Physician Empowerment

Dr. Kevin Mailo returns as host and welcomes Dr. Jordan Vollrath, physician and co-founder of Cherry Health, to the show to talk about how he created an innovative physician network. It started with just locums but Dr. Vollrath describes how far Cherry Health has expanded and how it helps physicians. 

Jordan Vollrath had only worked in clinical medicine for a brief time after graduating from his residency when contacts and ideas fell together in serendipity to create Cherry Health. He enjoys his clinical work, which he currently does very part-time at the Alberta Obesity Clinic, but saw a real opportunity to create a job connection network for Canadian physicians where one was currently lacking.

In this episode, Dr. Kevin Mailo and Dr. Jordan Vollrath talk about how Jordan’s start in locum work led to the first iteration of Cherry Health as a locum network, how it quickly expanded to all manner of medical employment, Jordan’s vision for the future information hub that Cherry Health will be, and why such a network will transform physician’s lives for the better. This episode will pique your interest in Cherry Health and the connection opportunities available. 

About Dr. Jordan Vollrath

Dr. Vollrath completed his medical school at the University of Alberta in Edmonton before going on to finish his Family Medicine residency at the University of Calgary.

He has worked in a wide variety of both urban and rural clinical settings including ER and hospital based medicine. He is a co-founder of Cherry Health, a Canadian technologies company. In 2020, he was awarded the Joule Physician Innovation prize by the Canadian Medical Association. He has a passion for mental health and its relationship with weight outcomes.

In his spare time, he enjoys being active and outdoors - skiing, camping, mountain biking and spending time with his French bulldog.

Resources Discussed in this Episode:

• Jordan Vollrath, MD on LinkedIn
• Cherry Health
• Doximity in the USA
• M3, Inc in Japan
• Doctors.net.uk in the UK

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Physician Empowerment: website | facebook | linkedin

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Transcript

Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness, and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice, and personal finances. Now on to today's episode.

Dr. Kevin Mailo: [00:00:35] Hi, I'm Dr. Kevin Mailo, one of the co-founders of Physician Empowerment and one of our podcast hosts. And today I am very excited to introduce to you Dr. Jordan Vollrath. Jordan is a family physician based out of Calgary who has developed, if you haven't heard of it yet you will, Cherry Health, Which is an online platform, online app, that allows physicians to connect with different locum services. So, Jordan, why don't you tell us a little bit about yourself, where you are in your career, what you do right now clinically, and then share a little bit about your journey?

Dr. Jordan Vollrath: [00:01:12] Yeah, for sure. So thanks for having me, Kevin. Glad to be here. It's an honor. But yeah, basically like right now I'm working at the Alberta Obesity Center, so I'm mental health specialist and really I'm only part-time there. So I'm doing about like one day a week on average of actual clinical practice. And then the rest of the week is working at Cherry Health.

Dr. Kevin Mailo: [00:01:31] Awesome. Awesome. How many years have you been in practice?

Dr. Jordan Vollrath: [00:01:34] I've been an adult since 2019, so we're coming up on like four here.

Dr. Kevin Mailo: [00:01:38] You've been a grown-up for a few years now.

Dr. Jordan Vollrath: [00:01:40] Yeah, yeah. We're getting older.

Dr. Kevin Mailo: [00:01:41] You're like, you're like a pandemic baby.

Dr. Jordan Vollrath: [00:01:44] Pretty much, yeah. Just before that I actually had like, a real job for about seven months, and that's when things started to shift.

Dr. Kevin Mailo: [00:01:51] Yeah, there was a time when we didn't wear masks for every patient encounter. There was a time, Jordan.

Dr. Jordan Vollrath: [00:01:57] I recall that briefly from residency. Yeah.

Dr. Kevin Mailo: [00:02:00] Okay. Yeah, yeah, yeah. I suppose it would have been some residency in med school before then. Okay, so tell me a little bit about, okay, where did you come up with this idea and then what were the early steps that you took to build Cherry Health? Right? Because I mean, clearly I mean, you had an idea. How did you take those first steps?

Dr. Jordan Vollrath: [00:02:18] So it evolved just out of solving selfishly, like a problem that I had for myself. So after graduating, I was working as a locum physician, so I was doing locums, you know, all around Calgary, Southern Alberta, rural/urban stuff. And then so I really liked just the flexibility of booking my shifts on short notice. So I would do short notice coverage. I'd do like short-term coverage for a day, a week, a month, you know, anything in that kind of ballpark. And it was really fun. It was a really rewarding way to actually practice, like covering for people when they got sick. If somebody needed like last-minute time off, it was very appreciated by like all the doctors in the clinic. So I'd actually be, because that was like a very sorely needed thing. They didn't really have very many people that were willing to practice like that, but it had its pitfalls practicing that way, right? So it was kind of if you want to cover short-notice things, you have to leave your schedule open until short notice. So that resulted in lots of downtime, lots of like days where I actually didn't have anything arranged. Not that I really hated having a day off here and there, but like in terms of efficiency of...

Dr. Kevin Mailo: [00:03:17] Yeah, quit bragging, Jordan. Keep going, keep going.

Dr. Jordan Vollrath: [00:03:23] You know what I mean? 

Dr. Kevin Mailo: [00:03:24] No, no. I know what you mean.

Dr. Jordan Vollrath: [00:03:25] It got to the point where there'd be like down days, down weeks. I'd be picking up a shift at a time, at some walk-in clinics, things like that. But anyways, like then the pandemic kicked in. Like I had only been working for six, seven months because I had graduated the previous summer and then took a month off. And then March came around and suddenly, like nobody needed vacation coverage anymore, you know, nobody was going anywhere. Nothing was happening. People weren't actually even leaving their houses. So zero people were showing up to the walk in center. And so now suddenly it got like even more of a stress, an actual like issue to try and book things back to back on this short notice. And so the whole inspiration for Cherry Health kind of was a bit of a serendipity. Like I was actually just like hanging out with some friends at one at somebody's house one day. And then I met a guy who worked at a local, it's called a venture studio, so basically, like what they do, instead of investing in startup companies, they invest their time and then they get a return of like a stake in the company. And so this guy, Maximilian Kurz, yeah, so I met up with this guy, Max Kurz, and he's a genius. So this is like what he does for a living at this venture studio. And we were kind of just like talking. He was telling me what he does, and I was like, That's super cool. Like, just like the whole process of innovating and coming up with new things and like, you have an idea how do you actually get it off the ground. And it's basically like consulting, but for startups and implementing all these different strategies for growth and building like operations and things like that.

Dr. Jordan Vollrath: [00:04:56] And so I was like, That sounds super cool. Like, you know, the creative outlet and the actual ability to, like, think outside the box. You know, I found that, like a lot of the times in medicine, thinking outside the box seemed like a good avenue to malpractice suits and losing your license. You're very much expected to think inside the box for a lot of things. So anyways, this just sounded very foreign to me, like this whole premise of like, how he operated. You show up to work one day on a Monday and you'd have really not necessarily an idea of what you'd actually do that week because you kind of got to figure it out as you go. So we're kind of just talking and I was like, Hey, if anything medical comes across your desk, drop me a line anytime. I'd love to weigh in or hear what you guys have planned. And then the next week he just called me up on the phone and he's like, Do you have anything in health care, like problems that you yourself have or anything else? Any ideas? We kind of just started spitballing ideas and it started out with, Hey, I do all these locums and it's a pain to organize sequential work and high-quality opportunities. And then next week he called me back again and he'd put together the most impressive, gigantic spreadsheet I'd ever seen. And he's like, I think we can do something with this. I think this is, I think this idea has got legs. That's really how it all started.

Dr. Kevin Mailo: [00:06:08] Wow. Wow. Excellent, Excellent.

Dr. Jordan Vollrath: [00:06:12] Serendipity, hey.

Dr. Kevin Mailo: [00:06:13] Love that. Okay, so. Okay, so we kind of know what, you know, what it started as. But tell us what Cherry Health is right now for Canadian physicians.

Dr. Jordan Vollrath: [00:06:23] Okay. So it started out with the locum perspective on it, right? So we initially launched it just to tailor it to like connecting these temporary jobs. It's since expanded. So now it's all across the country, it's no longer just family doctors, and it's no longer just locums. So now it's full-time long-term jobs, part-time jobs, telehealth jobs, contracting jobs, any physician specialty, really all the provinces in Canada. So it's kind of like the one-stop employment shop now.

Dr. Kevin Mailo: [00:06:51] Love that. Love that. And then talk to us about where you're headed with Cherry Health. Like what's your dream or what do you want for Canadian physicians with Cherry Health?

Dr. Jordan Vollrath: [00:07:04] So, okay, this is where the really interesting opportunity, I think, lies is we're building this network essentially, right? And so the backbone of this network currently is predicated on employment, on jobs. And so the goal is to like start strengthening those connections between people. So right now, they're looking for work opportunities. In the future, we want to start expanding it more into sharing research articles, into sharing medical news.

Dr. Kevin Mailo: [00:07:29] Oh, wow.

Dr. Jordan Vollrath: [00:07:30] Kind of becoming the one-stop, you know, kind of platform for digital physician networking in Canada. Like right now, there's not a whole lot of like infrastructure, like digital infrastructure for physicians in Canada. Like other countries, the US has Doximity, you know, the UK has physicians dot net, you know, Japan has M3. It's essentially like LinkedIn for doctors, all these companies I'm describing. So that really is kind of the goal, right? So you could, you take this network, kind of this core foundation that we're building that's, you know, founded around the employment thing, and then you start adding more tools, more widgets, more things on there to actually like help physicians make their lives easier, their jobs throughout the day. Right? So that really is the value of the whole thing is you've got this collection of people and you can start putting on new tools, new utilities, all kinds of different stuff, you know, resources, different articles like how to optimize your billing, how to optimize your clinic workflow, connecting you with all the other innovations, all the other exciting things that are popping up in Canada.

Dr. Kevin Mailo: [00:08:34] So as you grow, how do you maintain the quality of what's on the platform? Because I think it's one thing, it's like, okay, I'm a clinic, I'm advertising a locum opportunity, I'm a locum physician, I'll sign up, you know, Airbnb it, I get it, right? But how do you maintain, you know, quality? Is there a chat platform? Like what do you do in terms of that? Because I think one of the issues that we face in medicine, and I'm guilty of being part of that, is that we just throw so much information out there that it can be a little bit overwhelming for physicians. Like I kind of don't know what to do with the latest podcast episode on all of the different podcasts that I'm subscribed to, right? And so, you know, so talk to us about that, right? Like intentionality and finding some balance.

Dr. Jordan Vollrath: [00:09:24] So one of the things we did initially, we actually had ratings and reviews on there. So for the different clinics now that was a bit of a hot-button topic. Yeah, like there was a lot of physicians who were like, Wow, this is a sorely needed thing. Like, how many digital marketplaces do you interact with lately that don't have that on there? Right? Like Uber, Airbnb.

Dr. Kevin Mailo: [00:09:44] Yeah. Well, and you know, you step into like that clinic and you're like, blow the dust off the paper charts and you look in and you see like, it's going to be a little bit of a long week for me.

Dr. Jordan Vollrath: [00:09:55] So anyways, that feature did not get ported over to the new platform that we just updated. It released. It may come back at some point in this next little while, I don't know yet. But in terms of that quality otherwise, like that really is a big thing that I'm dealing with right now is like we've got this very sophisticated tool and how do you engage everybody to use it properly? Like so we've been doing some webinars for some of the local health associations recently just on like how to recruit. And this included a big focus on how to create a job posting that was actually appealing. Yeah. So that's a lot on us, right?

Dr. Kevin Mailo: [00:10:33] Yeah, yeah. I'll be honest. Like when you flip the pages of most medical publications, it sounds a little dry, you know?

Dr. Jordan Vollrath: [00:10:42] Okay, part of preparing for those webinars is actually one of the funnest things I saw was just looking through some of the job ads on the CMAJ and the CFP and like those things are very expensive. It's like, I can't remember, but you get so many.

Dr. Kevin Mailo: [00:10:56] I've advertised on some of those. Yeah, not cheap.

Dr. Jordan Vollrath: [00:10:59] Right? And so some of these job ads, like even though they paid all that money, they didn't even use up like the 80 words or whatever they were allowed to. It was like one sentence on like, Hey, we have a clinic and we use this EMR.

Dr. Kevin Mailo: [00:11:12] Yeah, think I was skipping spaces between words just to, you know, get my money's worth.

Dr. Jordan Vollrath: [00:11:19] So a lot of it is like, you know, it's on us to like really educate people and provide them resources on like how to actually successfully recruit. Recruitment is a very complex, difficult thing. That's why there's these professionals that actually do this for a living. And so physicians and most of us medical people, you know, never had exposure to that. And then you have a clinic and you need to like, how do you choose office staff? How do you hire more physicians? It's just very foreign to a lot of people. So in terms of ensuring that quality, that's definitely a big part of it is like teaching people actually like what needs to be done, and there is a messaging platform in there as well. To answer your other question, that's like coming out next week, I think. That will be updated finally. So we're super excited for that.

Dr. Kevin Mailo: [00:12:00] Very cool. So okay, so going back to the core offering. So how does it work if you've got questions about the locum, do you just like is there a messaging way back and forth between you and the clinic or do you just pick up the phone and call the clinic manager or the physician you're seeking to replace and just, you know, sort out the finer details there?

Dr. Jordan Vollrath: [00:12:21] So it would just show you right away the contact details. You got one outgoing message if you were interested, you got to put some text in there and then it would send a thing and show you the contact details. But again, as of like literally any day now, finally we will have the messaging system implemented in there. So they'll be like peer-to-peer chat now, if you have questions you can reach out. Very low pressure, low committal. You know, our generation of millennials and most of the people doing the locuming right now are a little, you know, afraid to pick up the phone and talk to a human. So text-based interface, it'll be nice.

