow Doc G's blog at www.diversefi.com where he goes into depth on these topics. You can also follow him on twitter @DocGDiversefi

This is the rockstar finance ranking of the bloggers by net worth. 4 of the top 5 are physicians, but Doc G is one of the younger ones. One of our previous guests is also on there. Dr. Cory Fawcett. (Episode 5 about debt)

Follow me:

Twitter @drmoneymatters

Instagram @doctormoneymatters

Facebook @doctormoneymatters

Ep 37 This is a 2 part episode, so make sure you listen to episode 38 (part 2)

How did this internal medicine physician achieve a high net worth ($6M) at a young age? How was he able to 5X his income from the time he started practicing to now as a primary care physician in a large metro area?

Many physicians are resigned to the work, work, work mentality but don't have a plan to increase their professional income. Investing is great and passive income is fantastic, but why not get paid appropriately for what you trained all these years for? Doc G talks about how he learned to optimize his workflow at all stages in his career and was constantly assessing what brought him income and joy and tried to remove those parts of his practice that didn't.

While we are constantly learning about medicine via journals, conferences, presentations, etc, how many of you are consistently optimizing your own practice? It's important because it will bring you greater job satisfaction and decrease burnout. The corporate practices do this but not for your benefit, so its vital that you assess how you practice.

It's also great to see that primary care physicians can become very successful financially in this era of medicine.

Let's continue the discussion over at the Doctor Money Matters private FB group (you need to request membership).

You can follow Doc G's blog at www.diversefi.com where he goes into depth on these topics. You can also follow him on twitter @DocGDiversefi

This is the rockstar finance ranking of the bloggers by net worth. 4 of the top 5 are physicians, but Doc G is one of the younger ones. One of our previous guests is also on there. Dr. Cory Fawcett. (Episode 5 about debt)

Follow me:

Twitter @drmoneymatters

Instagram @doctormoneymatters

Facebook @doctormoneymatters

WTF is up MOC? (Part 2)

If you have not listened to part 1, please do so first. (Ep 35)

How many of you listening write checks to your specialty board for the privilege of Maintenance of Certification? I will pay over $3k over a 10 yr period plus a ton of paperwork to my board so they can sign off on my certification. Most of you listeners do so as well. We do this because its just another of the burdensome regulations that physicians have to do to maintain licensure and certification and also most insurance companies expect it in order for us to bill our services. Most of us have never questioned the step even though we hate the fees and paperwork.

My next guest Dr. Westby Fisher looked into the board certification MOC for internal medicine and went down the proverbial rabbit hole and discovered or should I say uncovered a story that seems to have very little to do with physician certification or patient care.

This is a long episode that I split into 2 parts. Please listen to this episode first and then part 2. I would say you will be shocked but with the way things have been headed in healthcare, you probably won't be.

Thanks Dr. Fisher for all your work to help physicians become aware of the MOC process.

I encourage those listening to contribute to the go fund me page and help fund this fight. Lets stop this physician learned helplessness and take our profession back.

In my opinion, the whole MOC process is like a bad actively managed mutual fund. I see no value in the additional layer of management forced upon us and its costing our time and $$ while I don't see evidence of improved performance over time. I expect better than this from the "academic leaders" of our respective fields. What do you think?

Let's continue the discussion over at the Doctor Money Matters private FB group (you need to request membership).

You can follow Dr. Fisher's blog at http://drwes.blogspot.com/ where he goes into depth on these topics. You can also follow him on twitter @doctorwes and help fund this fight https://www.gofundme.com/practicing-physicians-of-america

Follow me:

Twitter @drmoneymatters

Instagram @doctormoneymatters

Facebook @doctormoneymatters

WTF is up MOC?

How many of you listening write checks to your specialty board for the privilege of Maintenance of Certification? I will pay over $3k over a 10 yr period plus a ton of paperwork to my board so they can sign off on my certification. Most of you listeners do so as well. We do this because its just another of the burdensome regulations that physicians have to do to maintain licensure and certification and also most insurance companies expect it in order for us to bill our services. Most of us have never questioned the step even though we hate the fees and paperwork.

My next guest Dr. Westby Fisher looked into the board certification MOC for internal medicine and went down the proverbial rabbit hole and discovered or should I say uncovered a story that seems to have very little to do with physician certification or patient care.

This is a long episode that I split into 2 parts. Please listen to this episode first and then part 2. I would say you will be shocked but with the way things have been headed in healthcare, you probably won't be.

Thanks Dr. Fisher for all your work to help physicians become aware of the MOC process.

I encourage those listening to contribute to the go fund me page and help fund this fight. Lets stop this physician learned helplessness and take our profession back.

In my opinion, the whole MOC process is like a bad actively managed mutual fund. I see no value in the additional layer of management forced upon us and its costing our time and $$ while I don't see evidence of improved performance over time. I expect better than this from the "academic leaders" of our respective fields. What do you think?

Let's continue the discussion over at the Doctor Money Matters private FB group (you need to request membership).

You can follow Dr. Fisher's blog at http://drwes.blogspot.com/ where he goes into depth on these topics. You can also follow him on twitter @doctorwes and help fund this fight https://www.gofundme.com/practicing-physicians-of-america

Follow me:

Twitter @drmoneymatters

Instagram @doctormoneymatters

Facebook @doctormoneymatters

1. Congrats to new residents. It's great to see your enthusiasm and brings back energy to everyone of us. We all remember the feelings of panic we had during our first days as actual doctors. Even when you talk to grizzled old attendings, if you are nice and enthusiastic, they will teach you.
2. I have taken a hiatus from the podcast this month. We took a family road trip in upstate new york. Beautiful and underrated area. If you have not seen niagara falls or the thousand islands, I suggest you make a plan to do so. Relatively inexpensive on the US side, but great scenery and helps you realize there is so much to see that is close by.
3. Physician confidence. I have spoken to a few physicians recently and encouraged them to know their own worth. While there are constant negatives in medicine bombarding us from all sides, for many of us right now, the job market is actually pretty good. There was an article in the WSJ recently about how quitters are winning. Its always a good idea to keep up with salaries and employment trends in your fields, so I encourage you to please take a look around at the various specialty job boards. I see to many physicians complaining about the lack of opportunities, and while it may be true for some, its probably not as bad as you think at this moment in time. Long term forecasts are always difficult.
4. I have many podcasts recorded and ready for release, but I would like some ideas from you all for new topics. Please join my FB group and my email list to submit topics for discussion.
5. I am meeting up with a few of my fellow physician podcasters next week, so who knows maybe we can do an allstar podcast. Keep listening.