Dr. Kevin Mailo: [00:12:52] Yeah, I got. What is the fee model for the core offering?

Dr. Jordan Vollrath: [00:12:58] So we got three things. Two of them haven't been released yet. The one that is on there so far, the partnerships model. So we actually have sponsorship deals with other companies that are doing really cool, innovative stuff in health care, clinical tools, things that will update your EMR workflow, things that will help you engage with your patients, all kinds of different like actual things. It's all these things that you've never heard of, right? Because advertising in medicine is incredibly expensive, right? Like there's tons of big conglomerates out there with large budgets that will send reps to your office.

Dr. Kevin Mailo: [00:13:32] Well, we compete with Big Pharma. Big Pharma writes the biggest checks.

Dr. Jordan Vollrath: [00:13:37] Yeah, exactly. And so there's so much cool stuff out there that's happening that you've never heard of because these companies can't afford to have you hear of them in a lot of cases. So forming partnerships with them like stuff that actually like adds value to the physician's lives. And so that's like one of the fee models. And then just like any other LinkedIn, indeed, you can upgrade your post. So that'll be coming very soon if you want it to be seen at the top of the pile, you can pay to play and get some more exposure, which, you know, kind of the whole premise of the platform is that we really want to democratize recruiting, right? That's the thing right now is that most clinics, most organizations, they cannot afford to pay to play. And so that's why we have this very sophisticated freemium model where there's like a ton of value and ability to, like, get your jobs in your locums out there based on meritocracy as opposed to just purely like the relative size of your budget.

Dr. Kevin Mailo: [00:14:30] Wow, isn't that great?

Dr. Jordan Vollrath: [00:14:32] And then number three is the recruiter seat. So actually, if you want to like take that advanced functionality and really start doing the outreach, the active outreach, to other people on the network, that's a paid feature. So those are kind of like the three things that fuel the network.

Dr. Kevin Mailo: [00:14:46] So listen, I'm not going to sit there and poke and prod you too much longer about it. I would encourage everybody who's listening to this to download the app. I did, and I love looking at it. I mean, I got, I'm very much busy enough as it is in my existing position, but I can see how much better this is than trying to track, track it down through, through traditional publications, trying to track down a locum through traditional publications or word of mouth or whatever. Right? And I think my big reflection on Cherry Health is that this is a massive productivity boost to the profession, right? Because at the beginning of this, Jordan, what you shared with us is your downtime, right? You know, here you are as a, you know, a young physician wanting to be in practice, but, you know, wanting to take your time to find out what you really like and what you want to be doing rather than just jumping and joining a practice. And so this locum app, you know, really allows you, Cherry Health really allows you to, as a physician, find, you know, maybe the thing that fits the best for you. But as across the profession, you can see that this offers a ton of value. Right? And it's not just, and I hate using the word productivity like at Physician Empowerment, we're always ranting about like it is not about churning more output in a given day. It is about living better, practicing your best medicine.

Dr. Jordan Vollrath: [00:16:11] But that work-life balance and like...

Dr. Kevin Mailo: [00:16:12] Exactly, exactly, right? Like it is, it's huge.

Dr. Jordan Vollrath: [00:16:16] So there's a couple problems in medicine right now, right? Like there's the absolute lack of physicians.

Dr. Kevin Mailo: [00:16:23] Only growing.

Dr. Jordan Vollrath: [00:16:23] Which is just a mess across everywhere. Yeah, only getting worse. And then there's the second thing, which is the actual like relative fraction of locums that are going around right now, right? So if you talk to anybody, there's just an absolute paucity of locums out there. Like it's a struggle to recruit anybody. So I think by making it easier actually, like making a big giant digital shiny pipeline of locum work, a lot of the new grads are going to be, you know, kind of drawn to actually practicing in that manner. And then we're going to have less burnt-out physicians, right? So once we start actually balancing and making that match a little better of the established physicians versus the temporary relief coverage like that's going to be huge to actually just cutting back all the doctors that are retiring early, cutting back their practice, moving away, taking time off, reducing their clinical hours, doing things that are non-medical. Right? So that's going to be one of the biggest benefits of like, obviously not today, but like as the months and years roll on. Yeah.

Dr. Kevin Mailo: [00:17:20] Oh long-term, right? I mean, this is the next step, right, in the labour shortage that we have across this country. Right? Because, you know, we're not about to suddenly get more doctors to address the shortage, but having them deployed in a better, more efficient way really matters. And I think, you know, again, reflecting on the other end of the spectrum, physicians that are late career and contemplating retirement, well, maybe they'll push that back if they can reliably get locums, right? Because if you can't get a locum and you know, you're 60, I mean, you know, 70-year-old doctor, which they're out there, you know, I work with one and you want to start slowing down, you want to start taking those vacations and you realize like, well, if I can't get a locum, well, then I'm just going to shut down my practice and retire, you know? So again, like there's just so many advantages here and it's truly inspiring to see what you're doing because I think it's a lot more than just a service, right? It's the opportunity to transform the profession and create better work-life balance for everybody, which we all need. That is a crisis within the profession. Absolutely a crisis within the profession.

Dr. Jordan Vollrath: [00:18:24] 100%.

Dr. Kevin Mailo: [00:18:25] Okay. So, of course, like, what did I tell you? 20, 25 minutes and we keep going on and on. But tell me, Jordan, share some reflections about your journey thus far. Tell us a little bit about how you went from being a family medicine graduate to here you are as a physician entrepreneur because we constantly, at Physician Empowerment, we always have the, you know, physicians that are reaching out to us, that they're developing something on their own, whether it's clinic based or outside of medicine entirely, or health tech or whatever. But talk to us a little bit about your journey, some of your reflections, maybe a bit of wisdom along the way.

Dr. Jordan Vollrath: [00:19:02] Well it's kind of funny looking back in the rearview mirror, right? Like when we got started, like the company is almost three years old now, getting pretty close, like, did I think I would be here today? You know, like almost not doing hardly any clinical medicine four years after graduating my residency. Like, was that my intention from the get-go? Like, no, absolutely not. Right? Like I really enjoy like, actually, my Monday is where I see my patients most of the time. It's one of my favourite days of the week. I actually really like health care. But it's just that it kind of evolved, right? And there was this window of opportunity to like really enact some significant systems change and it just kept getting bigger. So we've kept following it and I've kind of been just tapering back my clinical practice like as needed by the company. Right? It all started out like we won The Joule Physician Innovation Prize, in January 21 for physician or was it Physician Health and Wellness was the category, right, just for this creating a tool to actually cut back on burnout and that work-life balance. And so that really catapulted things, like that opened so many doors like as a for-profit company, right? Like as a registered incorporation, like a lot of the time in health care, it's very difficult to actually like get meetings and get things done because it's like, oh, it's one of those evil corporations, right? But like having that actual endorsement coming from the top down of the regulatory body opened so many doors. So that immediately, like obviously the money was a huge boost to just productivity and being able to like build more stuff and more technology.

Dr. Jordan Vollrath: [00:20:36] But that opened so many doors, and so leveraging that, like talking to more people, getting in with some of the like health care organizations actually getting like more reach and more awareness of the system. Got that going. We turned that into then some funding. So actually like we closed some private investor funding last year. So that really like really, you know, things just kept kind of skyrocketing past that point. Then we had more staff, more team members. Everything just kept getting more sophisticated. Now we're up to, I think, like seven full-time people. We've got a few interns and apprentices. We've got a job description posted right now hiring for another marketing person. So we just continue to grow and kind of that window of opportunity to like really do some good for Canadian health care system just keeps getting bigger. And so we keep just following it. But it's been a fun journey.

Dr. Jordan Vollrath: [00:21:25] It's definitely very different from like all the normal doctory things we're used to doing. But it's been a really enjoyable journey. The people you meet, like going to the, you know, networking events and business minglers, meeting other people that are in the health care space. There actually is a fairly well-developed like innovation space in health tech, right? And actually, as of yesterday, we just found out that we've been accepted to a health accelerator program. Like as the startup, I'm not allowed to name it or embargo on. I don't know when this is coming out, when this will actually be published, but so we're super excited that we'll be working with some of the biggest basically agencies in health care in Alberta for the next few months on some of these things. So you just meet tons of interesting people that are doing all sorts of really fascinating things. And it's very cool. Like I hadn't really seen any of that previously. Right? You're kind of just, you got your blinders on of clinical operations and patient care and, you know, whatever the thing du jour is. But now that you take a step back and actually look at what's going on around us in the innovation system, there's so many interesting things happening.

Dr. Kevin Mailo: [00:22:33] Awesome. Absolutely awesome. Okay, we're going to wrap it up.

Dr. Jordan Vollrath: [00:22:37] Yourself included, of course, like obviously like all your projects your company has on the go, all the stuff you guys are doing for physicians. Like that's how we match, right? It's just kind of like...

Dr. Kevin Mailo: [00:22:47] Yeah, honestly, I mean, a year and a half ago, somewhere around there, a little less than a year and a half ago, we were in Mexico teaching, doing our course. And like, if you'd asked me five years ago that I'd be lecturing in Mexico, I, you know, at a beautiful resort, I wouldn't have believed it. And knock on wood, we're off to the Galapagos in early 2023 for a big tour. So we'll see how that goes.

Dr. Jordan Vollrath: [00:23:10] That'll be a fun spot.

Dr. Kevin Mailo: [00:23:11] You'll get an invitation. I'll come shake you down.

Dr. Jordan Vollrath: [00:23:13] Oh, perfect. Awesome.

Dr. Kevin Mailo: [00:23:15] All right, good stuff. Let's wrap it up. Thank you so much again, everyone, this was Doctor Jordan Vollrath, founder of Cherry Health. Thank you.

Dr. Jordan Vollrath: [00:23:24] Awesome. Thank you so much, Kevin.

Dr. Kevin Mailo: [00:23:26] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.

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Dr. Dimitre Ranev steps in to host Dr. Jordan Frey, plastic surgeon and writer of The Prudent Plastic Surgeon blog, on the show. Dr. Frey’s blog addresses finances and passive income for physicians which is what he and Dr. Ranev discuss for listeners. What side gigs are available and how are they found? 

Jordan started his blog as a passion project and for the first six to nine months did not monetize it to ensure he could maintain quality content. He shares how the audience grew quickly and monetizing it became an easy choice. It now provides him with a solid side income that he appreciates not just financially but because he enjoys writing the blog so much.

In this episode, Dimitre Ranev and Jordan Frey talk about why addressing finances for physicians is not a taboo subject and should be more openly examined. Jordan explains the different sources of side income available to physicians, from blogs and podcasts to medical knowledge surveys, medical chart and insurance claim reviews, and of course real estate. Jordan provides real life insight into what each income stream requires and how to find one to pursue.

About Jordan Frey, MD

Jordan Frey is a plastic surgeon specializing in microsurgery and breast reconstruction. His hope is to spread the principles of personal and financial well-being to other physicians, trainees, and people of all walks of life by sharing his journey on this pathway of fulfillment, purpose, and happiness. 

Jordan runs and writes for The Prudent Plastic Surgeon blog and is also co-founder of BeautyTune.me.

Jordan lives in Buffalo, NY with his wife Selenid, a college professor, and three boys, Samuel, Emery, and Camilo.

Resources Discussed in this Episode:

• Save the Date for May 6-7, 2023 in Toronto
• Jordan Frey, MD on LinkedIn
• The Prudent Plastic Surgeon blog
• “Physician Side Gigs to Make You Passive Income” by Jordan Frey, MD, posted on MedPage Today December 16, 2021

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Physician Empowerment: website | facebook | linkedin

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Transcript

Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.

Dr. Dimitre Ranev: [00:00:35] Welcome back, everyone, to the Physician Empowerment podcast. We have a very special guest today. It's Dr. Jordan Frey. He's a plastic surgeon based in Buffalo, New York. And he also runs a blog called The Prudent Plastic Surgeon, where he shares his financial journey and helps full-time physicians like us achieve financial independence. Tell me a bit about, Jordan, about the blog. You it started how many years ago?

Dr. Jordan Frey: [00:01:00] It's been about two and a half years ago now. Yeah, And it started really at the end of the end of my fellowship. And I always joke, it was just, I was in a bedroom in Brooklyn because I did my training in New York City. My wife and kids had already moved to Buffalo, where I am now, as an attending, and we basically stopped renting out our apartment and I was just staying with her aunt in Brooklyn. But basically at the end, to backtrack a little bit from that, you know, towards the end of my training, I realized that I was feeling burnt out, which was a surprise to me. And I'd been feeling these symptoms of burnout for a long time. I didn't know that they were burnout. And I finally sort of came to terms with that, and so then started looking at what was causing it and which was obviously multifactorial. But a huge part was my financial situation, which was really stressing me out. And I realized that my financial well-being was really nonexistent and that was hurting me a lot because I was, you know, I was nearing the end of my training and people were telling me, oh, it's going to be great. You're going to be a plastic surgeon. You're going to be making all this money. And I was just like in my head going, No, you don't understand. It's not great at all. I, you know, I have half $1 million of student debt. I have credit card debt. I have literally no savings, no investments. I have a family, like this is not good. And yes, my salary is going to increase, but I'm just being told like I have to buy a big house, I have to buy a fancy car, I have to buy fancy clothes, like all this stuff, because now I'm going to be a doctor, like an attending physician. And so I felt really stressed about that. And long story short, my wife and I, we made a conscious decision that we were going to learn about personal finance and start getting our finances under control. Over the course of months, we began to do that and then started managing our own finances and we created a financial plan. And the shocking part to me was just having that plan. My financial well-being really shot through the roof and I actually felt my symptoms of burnout improve, even though, you know, my actual money situation hadn't changed. I was still in training. We still lived in New York City.

Dr. Jordan Frey: [00:03:16] We still had just as much debt and everything like that. But now I had a plan and I just said, okay, if I follow this plan, I can get out of debt, I can reach financial freedom, I can practice on my own terms. And that was just so powerful. And then, you know, there's this taboo in medicine that if we think about money, that's a bad thing, because we didn't become doctors for the money, which is true. But it's also true that it's okay to think about money. And I experienced that once I started thinking about money, I actually became a better doctor. I was more able to focus on what I loved about medicine. So that was really surprising to me. And then I started this blog basically for two-fold reasons: to try and break that taboo and also to show people that you can start in such a bad position like I was starting in and still make steps to improve and to create the ability to reach financial freedom, which I'm not at yet. I'm still very much in the process, but it's fun sharing that. So that was kind of a long-winded answer to your question, but that's where the blog was born out of.

Dr. Dimitre Ranev: [00:04:24] So I actually, I went through your blog. It's a great blog. I really suggest our listeners take a look. And I did notice a bit of pushback, actually. Early on, you had some comments saying, oh, you know, you shouldn't worry about money. This, you're not in it for this. I can't paraphrase specifically, but I remember reading some of those comments.

Dr. Jordan Frey: [00:04:42] Yeah.

Dr. Dimitre Ranev: [00:04:43] I'm just wondering, how much pushback did you get? Because you got some on the website, but were you getting more from your colleagues or...?

Dr. Jordan Frey: [00:04:51] There definitely was some. Yeah. It's, one of the very first comments that I had was a really negative one. Someone just saying like, this is totally... Just basically saying like, this is BS. Like why are you doing this? Why are you worrying about this? And I was actually like, Man, if I got this kind of an emotional response, I'm on to something.

Dr. Dimitre Ranev: [00:05:13] Yeah, yeah.

Dr. Jordan Frey: [00:05:14] And I think it's just that. It's because it's hardwired in and there is just, it's a taboo, it's something that I fell for where people just say, like, if you're thinking about money, you're not a good doctor. And it's not, I'm not thinking about money in the sense of like, oh, I'm trying to squeeze every penny I can out of my patients or something like that. Like it's the complete opposite. It's just like, Hey, we're blessed to be high-income earners, but doctors are really bad with money because we have a bad money mindset. We spend money poorly. We don't have any financial education. So there's a lot of pushback because people are just stuck in that traditional thinking. And my response is always like, look, patient care is still what's number one. It's just this, our financial well-being, it's an important part of our overall well-being. And if we neglect our overall well-being or any part of it, we're making ourselves worse doctors for our patients. And that's what I experienced firsthand, which is scary to say, because I did realize I was providing, you know, worse patient care because I wasn't totally focused and wasn't totally enjoying medicine. And when we enjoy medicine, that's when we're at our best. So I get that. And then the other form of pushback, I get a lot - kind of publicly and people just talking to me - is they're like, you know, Oh, you're always talking about financial freedom, which is this idea that you can, you don't have to work anymore. You're financially independent and you're only, you know, I'm in my third year of practice out of training. Like, why do you want to retire so early? And the truth is, I don't want to retire at all. I really love what I do. Like, I get really amped up and excited to go to work every day. But I do know that I am happier knowing that I can work because I want to, not because I have to. Which again is not a point, is not where I am currently, but that's where I aspire to be. So, you know, and I think my argument is always, Imagine if there was a world, you know, you're in Canada, I'm in the US, regardless of country or whatever, right, imagine if there was a world of doctors that were financially independent. That could work because we want to, not because we have to. And how we could change medicine for the better. Because right now there's so much bureaucracy and administrative restraints on what we're able to do. And a lot of doctors work at jobs they don't like because they need the paycheck and put up with things from insurance, you know, from whatever, because we kind of have to and if we could take back that control, I just can't even fathom how much of a positive impact that would have on just patient care.

Dr. Dimitre Ranev: [00:08:06] Yeah, but it also, if you're financially secure, you can stand up for your patients better as well.

Dr. Jordan Frey: [00:08:11] Exactly, yes.

Dr. Dimitre Ranev: [00:08:12] I mean, people don't realize that. But you can put your foot down and say, fire me if you want to, I don't care. I'm going to do the right thing for the patient.

Dr. Jordan Frey: [00:08:21] Exactly. Yeah. So that's so powerful.

Dr. Dimitre Ranev: [00:08:23] And that's true across the board, whether it's in the US, Canada or anywhere in any other country. And I think what you mentioned, you know, what's the specificity, what's the patient, the skill of a doctor who's thinking about his finances - well, he's he or she's examining you - right? Like they're not paying attention to you because they're worried about making the mortgage payment. So it's so interesting, the pushback, because we got the same amount of pushback when we started Physician Empowerment. This 'you can't talk about money'. You can't. But it's so important.

Dr. Jordan Frey: [00:08:56] So important.

Dr. Dimitre Ranev: [00:08:58] So let's talk about money. And I want to talk about, there's this great article that you published and I'll share as well, hopefully in the podcast, where you talked about side gigs. And I guess, what would you define as a side gig for a physician, Jordan? What's your definition there?

Dr. Jordan Frey: [00:09:15] I think, you know, it's pretty broad, sort of anything, anything outside of your main clinical gig or job, if you'd call it. You know, I'm a W-2 employee, which just means I'm an employed physician for a hospital. So sort of anything outside of that, I consider a side gig.

Dr. Dimitre Ranev: [00:09:37] And you have some examples and I'll now go through them. I don't want, I want to start with maybe the one that you have the most knowledge with. Well, a lot of knowledge with, I wouldn't say the most, but blogging and just the website process and the podcasting process. So I'm assuming you enjoy that a lot. Like you blog. You enjoy the blog process.

Dr. Jordan Frey: [00:09:57] For sure.

Dr. Dimitre Ranev: [00:09:58] And have you, if you don't mind me asking, have you monetized that? Like, does it bring you any income in any way?

Dr. Jordan Frey: [00:10:06] Yeah. No. I don't mind you asking at all. Yes, it does. And it started out, so like I said, it's about two and a half years. The first, like 6 to 9 months of it, I didn't monetize it at all. And I had some opportunities to. But I really kind of just said, you know, I want to take the first while - I initially said a year, but then it kind of took off quicker than I even anticipated or had hoped - but I wanted for the first 6 to 9 months to be purely just focusing on content, making sure that I could provide really good content and hone my skills in terms of writing and providing value and that sort of stuff. And then it started to get to the point of where I was doing that, and people were asking me for resources and advice that I couldn't sort of, I could provide in a general sense but not as specific. So things like, okay, I need to refinance my loans. Can you help me do that? And so I obviously am not a loan refinancer, but I could say here, this is who I used. These are companies that I trust that I've personally vetted, or things like that. Things like I need disability insurance, who should I use? And that I could say, well, this is who I used or this is who I know will get you what you need and be fair about it. So things like that. And it's obviously slow starting out. You know, I always tell people this is not something where, like if you're looking for this to be immediately a source of income, I think there's better ways to do it. And we'll talk about that because there are times people come to me and say, I want side gigs that are going to give me immediate money. This isn't really it, but if you stick with it, it will become a significant source, like so after that initial year, you know, the following calendar year, it made me, you know, somewhere like low five figures. You know, like 15,000, 20,000, something like that. But then in the second year now, it's making me in the six figures. So it's a significant source of income.

Dr. Dimitre Ranev: [00:12:32] Right.

Dr. Jordan Frey: [00:12:33] And it's fun because that ties in with, all of those sources of income from the blog tie in to my why with the blog which is just providing people avenues to reach financial independence. So whether it's things like the course I offer helping people to reach financial independence, whether it was, in the past I've done coaching, I don't do that now. So whether it's that or whether it's through other referrals or sponsors I have that I've used myself in my journey that I can help recommend to other people to accelerate their own journey.

Dr. Dimitre Ranev: [00:13:08] So it took a lot of sweat equity, but it paid off. And obviously you do it because you enjoy it. That's the first thing you have to enjoy it.

Dr. Jordan Frey: [00:13:17] If you break it down as like in a, you know, how many dollars per hour, I don't know how much it is, but it is a lot of work. But if you enjoy it, it's worth it. And that was the worst advice I got when I started doing this, was someone who's very well established in the field and probably was speaking from some point of self-preservation, but basically said like, you should not do this. It is a bad idea to start a blog on physician finance. And I try to tell people the opposite of that. Like, if you love it, if this is really something you're passionate about, you should do it. And I'm always, there's people that I've talked to and helped that have started their own sites or podcasts, you know, around this area. And there's no shortage of need for unique perspectives in this area like what you're doing. So if you are passionate about it, it is really a great thing to do and you can certainly monetize it and make it into a very viable side gig. It's just one that you plant the seeds and you have to water it and kind of let it grow. It's not an immediate one.

Dr. Dimitre Ranev: [00:14:23] I'm curious, you have a course and how long did it take you to sort of, to get that done from the beginning, the idea, to the actual recording it, like how many hours do you think you spend or how many months did it take?

Dr. Jordan Frey: [00:14:38] It took probably like a full year. And it's gone through a few iterations and improvements. So yeah, because you start out and you say like, I have this idea for a course and so my course is, it's really for anyone, but it's really geared for young physicians who are kind of starting and saying, I'm at the beginning of this process. I don't really know much about personal finance or how to develop the right habits or how to create a financial plan, how to set my course to financial freedom. So sort of starting from there. And so it takes, you know, going through and planning out what topics do I need to hit, what order, developing a script and then recording everything, doing video editing, which I didn't do myself. I outsourced that.

Dr. Dimitre Ranev: [00:15:26] It's very time-consuming.

Dr. Jordan Frey: [00:15:29] Yeah, very time-consuming. And then developing the, you know, different downloads and resources. And then once you actually have the course, guiding students through it, which is a process. I am fortunate in the sense that my wife has a PhD in education and so is really like...

Dr. Dimitre Ranev: [00:15:50] She had pointers.

Dr. Jordan Frey: [00:15:51] She's like okay, you need, yeah, you need to develop learning objectives for everything. And so could kind of help throughout that. But it's definitely a process.

Dr. Dimitre Ranev: [00:15:59] And do you offer your course only through your website or do you offer it through other like teaching websites? Just curious.

Dr. Jordan Frey: [00:16:06] I offer it only through my website mostly because that's the only way I know how to do it, I guess.

Dr. Dimitre Ranev: [00:16:12] Right, Right. No, I am just so curious.

Dr. Jordan Frey: [00:16:14] It's only through my website. It's evergreen. So like, at any point anyone can sign up for it whenever it's right for them and it's kind of self-guided but with access to me throughout. So, yeah.

Dr. Dimitre Ranev: [00:16:28] Okay. So you're there. You're sort of there for Q&A, for first-hand guidance.

Dr. Jordan Frey: [00:16:33] Yeah, exactly. So I offer like, anyone who is in the course gets personalized coaching with myself, gets access through email and phone calls, you know, as our schedules allow. So I didn't want it to be something where it's just like, you know, okay, you just have the recordings and you're on your own. Like, no, it's... I wanted it to be able to be personalized.

Dr. Dimitre Ranev: [00:16:54] Yeah. And as a teacher for both, I think educators really, getting the contact, it's just you get energized from it, from talking to somebody and helping them.

Dr. Jordan Frey: [00:17:03] Totally. Yeah, exactly.

Dr. Dimitre Ranev: [00:17:04] So you need that. That's great. I didn't know you had the interactive component there, but that's amazing. And again, our listeners should check it out. I think it looks like a really interesting course as well. So that's sort of one side. That's more niche, I guess. You have to like writing, you have to like teaching. You have to like helping people.

Dr. Jordan Frey: [00:17:21] Yeah. Yes.

Dr. Dimitre Ranev: [00:17:22] Let's talk about some more, I guess, general ones you can use. Just leverage your medical knowledge. And you mentioned those in the article as well. One of them is medical surveys. I like your approach to that, that you say that you should only do them if - I guess you're saying if you have nothing better to do, maybe, maybe phrase it better than me. But yeah, don't do them if you're supposed to spend time with your family or do something else. But if you have the extra 30 minutes while you're watching your sitcom or Netflix, you can do one. How did you, did you sign up for them, or did they come looking for you? Because in my case, they came looking through LinkedIn, they found me. I use the analytics. But did you look for surveys or how did you enroll in that?

Dr. Jordan Frey: [00:18:07] I initially did look for them, you know, and I was starting out, I was basically, you know, a new attending. And yeah, so I looked up, you know, medical survey companies and just signed up for them. And essentially what I would do is just yeah, wait for ones that I thought was a good fit. And they kind of come in a few different flavors, like some of them come and they say, you know, hey, this is a completely online survey and it's 15 minutes and we'll pay you 50 bucks. And that's what I mean, like you shouldn't, I wouldn't carve out other valuable time or other family time or something. These are ones that like, if I happen to be sitting there and just in a moment where I'm in the surgeon's lounge, like doing nothing, like scrolling through ESPN or something like that, and I have 15 minutes, I say, Oh, well, yeah, sure, I'll do this. And those are not ones that are going to, you know, get you to the point where you go, Oh, I'm making significant amount of income from doing these 15 minute surveys. But what it does is the more of those you do, those companies start to recognize and say, okay, this is someone who has a lot to offer, who's willing to contribute. And you start getting these ones that say, okay, this is actually a phone interview for 30 minutes. And we're going to pay you 300 bucks. And then it starts evolving to where those companies, and then you start getting on the radar of other companies where you can even set your own rate. And I set my rate at - which this is a totally arbitrary thing - I just said, I basically within my head and with my wife even, said, okay, how much would it take for me to say, Okay, I'm going to set aside an hour of my time? And we said $500. So I set a rate of $500 for an hour. And that's what I say. And companies can say, Well, that's too much. Or they can say, Oh, that's a fair amount for these opportunities. So they come along and these companies will approach you and say, I have someone who is looking to understand the breast reconstruction landscape or how you utilize breast implants and breast reconstruction, because that's something that I do. That's a focus of my clinical practice. And then I say, okay, yeah, I know a lot about that. I meet the criteria that the company is looking for, that's my rate, $500 an hour. And they say, okay, great, they want to talk to you and we schedule it and then you get that. And those opportunities start coming up more and more. So it starts off slowly and then it can build up and it can really be something significant. Not myself, but I know people who make tens of thousands of dollars each year doing that. So that's one way. And then the other way, of course, is if you, within your field of medicine, if there's certain products, whether it's pharmaceutical or actual devices that you use a lot and you believe in and aligns with your sort of clinical values, you can just approach those companies and be like, Hey, do you want me to do talks for you? Is there anything I can do to help you with your stuff? And a lot of times they'll approach you if you're a real user of their products. And honestly, that's not something that I have done to this point. But that's certainly something I know other physicians have done very successfully.

Dr. Dimitre Ranev: [00:21:38] And another way to leverage your knowledge, but yeah I can attest for the surveys. I'm sort of in the same steps as you, now I'm getting to the interview part so it happens. For our listeners, I would say M3 Global seems to have a - I into it - seems to have also a Canadian area and the analytics is the Canadian one. So if you guys are interested, you could take a look and yeah, just like you're sitting in the lounge and you can do one in 15 minutes, it's worth your time. I would again agree with you. Anything more than half an hour, though? I don't know unless it's a phone call.

Dr. Jordan Frey: [00:22:13] Yeah.

Dr. Dimitre Ranev: [00:22:13] But 15 to 30 minutes is, it's the right spot for me.

Dr. Jordan Frey: [00:22:17] Yeah, 30 to 60 I kind of reserve for phone calls because they tend to, you give more value to the survey company as well and you get compensated better. And I'll say, too, it then evolves into something where you can refer colleagues to these survey companies and you get compensated for those referrals, and sometimes really nicely because they run promotions. So there's a lot of ways that you can kind of leverage that that makes sense as a doctor.

Dr. Dimitre Ranev: [00:22:49] 100%. So listeners, look into it if you like pressing buttons and doing surveys.

Dr. Jordan Frey: [00:22:55] Yeah, exactly.

Dr. Dimitre Ranev: [00:22:56] The other thing I want to ask you about, again with the idea of leveraging your knowledge, medical chart reviews, and perhaps insurance claim reviews as well. Have you done both of these or are you still doing any of these things?

Dr. Jordan Frey: [00:23:09] I haven't personally done those just because of time commitment and obviously the blog and stuff, that takes a lot of my time and tends to be a focused side gig of mine. But I know a lot of colleagues who do this and it's really beneficial. And I know initially people get, or doctors get this really like kind of bad feeling when they're like insurance reviews, Oh, insurance is the bad guys or, you know, medical chart reviews are like, you know, they're the bad guys or expert witness work lawyers, they're the bad guys. But you have to think - and the more I've learned about this and got on the inside of it - because those were kind of my initial reactions...

Dr. Dimitre Ranev: [00:23:51] Mine too.

Dr. Jordan Frey: [00:23:51] ... You know, it's really kind of a disservice if you have that reaction because like it or not, again, depending on where you are in the world and stuff, but pretty much everywhere, you know, lawyers, malpractice cases or whatever, insurance claims chart review, these things are just realities of medicine currently. And yes, once we all become financially independent doctors, hopefully we can eliminate that. But there are current realities and there's a need for ethical, responsible, knowledgeable physicians to assist with this. And a lot of times - and this is making a sweeping generalization - but a lot of times the physicians who maybe are doing this aren't as knowledgeable or as plugged in as they could be. And I'll give an example of this. You know, even myself doing, again on the US side, we have private and public insurance, but it's largely private. And so, you know, I'll have these surgeries that I'll need to do. Like sometimes I'll get a surgery that's a combined case. So a patient that has breast cancer is getting a mastectomy. So it's getting their breast removed to remove the cancer, and then getting breast reconstruction, which is by law a protected and covered procedure for them, for psychosocial reasons and everything that's been shown to be beneficial. But anyway, sometimes these, which you would think is just like it comes across an insurance person's desk and it's like, okay, yes, that's obviously covered, sometimes these get denied and then I have to do peer to peer review and I'm doing a peer to peer review with like, you know, a psychiatrist or something, who, to be fair to them, doesn't quite understand. But then like continues to deny this claim, which is just a horrible thing. And if there was just someone on the other side who was a little bit better educated or familiar with the procedure, familiar with this area, it would go a lot smoother and be better for patient care. It'd be better, frankly, for the insurance company because ultimately they are going to have to accept this because it's literally a law in the US and now they're just wasting their own resources at this point. So it's beneficial on all sides. And same thing with the malpractice review. You know, people worry about, oh, I'm just screwing - I guess, pardon my language on that - but I'm just screwing other physicians because I'm like testifying against them or something. A) that's not really the case. A lot of times you're supporting physicians who are being sued by patients or other entities or something like that. But you want to protect good patient care, and that's what you're doing by offering your services. You know, you are a very qualified, knowledgeable person. You want to make sure that qualified and knowledgeable physicians are being supported or if there is actual malpractice happening, that patients are being protected. So in that sense, I do think it's really valuable. And, so yeah, it is. And you get compensated well for doing that for your time. And it's actually pretty, I don't want to say easy to get plugged in, but like the opportunities are there.

Dr. Dimitre Ranev: [00:27:28] Yep.

Dr. Jordan Frey: [00:27:28] Like there is, there is a need for your knowledge and expertise in these arenas and you just kind of need to know where to look for it. But once you get started, like it's certainly possible if you are looking to get out of clinical medicine for whatever reason, to completely replace your income by doing these sort of endeavours. And alternatively, as a side gig, it can make you a good amount of money as a side gig. So definitely things to look into. And again, I haven't at this point because my other side gig, my other passion, kind of takes up that time. But it's something I'm learning more and more about and I'm even, you know, taking a course to learn about expert witness work and kind of how to find it, and how to be the best at it, because it is something in the future that I think I will do.

Dr. Dimitre Ranev: [00:28:26] So I did insurance check reviews and I agree with you. If anything, it also helps you as a doctor to your patients being able to, when they do have to deal with insurance companies, you know how the process works so you can actually advocate better for them.

Dr. Jordan Frey: [00:28:40] Yeah, that makes sense.

Dr. Dimitre Ranev: [00:28:41] Yeah. And I've done that before and it pays very well. It pays better than clinical work and you need good guys there. You're right. You need good guys because it helps everybody. Patients, insurance companies, the system. And there's a lot of demand in Canada, in the US obviously. So if a listener is interested, I can give, I mean, I know with the companies in Canada what they are, but obviously this is different, but I can give some references. So I know we're close to the end, even though I have like a thousand questions here, but I'll finish off because, you know, Physician Empowerment talks a lot about real estate. So real estate also could be a side gig, obviously.

Dr. Jordan Frey: [00:29:21] Yes.

Dr. Jordan Frey: [00:29:21] And just quickly, I know you have to go soon, but can you tell me a bit about that? Like how you got into real estate, how much time are you spending on it, and what specific things you invested in when it comes to real estate, if you don't mind.

Dr. Jordan Frey: [00:29:33] Yeah, I really enjoy real estate and think it's an awesome side gig, particularly for physicians. And I say that now. The first time I heard other physicians talking about real estate investing, I had what I think is a typical response, which is, What are you crazy? Like, don't have the time for this. And I do probably what's considered the most time-intensive form of real estate investing, or active real estate investing. So what I do is - and I say I, it's my wife and I - but we buy small multifamily properties like duplexes or triplexes within the Buffalo, New York area, which is where we live. You certainly don't have to buy them where you live. You can do it from afar, but we enjoy investing in our community, so we buy them and we rent them out and we manage them myself, my wife and now my brother who we've hired on to kind of assist us with it as we've grown the number of properties that we have. But it's really, really a powerful thing for a number of reasons. Obviously, you get cash flow from the rent that comes in and you make money above the mortgage you're paying, etcetera. You also build equity as your tenants pay off the mortgage. There are significant tax advantages, especially if you achieve something called real estate professional tax status in the US, which allows you to use these paper losses that exist in real estate to offset your active doctor income.

Dr. Dimitre Ranev: [00:31:07] Interesting. Interesting.

Dr. Jordan Frey: [00:31:09] That's a really powerful thing. And we do that because my wife is a real estate professional from a tax standpoint, and that's just based on the number of hours you put into participating in your property. But the real beautiful thing about real estate is, you know, our clinical work as doctors, when you really break it down, we're in the service industry. Our income is tied to the work that we put in in a 1 to 1 fashion. Real estate, you know, doing active real estate like I do, buying properties, renting them out, managing them, there is active work that goes into it, a lot on the front end. But then that 1 to 1 ratio starts to get broken. All of a sudden it becomes that there's not a lot of work, especially as you start to automate your processes and get more experience, etcetera, to where you're not really working a lot. And that money keeps coming in, so it becomes more passive income and that's really powerful. You know, we started two years ago. We bought our first place, just a small duplex, and now we've built it up to where we own seven places, which is 16 units, and that brings in $10,000 a month in net income for us. And a lot of that is tax protected. So that's income after mortgages, after maintenance, after things like that. So that's really powerful. And now we just, the way we've been able to scale so quickly is we just take that income and we use it to invest in more real estate. But eventually what it'll do is just become extra income that we can use for, you know, fun stuff. For vacations, for our kids' education, and for our retirement. So that is really powerful and that's like a whole podcast episode in itself.

Dr. Dimitre Ranev: [00:33:07] I'd love to. I'd love to, just thinking, I want to talk to you again.

Dr. Jordan Frey: [00:33:11] We can definitely, definitely we can do that. And there's tons of resources on my site about it and I'm very open. You know, it's not all, it's not all biscuits and gravy. You know, there's hiccups and there's stuff along the way. It's ultimately very worth it. But I try to be even, I'm obviously very open about our successes, but I am equally open about our mistakes and about the tough parts because I think not enough people do that. But it's really, really a powerful thing and that's what has accelerated our wealth building or our path to financial freedom, kind of more than anything else. And I'll say there are much more passive ways to do it. You can, you can do what we do, but also use a property management company to manage the day-to-day workings for you. You can invest in things like syndications, which is basically you are, you're just a money person, you just contribute the money. Someone else does all the investment aspects for you and there's pros and cons to all of this, but there's lots of ways that doctors can be involved in real estate investing very successfully.

Dr. Dimitre Ranev: [00:34:21] Yeah, I have to have you back. This is so fascinating, Jordan.

Dr. Jordan Frey: [00:34:26] And I'm happy to do it.

Dr. Dimitre Ranev: [00:34:28] Listen, thank you so much for your time. I suggest the listeners take a look at the website. It's really good. Take a look at the course. And Jordan, thank you again. We have to talk about real estate because you have so much knowledge, I have so many questions. But this is, it's about time to stop. So all the best, Jordan. Hopefully we speak in the future.

Dr. Jordan Frey: [00:34:47] Absolutely. Thanks so much for having me again, Dimitre.

Dr. Dimitre Ranev: [00:34:49] Take care. Bye.

Dr. Kevin Mailo: [00:34:50] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you I'd really appreciate it if you would share our podcast with a colleague or friend. And head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.

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Dr. Wing Lim takes the lead in interviewing tax lawyer Jason Pisesky. Jason explains the specialties of a tax lawyer, how they operate with accountants, and how tax lawyers like himself benefit incorporated physicians with their knowledge. Jason will also be part of the roundtable AMA at the May 6 and 7 Toronto conference. 

Dr. Lim actually met Jason Pisesky in a personal capacity before working with him - they met at a dance class. Wing says this is the benefit of meeting professionals and staying in contact, sometimes in the future you realize you need a person with specific expertise and you already have someone to contact. Wing talks about his personal experiences working with Jason and asks Jason to share his insight on taxation law. 

In this episode, Wing Lim and Jason Pisesky examine exactly how lawyers become specialists in taxation law. Jason details how familiarity with tax strategies leads him to new ways of benefiting clients, the differences in liability between accountants and lawyers, the cost analysis of hiring a tax lawyer versus ROI, and what tax laws have changed since 2017 that directly impact professionals like physicians. Jason’s knowledge is profound and very applicable to doctors today. 

About Jason Pisesky

Jason is a tax lawyer, whose practice background is extensive and includes personal and corporate tax planning as well as litigation and dispute resolution. Whether you are scaling up your practice or winding it down, proper coordination between a tax lawyer and your accountant can ensure you're doing it right.

Resources Discussed in this Episode:

• Save the Date for May 6-7, 2023 in Toronto
• Jason Pisesky on LinkedIn
• TOSI

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Physician Empowerment: website | facebook | linkedin

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Transcript

Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician empowerment we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.

Dr. Kevin Mailo: [00:00:34] All right. Hi, everyone. I'm Doctor Kevin Mailo, one of the co-founders of Physician Empowerment. And today we've got Dr. Wing Lim, another co-founder, interviewing Jason Pisesky. And Jason is a tax lawyer with KPMG. And the three of us go back a number of years, but today's topic is probably going to be one of our best, one of our most relevant and very unique because this is not something you typically find when you sit down with your accountant, your financial planner, or even your regular lawyer. And what Jason is going to be doing is getting interviewed by Wing as they go through different aspects of tax law and why this applies to incorporated physicians and why everybody should be consulting with tax lawyer as we go through our financial lives. And so with that being said, I think I'm going to step back. I'm going to let you, Wing, go for it and let's get started.

Dr. Wing Lim: [00:01:33] Okay sure. Yeah. Welcome, everyone. And so, yeah, I'm Dr. Wing Lim. I'm one of the co-founders of Physician Empowerment. And so this webinar series slash podcast, because every webinar will be reincarnated as podcast and I'm working on still the proper motto, but we interview interesting people on interesting topics that will impact physicians' lives, will help physicians live better lives. And with that, Kevin, I'm reminded me to put a plug in May 6th and 7th. Make sure you guys register for that. This year it's going to be Dynamo and May 6 and 7, it's going to be jam packed with information. And we're actually going to invite Jason in Sunday, the 7th, as part of the panel discussion. And it's basically roundtable AMA, ask me anything about, well, planning and whatnot. So Jason and I went back a while back. So this is supposed to be a fireside chat, sorry, I couldn't find a fireside background. And Jason, as you can tell, is a really lovely dude and he doesn't have a big ego, unlike most other tax lawyers I've met. And so actually I met Jason probably five years before we talked on a professional basis. So I met Jason on a dance floor of all places. And why would we meet on a dance floor? Because it's one of those life up to 50, what are you going to do when you turn 50? And my wife says, Let's go dance and it took her only four years for me to say yes and dance like Pinocchio.

Dr. Wing Lim: [00:03:07] And my kids corrected me and say, No, Dad, Pinocchio can dance. Okay, I stand corrected. I can't even dance like Pinocchio. And that's where we met at Dance lesson. Right? And so we had a lot of fun in the class. And then a number of years later, Jason, how much of that do you remember? I was kind of stuck in a spot, right? And I was doing major corporate reorg in a few tax strategies. And we hired a tax lawyer. No, sorry. Yes, we hired tax lawyer through a specific accountant who trapped himself as the tax accountant. And then we were just stuck because the building was crazy. What they proposed was ridiculous in terms of price, and they're not very honest with their pricing with the billing practice. And then anyways, I turned over to to Jason and said, Jason, I think you're a tax lawyer, right? And then we went and turned on the file and Jason and his group, there was a top tax firm and they revamped a bunch of things and I got up really, really happy. So that's how we met. Hey, Jason, how much of that do you recall?

Jason Pisesky: [00:04:10] I remember most of it, although, yeah, it's now been I think I've stopped dancing because of COVID in late 2020. Obviously shut down because of COVID and then started doing private lessons just with, you know, 2 or 3 people in the room at a distance. But yeah, now it's been probably two years since I've been dancing, so you need to get back to that. Yeah.

Dr. Wing Lim: [00:04:30] Yeah, it's been a while. Yeah. And then so the topic today is why, when do I need a tax lawyer. Right? So let me maybe prep something for everyone - everyone dialing in or future podcast listeners - we all, most of us are incorporated. And even if you're not, you're still a provider. You will have an accountant, you will have a lawyer. And isn't that enough? Right? Why would we ever need a tax lawyer unless we get audited? I think that's the everyday doctor's first notion of it. And so, and I reached a point because as you know, when you build your businesses and of course I do a lot of entrepreneurial stuff and real estate, so each time you start a venture, you start a company. So before you know it, I've literally have a spider web of so many corporations. I think by the time I brought it to Jason, I have about 8 to 12 companies and every year there's just money flying everywhere and it's just become bonkers, right? And my accountant can't even keep track. And actually one of my ex bookkeeper made a six figure mistake in these loans, and it would have been a disaster. So we said we need to simplify, right? And then we built a strategy to have a family trust. We did major reorg. There was pipeline, there was a few strategies we're doing and then so we just needed somebody to clean it up and have a look in from the tax code, right? So, Jason, when you encounter professionals, business owners, especially doctors included, why do they come to you?

Jason Pisesky: [00:06:04] Yeah, so, and that's a great kind of summary of how people often do come to us is, you know, the structure has just grown to a level of complexity where it's hard to keep track of and it's good to have even just a second set of eyes to look at it, at where you've ended up. So you definitely hit the nail on the head of the easy answer of when the tax lawyer comes in, is when a dispute comes in. That's definitely a subset of tax lawyers. I, small mix of my practice, I do spend more time on the planning side, which is, of course, where I met you, so on the planning side, it's kind of a mix of tax lawyers, we kind of exist in the middle between the accountants and lawyers because tax for both of them is a specialty. I think people kind of inherently know that for lawyers, you know, you have family lawyers, criminal lawyers, real estate lawyers, litigation lawyers. I think sometimes people don't realize that with accountants, not every accountant is a tax accountant. There's auditors, there's evaluators, there's compliance people, there's all different kinds of accounting. And even amongst taxation, there's different kinds. There's indirect taxation - ie GST - international, there's M&A tax, there's domestic, international, US, all these different types of tax too.

Jason Pisesky: [00:07:20] So I think people, first of all, need to kind of appreciate that, that not every accountant knows exactly the same things and what to look out for in every type of file. So, and that's a good thing about tax lawyers is we kind of exist in that middle ground and where a lot of people come to us, and kind of it was your experience of, you know, you may have an accountant who is not a tax specialist who needs that tax expertise and they'll come to a tax lawyer because we're very non-threatening, am not going to take anyone's accounting work. I'm not an accountant. I don't want to do your financial statements and bookkeeping and all that stuff. I want to help with the tax side of things. By the same token, you may also have an accountant who is really strong in tax. There are lots of them and they may be doing something complex and your lawyer may not feel comfortable doing that and assisting with that. Right? They might be a general practitioner or just a corporate lawyer who doesn't do very much in tax. And so they feel that, you know, the transactions are sufficiently tax motivated. You know, you want to make sure you do it right so you don't trip up with Canada Revenue Agency.

Jason Pisesky: [00:08:25] And so they, again, bring in a tax lawyer specialist side to assist on the the lawyer side, the corporate side, to make sure things are done correctly and with the code. And that kind of circles back to the point of - and I'll use the analogy, I think everyone here is probably a doctor everyone's familiar with, you know, the GP, right, for medical practitioners, and in order to speak to a specialist, you have to go to your GP first. You know, if you want to talk to a heart or a brain specialist, you have to get referred to them, at least in our province. That's not the case with tax lawyers, or accountants and lawyers, I should say, generally. And that was your experience, right? You wanted a second opinion. You didn't have to go back to your, you know, your general practitioner and wait 6 to 9 months. You were able to pick up the phone or meet me on the dance floor and say, Jason, I want a second opinion here. Can you give me one? Which is, and there is a sizable amount of work to do, just kind of pick up the phone and say, Hey, I'm not sure things are right or I just want a second set of eyes or, and what also happens when you do have an accountant or a lawyer who's the GP type and there's certainly nothing wrong with it, having a GP for an accountant lawyer is great. The job is to just issue spot and again make those referrals. Sometimes you disagree though, but sometimes GP's can also be on the more conservative side because if they're not super deep into the tax things, they can be put off by maybe advanced strategies and say, Ah, it's too complex. I don't understand where the win is there. Why would we do that? Let's keep it simple. Um, so yeah, being able to just pick up the phone and talk to a specialist if you've heard, you know, a great idea on this, on these webinars or this podcast, you say, you know, Wing's telling me that this is a good idea, I want to explore it, and your accountant kind of maybe has never heard of it before or is afraid to try it. Then again, talk to me directly and then I can kind of speak to your accountant to explain it to them myself or another tax lawyer, of course, can kind of explain it to them and get them onside and make them feel comfortable with it.

Dr. Wing Lim: [00:10:21] Yeah, so let's dwell there a little bit because I've got a few horror stories to share. Um, yeah, so I have some colleagues - I'm in a partnership - and I've deliberately planned for them to retire gracefully, right? I know, I tell people I'm not a tax lawyer, I'm not an accountant, I'm a doctor, but I know enough just to be dangerous. Right? So we structure our company carefully so that when they retire, they can be bought out and take advantage of the lifetime capital gains exemption. And then to do that, you need to purify your company. That's another concept. Sorry, guys, we just throw these things out because they are relevant but we will delve into them later on. So actually, definitely by the end you'll know how valuable Jason is. Jason will be coming back. And actually I'm drumming up something called a tax series that I want to have Jason come in on a podcast level. Right? And I'm thinking like tax hacks for busy physicians, something like that. And we'll dive into a few of these. Yeah, so anyways, and so ten years came and gone and their accountant says oh no you don't need to purify, purification is for people who are dead. So, what? And so a lot of, we find out a lot of accountants are so risk averse, right, and so compared to them like how do you see, it's the same tax code, right? How do you guys see it differently than the average GP accountant?

Jason Pisesky: [00:11:49] Um, I think it just comes with that experience. I mean, I, from practically day one that I kind of stepped out of law school and right into a tax law firm, I was doing kind of the advanced strategies and that is definitely an advantage of the lawyer side where the career of an accountant is much longer to get to doing tax practice. You know, you've got to spend a couple of years just grinding through audits, usually at a big four accounting firm. Then you enter as a specialist, they're called. Then you have to slowly work your way up. Then you have to take the tax specialist program put on by the Tax Foundation. And then you have to switch to your tax group. So to become a tax specialist in accounting sometimes takes ten, 15 years and then they start to work on, oh, I want to roll over some assets, I want to do an estate freeze, I want to, again, these kind of more routine transactions, whereas again, kind of right out of law school while I was still articling, the first thing that kind of appeared on my desk was some of these strategies. And so I think just that familiarity with them and kind of a good understanding of the risk levels just because from day one that's what I've been working with. The familiarity of them I think is probably biggest one. And yeah.

Dr. Wing Lim: [00:13:03] Yeah. So to finish the story, so my partners eventually, one got bought out, one did not, the one got bought out because the passive income was too good, stock market was too good. They ended up with losing this small business deduction and ended up with 53% tax bracket. And accounting just gladly says right a tax and and this guy makes a lot of money, so that year was $530,000 of tax. I would have thrown up. Right? So, and the other guy did not listen. Finally there's a time to be bought out and this guy did not purify the company, so he said no. And then the chance is gone. Now the company has no money to buy him out. And then I met another lady - so I think I send that person to to Jason - so the husband died, right? And unfortunate, so this is a fresh widow. And the husband got bought out by the company. And except the money was given to the kids and my friend was given a tax bill. And so because, again, did not do it right, did not purify, did not do the lifetime capital gains exemption. So this poor widow, fresh widow, apart from morning and running the funeral, was told by her accountant, say, did your husband invest in something? There's a T5 for $400,000 and now you have a tax bill of $200,000 due in two months. It's just such a horror story. Right? And so she didn't see the money, but she has to cough up 200 grand. And if she's not liquid enough, then she would have been in trouble, right? You know. So do you see horror stories like these, Jason? You must have seen some of these.

Jason Pisesky: [00:14:55] Absolutely. And I mean, the hope is always that you can turn the horror story around because not a small portion of the practice comes from people who, oh, I've built this business over the last 20 years, I'm ready to retire, I just got this offer in the mail, help me structure this for sale. And it's well, again, often we can help, but it is usually more complex and expensive when you're doing it on the precipice of retirement, when again, you have to do these purifications, take all these extra steps, where again, but I'm sure, again, speaking to, you know, medical analogy, the preventative care doing it all along usually leads to a much better end result at the end of the day, the last stages of the business as well. Making sure that you, you know, if you're generating tons of surplus money, you have a place for that to go that you don't have to purify as much, making sure you have the right types of shares and the right types of places to get the most efficient tax treatment at time of sale.

Dr. Wing Lim: [00:15:52] Right. So I think most of, I'm talking about personal experience, most of my tax advisers are very conservative. Right? This side, you never get audited, this is the side that you may get audited. And so they say, remember the first accountant, you'll never be audited with me. But of course, I pay taxes through my nose. And ten years later, I went to seminars, webinars, whatever, and I say his name was John Whatever, John, can we do this now? He said, yes. Could have done it last year. Yeah, could have done it ten years ago. Yeah. Right? Wow. Like the tax implication was huge. Right? And so as our financial IQ goes up, these advanced tax strategies show up. And then you find that, oh, people who are high up in the high net worth sphere, some of them do it every single year. You know, but then the accountants don't want to touch it. And then so my first tax lawyer met, he says, I stamped approved my advice and I go to court on your behalf. Right. And he told me that the difference is the penalty. The accountant versus the lawyer. So do you want to expound on that a little bit, Jason? Like, how much are they liable?

Jason Pisesky: [00:17:05] Sure. Yeah. So at least in Alberta, and I think several other provinces, accountants have the ability to limit their liability as low as the fees paid. So they come up with a complex tax strategy that's going to save you $1 million, but something goes wrong. Whose fault it is? Who knows? The fees may be limited to, sorry the liability may be limited to just the fees paid. So you're fighting with the CRA. You owe them a million bucks, but you only pay the accountant the $50,000. That's what you can get back. Off you go. Lawyers generally do not have the ability to limit their liability. So, and that's an important point. Lawyer's fees are often higher than accounting fees, but that comes with kind of you're paying almost for insurance at that point too, where if something goes wrong, you have the ability to, you know, the lawyer is liable for that amount. And generally the the lawyer's kind of liability funds are, take that into mind, too, that lawyers have higher liability as well. So that's definitely a relevant consideration when you're choosing between a tax accountant and a tax lawyer. Yeah.

Dr. Wing Lim: [00:18:17] Right, Right. Yes. Now, talking about cost, I often have people say, well, I don't want to pay the money to see a tax lawyer. And last month our webinar is with Goran, and some of you were there, and he's a tax strategist and he's not a lawyer. And so Goran and Jason, they do work together and he threw a lot of these things out. Right? And people said, well, how do we do that? And then somebody is typing in the chat and say, sounded expensive. Right. So then, so okay, let's address the elephant. Doctors are cheap. Doctors go to seminars, learn to DIY yourself to financial independence and the wealthy land right? You know. Hello. Hello. Hello. You never went to school. How do you think you can DIY? Right? But doctors are cheap, right? They want to fire all their advisors and buy some index funds and then buy some crypto on the fly and be rich. So what are kind of the costs? You know, we have a national audience, right? Nationwide. How much a tax lawyer is worth? Like, do they charge by the hour? Do they charge by the case?

Jason Pisesky: [00:19:26] It depends. Usually by the hour. Although if you're kind of doing something kind of more routine planning, I am comfortable block quoting and saying this is what that particular strategy for you, based on all your circumstances, should cost and sticking to it. I do that quite a bit because I find clients do like that. You know, we can all quote in ranges and say what your hourly rate is, but then, you know, what does that really mean? Of course you give a range and the client sees the low end of the range and the professional sees the high end of the range. So I do find it to the extent possible, it is always great to give a fixed quote because everyone knows what it is. And oftentimes for when I can give a fixed quote, it's for a strategy where the the benefits are easily calculated. So I can say, you know this planning strategy, whether it's on a sale, whether it's a kind of annual planning, it's going to result in tax savings of X, it's going to cost you Y, X is bigger than Y, why would we not do this? On hourly rates, but so that's where, again, it's, you know, relatively predictable what's going to be involved. You know, assuming people have clean minute books and no skeletons in the closet, once you start moving into more bespoke unique things, hourly rates are definitely relevant. It's hard to to tell you exactly, I mean fresh out of school I'm sure there's tax lawyers somewhere in this country where their rates are, you know, $200 an hour. I know there's some in Toronto their rates are over $2000 an hour. So it does depend on seniority, what region you're in. Good thing about tax practice, though, is it's national. So you do have the opportunity to pick your professional, generally speaking, across the country because our tax code is a national code and I can work on someone who has an issue in Ontario with the national tax code as well as someone in Alberta. So yeah.

Dr. Wing Lim: [00:21:15] Yeah. So there's a wide range of course there, hundreds of dollars per hour. Right? And then people say, well, you know, do you get the money worth? So I can say from my personal experience, yeah, we did a strategy where Colombo, I think my fee was about 30, 35, and we saved about $375,000. So the net savings was about $300,000 north of it. So and I talked to my colleagues, just I tell people I put the money where my mouth is, where everything I share, I've done it, right? And so people chase the returns, chase stock, the stock is hot, right? Go up, crypto hot or this real estate is really good, flip it. Make the money. Well, are you ever going to make that kind of return? 10 times. 100 times, right? Like, but if you don't, well, first of all, when you put it like that, it's a no brainer, right? You spend 30 K and save 300. But most people don't even understand that, right? They're just chasing the DIY index fund.

Jason Pisesky: [00:22:16] Absolutely. And that's usually the conversation I do have with people. And it's always good to have it at the outset, right? I mean, if I went to you and said, hey, pay me 20,000 and I'll give you 200,000, you know, if that's, and that can usually be fairly easily quantified close to the beginning, maybe not precisely if you're talking something more complex like a sale or something, maybe it's you know, it's going to depend on some of the attributes of the companies. But you can often get pretty close to, you know, what the advantages are to a plan. And again, they're not always pure tax savings. Sometimes they're tax deferral, which is more confusing, where you've saved immediate tax, but the tax has been kicked down the road and it'll have to be paid later. But that does have advantage if you've deferred tax in a company and you can invest it, you know, a higher starting nest egg. Yeah, so the ability to kind of talk about those advantages, that's definitely great for a tax practice generally. I know I sometimes feel for my family and criminal law colleagues who, it's much more uncertain what someone is willing to, I don't want to go to jail, I'll pay any amount not to go to jail, until you get $100,000 bill. And it's like, well, how long was it in jail, really? Like, you know, I want my kids, you know, 100% access to my kids. Right? And again, until you get the massive bill from your lawyer and maybe you just ended up at 50% anyways, but you got your lawyer to fight for that. So I do like tax practice generally because you can, it is math of here's my fees, here's the savings. Yeah. And so I think clients generally appreciate again that and I think you probably know those numbers because you know how I draft my reporting to you. I set them out. I'm like, here's itemized exactly what we did and the results you got from it. Yeah.

Dr. Wing Lim: [00:23:55] Right. And then I kept sharing with my colleagues as we lived through especially the last few years, CRA has been changing dramatically how they deal with business owners, professionals, especially medical PCs. Right? So, and every time I heard about something, I have to pick up the phone and talk to somebody smart like Jason or my other tax consultants. Right? So what have you seen since 2017? What big changes are there and how does that eat us up as professionals? Those new tax laws.

Jason Pisesky: [00:24:29] I mean, the big one is the the TOSI, the tax on split income, which I don't know if you've talked about it on past ones, basic rules kind of being before the TOSI rules, I'll call them, people used to have spouses and children being shareholders of their active PCs and they would pay dividends to them. It's great if you had a non-working spouse, you could take advantage of their lower brackets. Same if you had kids going to university or, you know, buying their first home or a first car, you can kind of put the money right into their hands, use their brackets as opposed to taking it all at your high brackets. So those rules came out in 2017 and they were definitely a wrench. And they changed the tax landscape. There have been some other changes. I think it was, gosh, now I can't remember it was before or after that, they also changed the - I think it was after - the ability to practice in a partnership and have kind of the ability to have everybody get their small business deduction, the 500,000. Yeah, that was a big, that was a big one. It used to be able to have, and I knew of them, you'd have practices of, you know, 50 to 100 doctors in a clinic. And despite the size and the revenue, everybody was able to get their small business deduction. That's not the case anymore. They've closed that with a very, very complicated series of rules. And then, so now it's kind of like everyone shares one crack at it, the one $500,000 limit, as opposed to everybody having their own $500,000 limit. So the general... and I don't, I think it's unfair, although maybe I'm biased, Parliament does definitely have a take that professionals generally, be they accountants, lawyers, doctors, you know, that they're not business owners, which I strongly disagree with. I don't know what that means. You know, we go out, we get clients, we drum up business, we start clinics, put up signs, all these things, and take significant risks. But they seem to like to treat, or seem to be trending towards the direction of, you know, they should be treated like employees. It's not fair for them to have PCs. And so think that I haven't seen anything softening that tone of, you know, professionals need to be treated differently than a business, you know, producing widgets or whatever the classic university example is of your textbook business, and economics is my undergrad, it was always the widget factory they used.

Jason Pisesky: [00:26:56] But I think a lot of times I'm sure a lot of people on this webinar and a lot of people listen to this podcasts spend a lot of sleepless nights at times thinking about, you know, if their business has been going through a rough patch or how they're going to grow or what the next year looks like, and how they're going to retire because they don't have a pension plan like like someone who's, so yeah. And we see technicals come out where there's a technical recently where CRA made some off the cuff comments about a medical professional that was working for a hospital, that kind of a bit of a uproar there about, again, were they really in business if they were just working directly for the hospital as a director? And so kind of a lot of off the cuff comments and material tax changes as well, that they don't necessarily... I mean, the rules that talked about TOSI, and changing those rules around the $500,000 limit so people couldn't get multiple, those don't just go after doctors, but they definitely impact doctors materially.

Dr. Wing Lim: [00:27:54] Right. Now so we need to wrap the formal part up and then we'll open up to Q&A. But I think, I've been around three decades and I've seen a lot of changes, and definitely it's eaten up autonomy from professional level and also from the taxation point of view. Right.? Our take home pay has been less and less, not just from our respective colleges and provincial payment mechanism, but also from the taxation point of view. It's less and less friendly, right? And if you don't understand it, if your tax accountant is having this, your accountant is having same lesson plan as 20 years ago, it's like Mrs. Jones teaches English for the last 20 years, the same Macbeth, same same playbook. Right? So it's changing, right? And I definitely see way too many of my colleagues still using the same outdated tax strategy. And then so, a lot of these off - what we call it - the off cuff discussion, right? And people like you, Jason, read those all the time. That's your pastime. Right? And then you can tell us, well, hey, is this a smart one or not so smart one, right. For example, one is just did one prescribed rate loan for my daughter. And who just getting her first condo and based out of college and I'm exactly the guy sitting next to me his daughter in the same boat said, have you heard of this? He said, No, I haven't. So if you plug in with smart people, you get smart advice and that could change dramatically, dramatically your cash flow, your long term tax planning, even estate planning. Last mastermind we had was, masterclass, was beginning with the end in mind, right? With estate planning all that, it could be huge difference to your offspring. Right? So anyways, I just want to wrap it up and say we need - our goal here at Physician Empowerment is not to sell you guys anything but to share our ideas and to disrupt you so that you can think, and to equip you so that you can ask smarter questions next time you meet with your accountant or with your tax consultants. Right? So I want to thank Jason and we'll have Jason back again May the 7th. Virtually, him and other panelists will talk and we'll open for Q&A at the end of our whole weekend. Okay, so and Jason, yeah, as I said, and Kevin introduced, he works for KPMG. It's a national firm. It's one of the biggest firms in accounting. And he is in the law division. And I heard that you're doing your West Coast division, right? Right now.

Jason Pisesky: [00:30:28] Yes, I'm working towards starting up kind of western Canada arm, to the extent it does exist in Calgary and Vancouver, but we're seeing kind of a bit of an expansion and stuff. So looking into that.

Dr. Wing Lim: [00:30:39] Yeah well so congrats and hope everything turns out good. So I definitely thoroughly enjoy our friendship and every time I get smart advice from Jason.

Dr. Kevin Mailo: [00:30:53] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.

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Dr. Kevin Mailo welcomes Alberta-based anesthesiologist and first Indigenous president of the Canadian Medical Association, Dr. Alika Lafontaine, to the show. Dr. Lafontaine talks about the importance of narrative, our personal narratives and the stories shared about medicine and with patients, to create hope and foster well-being. 

Dr. Alika Lafontaine shares his personal story, some of the struggles he faced with learning and growth in his early years and the ways in which narratives offered to him affected his outlook. He tells about how his parents helped shape him in positive ways and the personal self reflection ability he developed through performing with his siblings. His experiences, good and bad, have shaped how he views medicine and the importance of the stories told within the profession and to each other.  

In this episode, Dr. Kevin Mailo and Dr. Alika Lafontaine address the question of what you’re willing to sacrifice to the altar of medicine as a physician. They examine how the narrative we have with ourselves influences how we do medicine, and how the narrative we have about medicine influences the experiences we have with patients. Alika shines a light on reframing perspectives and realizing how the narratives we tell ourselves about others contributes to bias and exclusion in treatment. This is a powerful episode about the possibilities of medicine and the vitality of connection with oneself and others through the stories we tell.

About Dr. Alika Lafontaine

Dr. Alika Lafontaine is an award-winning physician and the first Indigenous doctor listed in Medical Post’s 50 Most Powerful Doctors. He was born and raised in Treaty 4 Territory (Southern Saskatchewan) and has Metis, Oji-Cree and Pacific Islander ancestry.

Dr. Lafontaine has served in medical leadership positions for almost two decades. At the Alberta Medical Association, he has served on the representative forum (since 2012), the nominations committee and the Indigenous health committee, and he is a current board member. At the Canadian Medical Association, he has served as an Alberta AGM delegate, has been a member of the appointments committee and has chaired the governance council of the Canadian Medical Association Journal. At the Royal College of Physicians and Surgeons of Canada, he has served on the Indigenous health advisory committee and search/selection subcommittees, he has chaired the regional advisory committee (western provinces) and he is a current council member. He is a member of the board of HealthCareCAN. He has also served as vice-president and president of the Indigenous Physicians Association of Canada.

From 2013 to 2017 Dr. Lafontaine co-led the Indigenous Health Alliance project, one of the most ambitious health transformation initiatives in Canadian history. Led politically by Indigenous leadership representing more than 150 First Nations across three provinces, the alliance successfully advocated for $68 million of federal funding for Indigenous health transformation in Saskatchewan, Manitoba and Ontario. He was recognized for his work in the alliance by the Public Policy Forum, where Prime Minister Justin Trudeau presented the award.

In 2020, Dr. Lafontaine launched the Safespace Networks project with friendship centres across British Columbia. Safespace provides a safe and anonymous workflow to report and identify patterns of care; patients and providers use the platform to share their own experiences and contribute to system change without the risk of retaliation for sharing their truths.

Dr. Lafontaine continues to practice anesthesia in Grande Prairie, where he has lived with his family for the last 10 years.

Resources Discussed in this Episode:

• Save the Date for May 6-7, 2023 in Toronto
• Dr. Alika Lafontaine
• Val Arnault-Pelletier
• Dr. Krishna Kumar

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Physician Empowerment: website | facebook | linkedin

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Transcript

Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.cam- that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.

Dr. Kevin Mailo: [00:00:35] Hi, I'm Doctor Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. And today I'm very, very excited to be bringing on current president of the Canadian Medical Association, Dr. Alika Lafontaine, who is an Alberta-based anesthesiologist who is also our first Indigenous Canadian Medical Association president. And today we've got Alika on the show to talk about the power of narrative in our personal and professional lives as a way of connecting with one another, but even connecting with ourselves. And this is one of the central themes of Physician Empowerment, where, you know, we come together and we talk about our practice journey or our wellness journey or our financial journey, but it's important to discuss, you know, not only, you know, facts and figures, data, but it's important to share our struggles, our failures, our successes and what we learned from those. So with that being said, Alika, why don't you say a few words? Tell us about yourself.

Dr. Alika Lafontaine: [00:01:39] Yeah, absolutely. So first off, thanks for inviting me on to the podcast today. I think that the subject of narratives and the stories that we hear and the stories we tell ourselves about medicine is something that has definitely gained greater focus in this year. You know, when you talk about moving people just generally, before getting into my own story, people are moved by where they think they're going, not necessarily where they're at. You know, I think when you talk about why we get stuck is because we get so focused on, you know, what's going on in the moment. But when you talk about really being motivated, when you talk about big system change, when you talk about doing things differently, it's because we get caught up in a narrative that has this imagined, like a better world, a better place, you know, somewhere that we should aspire and you know, work towards getting towards. And that definitely has application in my own life. So when I was young, I grew up in a great family, two parent home, my dad made enough for my mom to stay at home and raise us five kids. We weren't a rich family, but we always had enough food on the table. We had a warm home. Like we didn't go vacation in exotic places, but we had a lot of fun together. Right? And my mom was a first generation immigrant from the island of Tonga. She came to California before meeting my dad and coming up to Saskatchewan. My dad was a Metis kid who grew up in small town Saskatchewan, a place called Lestock. And together they raised a family where we were really taught that, you know, community was super important. You know, respect for oneself and each other was super important, but really, really central to their message of where we could get to if we worked hard was the idea of education. My dad was the first one to go off and get an undergrad and a master's degree in his family. My mom gave up her education dreams and she reminded us, you know, I'm here for you. I've lived my life. Now I'm here to support you. So you need to go off and, you know, achieve that next step so you and your family can continue to have a better and better life. Right? Similar narrative to a lot of things that we've all been taught, you know, in the generation that we grew up in. And I remember in grade school, my teachers were very concerned around, you know, grade three, grade four, grade five about my ability to read. And it wasn't that I couldn't pick up concepts, its that I had a very difficult time expressing myself in a way that they could understand. So I would mispronounce letters. I had a very bad stutter. I think all of these things created a lot of anxiety for me, you know? And as a result, I had a great difficulty reading out loud to teachers.

Dr. Alika Lafontaine: [00:04:39] And they did a lot of work to try and figure out what was going on, but eventually reached a point where they sat down with my parents and me and they told my mom and dad, you should plan for him not to graduate high school. He's not going to do anything else with his life. And I remember that moment in the vehicle after my mom was holding me and she was kind of rocking me back and forth. And she was telling me, you know, you're not broken. You're not broken. And that really set into me, you know, this narrative that I told myself growing up, you know, I have to prove to each other that, to other people, that they're wrong about me. You know, I have to live up to, you know, not only the dreams that my mom had, but also I have to, like, prove to myself that I'm not broken. Right? And, you know, my parents, to their credit, they put a lot of time into me. My mom doubled down with kind of taking care of us at home by, you know, becoming a teacher for me and home school. You know, eventually my younger siblings were pulled out of school so we could all do home school together, which I think was was really positive for me. So my two older brothers continued on to high school, but me and my younger siblings, we all took home school together. My dad went off and he had been trained as a teacher. He had gone to law school for a little bit, went off and did his master's in educational administration. So he went down to the States and got some extra training in different learning techniques, whether it's a mix of what they did or whether I grew out of it or whether it was, you know, addressing ear infections that I had when I was a kid, for whatever reason, I started to turn a corner. And it was interesting because I was labeled as learning disabled. So a learning delay with a speech impediment when I was younger, and a few years later I was labeled as gifted. And so now suddenly I had a completely different narrative that was going on in my life. And you know, that really propelled me, I think, through a lot of the frustrations that we all go through when we're trying to get into medicine and, you know, going through med school and other things. You know, what is it that drives you to, you know, do what you do? And obviously, I had the same sorts of things that I wanted, that a lot of people that come into medicine want, where we want to help people, we want to have a life of meaning, you know, these other things. But there was the added motivation that I had that I had to prove myself, right?

Dr. Alika Lafontaine: [00:07:09] And I think those things together, you know, not just having my own life story, but also sharing a lot of the stories that we all have when we come into medicine, it made me particularly sensitive to burn out this belief that I had to be everything to everyone. This intense disappointment when I didn't succeed. I remember in my first year of medicine getting a, I think it was like a 74 on a histology exam, average person they're like, oh, 74 that's probably not a big deal. I thought my my life was over. I went over to the histology professor and I asked them for extra tutoring help. And I remember that whole first few weeks just really feeling out of place. I was meeting these kids who came from multigenerational physician families, people that were fairly well off. I was the only Indigenous kid in all four years at the time. And the teacher, instead of reassuring me, said, You know, it's probably not the end of the world if you don't pass first year and repeat it. And kind of waving me away and I remember walking out of that room and saying to myself, I'm done, I'm done med school, I'm not going to continue on in a place that I don't feel like I belong and I'm not going to be able to succeed. And I walked down that hallway and I met Val Arnault-Pelletier, she's a current lead for the Indigenous program over at University of Saskatchewan right now. So she's been there for a very long time, helping many, many kids like me get through the challenges that I know I shared with many, many people. And, you know, she really helped me along with many, many coffees with the dean over the next four years to help me tell a different story to myself that it was okay not to always be perfect in every situation and that there was a lot of learning and growing that had to go through and I had to give myself space to do that, you know. So my life's interesting in retrospect now because I can see how the very negative narratives that I was taught were both heartbreaking but also motivating. But then the very things that brought me into med school were the very things that broke me early on in med school as well, you know. And so I've learned different stories about myself over and over again over my career. I continue to learn different stories about myself. And I think when we talk about telling stories, it's not only about stories that sweep other people up in movements to create a better type of health care system. It's also stories that we can believe, so we can thrive, so we can address a changing world around us in a way that's maybe a lot more healthy than we did before.

Dr. Kevin Mailo: [00:10:05] Yeah, that's so powerful. I mean, I think what you're touching on is what perception can do in our lives, right? I mean, you know, the same events occur to us, but our perception changes our experience of that set of events in a given moment in our lives. So before we get to, you know, our relation to other people in narrative and storytelling, I like the word storytelling. How do you look inward? What does that process look like for you? Because I think everybody's a little bit different. You know, some people will go take a vacation by themselves. I drive with the radio off in my truck for a few moments here and there and just reflect or people will meditate. But what does connecting with our own narrative look like for you, and looking inward look like for you?

Dr. Alika Lafontaine: [00:10:56] It's interesting how you have a lot of experiences that seem very disconnected over your life. But then when you end up doing something really meaningful, it seems like everything kind of converges into a single point, right? And you realize, hey, that thing that I thought was very different than what I ended up doing maybe is at the core of why I do what I do well. Right? So another thing my mom really encouraged us to do when we were young was to sing together, I was actually part of a boy band for like two decades, right? It was, it was me and my five, the five of us siblings, like touring across Saskatchewan, Manitoba, Alberta. Eventually it was Canada-wide, we toured parts of the US and performed in the Pacific Islands and things. But over those two decades of performing, you start to get a real sense for feeling the emotions of the people that you perform for, but then becoming hyper aware of your own feelings. Because if you're not, you actually can't give a good performance.

Dr. Kevin Mailo: [00:11:53] Wow. Yeah.

Dr. Alika Lafontaine: [00:11:54] And so, I, over the years of performing with my family, really had a lot of opportunity to verbalize the way that I was feeling, reflect on how I was feeling, you know, inject that into this performance piece. So we were vocalists, like it was an R&B kind of pop group. We wrote our own music. We published three albums over the time that we were performing. This was all before YouTube, so you're not going to find a whole lot of stuff on us online.

Dr. Kevin Mailo: [00:12:25] So I can't just look you up on TikTok.

Dr. Alika Lafontaine: [00:12:27] No, no, you can't look me up on TikTok. But we ended up doing some pretty big shows. Like when EPTN opened, we were part of kind of the opening set, we opened for Susan Aglukark, I think was right after us. We were on the Inspire Awards, which back then was called the National Aboriginal Achievement Awards. So that had viewership of like 2, 3 million people across the country. So I had a lot of opportunity to self-reflect and understand why I did the things that I did. Now you can obviously be educated about something but not be able to, in the moment, manage yourself. So I mean this isn't to say was like a philosopher at the time of being in med school, but I did have tools available to me to understand myself. And some experiences where I could sit back and say to myself, Well, this is what we did when we wrote this song. This is what we did when we prepared for this set. So maybe I'll sit down and kind of figure out exactly where my head is at with all of this. And I think when you're looking at yourself, there's two parts that I found really, really useful. And it's different for everybody, but two things that I've found really useful. The first is being brutally honest with yourself about how you're feeling in the moment.

Dr. Kevin Mailo: [00:13:35] Wow. Yeah.

Dr. Alika Lafontaine: [00:13:37] You know, it doesn't make a ton of sense to deny yourself the reality that, hey, I'm sad, I'm happy, like all this other stuff. And then the second part is linking that and understanding how the things you experience trigger those emotions and put you into different cycles. Right? And I get caught up in them just the same as everyone else. I mean, we all know that there's unhealthy habits that we get into once we get into heavy call, right? I mean, you're up at 3 am, you had a horrible night, maybe in extremely horrible nights you had bad patient outcomes or some sort of disagreement with a colleague or other things. There are natural like things that we reach out for whenever we're feeling like that. Right? And so being able to understand those two parts of myself, I think has been really helpful. And I think when you're looking at how do you bridge, how you feel about yourself to now interacting with the world, it's negotiating with yourself about what exactly you're going to give the world to bring the world to that point where it can give you what you're looking for. I had a physician that did research projects under when I was a medical student. His name was Krishna Kumar. He was a neurosurgeon in Regina. And, you know, consistent with my story, I picked the hardest thing I could think of once I got into med school as far as what I was going to go after, as far as, you know, residency and is this true or not? I'm not really sure. But 19 year old me thought that this was what what I should chase after. So I wanted to do neurosurgery. And so I followed around Dr. Kumar for a couple of years. And this guy, I mean you won't find a harder working physician anywhere. 16 hour days, 12 hour surgery standing up, working on Saturdays and Sundays, flying around the world, doing presentations. He had the largest research body for spinal cord stimulation, I believe in the in the world at the time that I worked with him. So I kind of fell in this opportunity with this amazing physician. And I really poured my heart and soul into it for the first, like year and a half, showing up his house at 2 am to do presentations, being available any time of the day to to sit down and do different things, following around inside the OR and other places. But he noticed halfway through my second summer, I became a little disinterested in what was going on. And at that time I'd actually met my now wife, and I remember him sitting down with me over lunch and he had this thing where he'd like, peel radishes and like, give you slices as he was eating. And he's like giving me these radish slices as we're chatting.

Dr. Kevin Mailo: [00:16:21] It's funny how we remember...

Dr. Alika Lafontaine: [00:16:22] Oh, yeah, totally.

Dr. Kevin Mailo: [00:16:23] .. those things in the moment, right? Yeah.

Dr. Alika Lafontaine: [00:16:26] Yeah, sense and sounds. And I still remember how he looked and and all that stuff. And he's, he's chatting with me about work and then he makes a turn in the conversation, asking, like what's going on. You know, you seem just a little bit distracted, was the word that he said. And I told him about this amazing girl that I'd met. And I'm sorry if it seems like I'm not paying as much attention, she's just really incredible and all this other stuff. And Dr. Kumar was not an emotional guy, right? He was a warm guy, don't get me wrong, but he was very business. Right? And I noticed a softening that came over him. He reached his hand out onto my shoulder. He wasn't big for physical contact, but it was like a very, like fatherly touch.

Dr. Kevin Mailo: [00:17:11] It meant something.

Dr. Alika Lafontaine: [00:17:12] It totally meant something. And he leaned in and he said, you know, Alika, don't sacrifice your life on the altar of medicine. It's not worth it. And then we went back to talking and, you know, it never came up again. And I look back at that moment as really formative for me. I don't think I realized just how much it impacted me until later. But you have this person who, world leader in what he does, sacrifices almost all of his life to medicine, raised a beautiful family, had a good relationship with his wife and kids, but he missed out on a lot of important events in his family's life because he was focused on creating those moments for other folks who were sick and otherwise. And, you know, he's telling me, don't sacrifice too much. You know what I mean? And so it's interesting when you think about the stories we tell ourselves about our contribution to medicine and how much we need to give and all these other things. And the reflection of someone like him at the waning years of his life that maybe what we think we're getting out of medicine isn't really worth the amount that we think we're getting out.

Dr. Kevin Mailo: [00:18:29] I think that's very powerful. And, you know, my own reflection on that is that we can give the health care system, our communities, our best when we are at our best. And part of that process involves self rejuvenation and having a notion of self outside of the profession because it's, I think, very easy for medicine to become quite consuming to the point that you look in the mirror and you say, Well, I'm such and such type of doctor. Right? Or our credentials. But the real us is so much more. It's all the way back to those formative years in our childhood, even the inner child, if you want to call it that, but our relationships with the others, but even with ourselves. And that's a very powerful observation. So how do you set that balance then, Alika, of, you know, the professional self and the personal self? And that's a concept we actually talk about at our wellness events, is the notion of different selves, that there's a financial self, a personal self, a professional self. How do you find that balance between personal and professional self?

Dr. Alika Lafontaine: [00:19:34] So as someone who has been both balanced and unbalanced throughout my life, I think the first thing to recognize is that there will be times when you'll be completely unbalanced. Right? So this year, as president of the Canadian Medical Association, has been all consuming. And it's just the nature of, you know, the value add that I want to provide to colleagues across the country, but also just the nature of the work. Right? Residency is all consuming, right? Early practice, to some degree, can be very all consuming. The first time you take a leadership position as, you know, someone in your department contributing or elsewhere, it can be all consuming for a period of time. Right? And so I think that there's times and seasons to everything. And just to be aware that balance 100% of the time is probably not, it's not the accurate way of describing it.

Dr. Kevin Mailo: [00:20:32] It's very hard to do.

Dr. Alika Lafontaine: [00:20:34] The way that we work. Yeah, yeah, the way that we work in medicine. So I think the goal is to work towards balance and at times achieve it, but then recognize that from time to time it's unbalanced and just own those moments, right? And if it's too unbalanced, reorganize your life so it becomes less unbalanced, but it will remain unbalanced from time to time. Right? So that's kind of the first part. I think the second part is that when we look back, so I'm a big student of history, right? So I think one of the best ways for us to understand where we're going is to know where we came from. And if you look at the medical system and what a lot of us would refer to as very unbalanced practice patterns, I think the world has changed a lot from the times of folks that we train under who've been practicing for, you know, 40, 45 years. Right? If you go back even 20, 25 years, a physician in a community was at the center of a lot of the work in the community. Right? When you volunteered at the hospital, you were also volunteering at your community. There wasn't a division between the two things, right? You could especially see this in small town Canada, where your doctor was also someone who interacted pretty closely with the Parents Council, the community association, you know, the mayor's office, like all these things.

Dr. Kevin Mailo: [00:21:56] Like people look to you.

Dr. Alika Lafontaine: [00:21:57] People look to the doctor or doctors as part of building up the community. Now, since that time, that's shifted, right? And so we introduced these new divisions into the way that society interacted, but we didn't update the way that we saw ourselves. And so there was a turn in the late 90 seconds, early 2000, where there was like this value extraction, for lack of a better word, that occurred where people leaned into this narrative that we had that we were willing to sacrifice on the altar of medicine in order to get, you know, meaning out. But that meaning increasingly disappeared from the practice of medicine. You know, we still had those moments where we really connected with patients. I mean, I've had lots of experiences that I mean I'll always treasure that I've had with patients, both good and bad. But the job itself become became much less of a place where you could you could wear dual hats at the same time, you know, be a part of the community, be a part of your family, be a part of, you know, work. Right? And I think that value extraction has continued up until today and it accelerated, I think, in the last five years. And it wasn't until COVID came along that I think a lot of us sat back and realized just what was happening. We were moving too fast.

Dr. Kevin Mailo: [00:23:25] No question. I mean, there's no limit to what this career can ask of us as individuals. Truthfully, there is no limit.

Dr. Alika Lafontaine: [00:23:34] Yeah, Yeah. And so with that pause that COVID gave us and that opportunity to reevaluate what was important, and I think it was a moment where we, a lot of us honestly sat there and said, Do I want to live and die for this? I remember March of 2020 coming back from a canceled leadership gathering because of this unknown virus that was floating around. Touching down, going into work, we started putting masks on patients who were coming down from the floor. We started continuous masking. We were told we're going to run out of masks if we, you know, continue to do this. We're going to run out of protective equipment. And so there was strong efforts to really, really slow down the utilization of this, which to many of us, we felt like there was no protection.

Dr. Kevin Mailo: [00:24:24] Yeah, there were those moments. Absolutely. Absolutely.

Dr. Alika Lafontaine: [00:24:27] Yeah, yeah, yeah, absolutely. And so I remember coming home from work that, the second night that I had been back, and sleeping in the garage. And I actually slept in the garage for like the next three, four weeks. I know many of my colleagues that slept in the, because you didn't want to get your family sick.

Dr. Kevin Mailo: [00:24:44] You didn't know. And that's when it becomes so real. What we might be asked to give up.

Dr. Alika Lafontaine: [00:24:52] Yeah. And I think a lot of us sat there for the first time in our careers. I mean, we always knew it in the back of our minds that it could be possible. But we were actually confronted with that moment of if someone was dying in front of you and you could get infected, were you willing to die for that patient and were you willing to potentially make people that you loved very sick and potentially die as well. You know, it's, I think it's easier right now to look back and, you know, say to ourselves, well, we know this now and all these other things. And I think pre-vaccine, it obviously was a completely different game. You know, we didn't have what we have now. But I really think in that moment, a lot of us realized for the first time, I don't, I think there's a line to what I'm willing to give. You know, and I know for myself, I never actually defined a line of how far I'd go in order to, you know, sacrifice for the health care system. And I think that was the beginning of me realizing I really do need to make sure that the most meaningful parts of my life are protected. And that I can find a way forward to separate, you know, the story I tell myself about the doctor that I want to be and the kind of person I want to be in the rest of my life. And I see that that conversation going on in the minds of a lot of colleagues across the country still.

Dr. Kevin Mailo: [00:26:16] And I think you're absolutely right what a powerful experience the pandemic was, because in that, in those moments, you know, we're worried about catching the virus, getting sick or getting a loved one sick. You know, it crystallized that reality of what medicine asks of us, but in reality, day to day, medicine is chipping away at us or some of us in terms of our health and well-being or our relationships. Right? You know, when you're, you know, you're working those long hours or you're constantly on call, you're constantly exhausted, you're constantly tired, how present are you for the people in your life? How present are you for yourself, for your own wellness? And, you know, it's just those those things aren't so explicit because we say, well, it's just one more night shift or it's just, you know, one more week of call and I'll be off for a few days or whatever. Right? But in reality, these are big asks of us in terms of our well-being. And we just don't necessarily recognize them because they're built into the culture of medicine. Like you said. You know, it's begun sort of, it's ubiquitous.

Dr. Alika Lafontaine: [00:27:25] And sometimes it's pretty striking things that in the moment you think are so normal, but in retrospect, you're like, wow, that was really abnormal. I mean, I remember in residency knowing that at 72 hours of no sleeping, I would just kind of collapse on the floor and fall asleep. Right? And I know that it happened multiple times. Like I'd, I would push myself past what I could do and then keep on going. And I'd go home at the end of the day and I'd wake up on the floor at like 1 am and young kids and my wife had just kind of, step over, let me sleep there. They put a pillow under my head and threw a blanket on me. But, like, they they knew that it was more disruptive to try and wake me up and get me to bed than it was just to let me lay there. And I just thought it was something that everyone just did. And then you get out into the real world where you're not interacting with just doctors anymore and you realize that that's not normal at all.

Dr. Kevin Mailo: [00:28:24] So talking about narrative, we talk about relating to ourselves and connecting to our self with our own stories. And I thought this was so powerful to go back through the decades of your life and see those moments, like you said, like cutting what was it, radishes on a kitchen counter, you know, in the middle of the night. And so talk to us about narrative as it relates to one another professionally. Right? And talk about, you know, how narrative relates to our patient encounters. Because I think there's a lot of beauty there.

Dr. Alika Lafontaine: [00:28:54] Yeah, absolutely. And we we've talked so far a lot about, you know, our personal narrative that we have with each other or with ourselves. And then we we talked a bit about that value exchange that goes on between us and kind of the broader narrative of what is medicine and what does medicine expect of us? I think when we're interacting with each other, there's the narratives that we also tell ourselves about what other people think about us and how they interpret what we do. And then there's also narratives that we project onto other folks, you know, so I've obviously done quite a bit of work in the area of equity, diversity, inclusion, anti-racism, etcetera. And part of the way that I now explain things has come from my own feeling about performing and audiences. You know, I think people to a great degree are always well meaning. And they're being taken on this emotional journey that they may or may not be consciously aware of. That's not to say that unconscious bias is what drives inequity and exclusion and racism, etcetera. But it helps to frame things in a way that people can plug into emotionally instead of just telling them that you're like a bad person, right? The worst, the worst feeling I think for a physician is to be told after 36 hours of being on call that you don't care about patients.

Dr. Kevin Mailo: [00:30:22] Exactly. Nobody's going to work trying to screw up here.

Dr. Alika Lafontaine: [00:30:25] Yeah, 100%. And I think if you take that as a starting point for the majority of people, that's a place that you can have people come together more easily than other places. It also gives someone the opportunity to be more harsh with themselves than you are with them. Because the truth is, if people want to change and recognize that they're creating bad experiences for those around them and potentially harm, you know, because sometimes the decisions that we make, because of bias and other things, actually do create harm. If you want people to be introspective and actually change, they're going to be way more harsh with themselves than you could ever be. Right? And so that's kind of the first point. The second point is that we're often swept up by these things because the ways that we thought about things kind of worked. You know, even going back to what I was talking about with physicians who sacrificed their life and, you know, spent all their time at the hospital, you know, 25, 30 years ago, it worked for them. They were still able to see their family. They were still able to be a part of the community and all these things. But the world changed, right? And I think that that's the same case with a lot of the stories that we project on to other people. At some point that story made sense, right? At some point that story was true. But it's whether or not in that moment, is that story true? Is that story adaptive? And I think increasingly people are realizing that stories that tend to be pretty prevalent can lead to significant, you know, harm and pain for folks and especially patients. So one of the things that I've had the chance to be an advocate for and, you know, participate to some degree as president is, like, in the area of forced sterilizations for Indigenous women. And I and I remember as a resident, that there were situations where, you know, the surgeon would lean over, your patient would be under a spinal like doing a C-section or whatever, and they'd say, okay, I'm going to clip your tubes. And then a tear would roll down their face. And in the moment, I would sit there and think to myself, Oh, my spinal must not be working. So then I'd go grab the ice, I'd like check whether or not things are moving around, I'd peek over and see whether or not they externalized the uterus, which can sometimes cause referred pain up into the shoulder. It just never crossed my mind that they did not feel that they had a conversation where they were fully informed that this was happening. And in retrospect, it's easy for me to see what could have happened. Right? But I think for a lot of folks who are currently practicing, if you want to understand how to be a better physician, you have to be open to, you know, reframing what you thought you were doing and how you thought you were affecting other people and why people were reacting in the way that they did to you, into a way where you give some space, Hey, maybe I just didn't see what was going on. Maybe I actually was, you know, I don't think a lot of folks realize just how how hurtful it is when you meet, you know, an Indigenous person with a traditional name and you don't even try and pronounce it. So some folks, yeah, and people think, well, I'm being respectful, right? When in reality, like, it's very, very hurtful. Right? But you wouldn't know that unless you actually were able to talk to someone about it. That's not something that's a classic narrative that you would pick up just from day to day life. And so, you know, I think when we talk about patients and each other and other things, we have to get to the point where we can talk about the stories that that we believe and project on to other folks and also hear them tell us what are they feeling.

Dr. Alika Lafontaine: [00:34:07] And I do feel that we we should celebrate to some degree that we are in a place where we can say racism out loud, sexism out loud, discrimination out loud. And I do hope as we continue to move forward, we'll start to realize that the goal is not to get rid of everyone who has those those thoughts or those feelings, because that's kind of a part of the world that we grew in, grew up in. Right? Those are the stories that we heard and adopted. But instead try and help people not to, you know, mindlessly act in a way that's harmful to other folks. Like that, I think, is the actual end point. Because when you when you talk to patients about, you know, racism, what do they want? They just want the harm to stop. Right? They don't necessarily need, you know, every racist thought or other things to be eliminated from the provider's mind. What they actually want is for the actions to stop. And I think if we approach it from that point of view, it's a very different, it's a very different problem. It's a much more achievable problem. Solvable problem.

Dr. Kevin Mailo: [00:35:10] But I think it's so powerful when we hear the stories of what patients have experienced going through our healthcare system with systemic racism or sexism and hearing the stories on an individual level, like the case of that patient having her tubal ligation really with no with no discussion or consent. Proper consent at least. And so those are the kinds of things that can be very powerful to motivate us, to help us to see things from another's perspective.

Dr. Alika Lafontaine: [00:35:44] And I think that that brings us closer to what we actually want to get out of medicine. And this goes back to like the the the the altar analogy, is not that we can't get meaning out of medicine, it's just that the world has changed. So we have to change too, like our meaning has to change. You know, the way that we get it has to change. And I think at the very beginning of all of this, like you talked a lot about, or you mentioned burnout and the need for wellness and, you know, having people step back and realize there's different parts of who they are and what their needs are and and other things. And 20, 30 years ago, we wouldn't talk about that. Right? And I think today we have to confront it because that's a necessary part of the new story we have to tell ourselves so we can start to thrive in medicine again.

Dr. Kevin Mailo: [00:36:25] And I think it's important to use, you know, storytelling and shared experiences to humanize medicine because too often I think we look at it from a very technical perspective. I mean, you know, you come into the emergency department and you're there to, for instance, you know, on shift and you're there to say, Oh, you're not having a heart attack. You rule out anything serious, but maybe that patient's having chest pain because you need someone to talk to. You know, that they're struggling with anxiety or depression and it's presenting, you know. But when we don't create that space to hear people's stories, we end up being very technical. But there's a downside. It's not only, you know, that the patient has lost out, but so have we, because some of the most meaningful moments in my practice have been when I actually just sit and listen to a patient. As we humanize the experience in medicine and humanize our interactions not only with our patients but with one another, I think we feel more connected to our jobs and we derive more meaning from it and we do better care.

Dr. Alika Lafontaine: [00:37:26] And, you know, this has me thinking about, you know, something that that's come up over and over again with with being president of the CMA, and that's how do you get unity within the profession towards things that will not just help us, but also help patients. Right? And my mind over the past year has gone back a lot to this whole idea of social cohesion. You know, this idea that we're, we have shared values, we have shared problems, and we find shared solutions together. And I think increasingly, what's the number one challenge of patients across the country? It's access. It doesn't matter which part of the ideological spectrum you're, right, how much you think government should be involved or not involved in your life. You know, if you're sick, you want access to care. You want access to to people that, access for people that you care about. And the polarization that we have, I think, has introduced this idea that somehow we'll get that access if we're right, if only people would do our solution, you know, everything would work out. When in reality, I think the way that we improve access is to improve cohesion within the health care system and between like the people that provide us care and the people who are coming for care. If you don't feel united with your provider, you're not going to share with them what's actually on your mind. If you don't work in a team where you feel like you can lean on them, you're not going to be able to find those moments where you can create additional time that you didn't have the day before because now you're working with the team that you're working well with, right?

Dr. Kevin Mailo: [00:38:55] Absolutely. Absolutely. It's so true. I mean, just again, it's that shared experience, not that we have to agree on everything, but like access will improve when we identify it as the key, key priority that we need to address in our health care system currently. So, Alika, this has been absolutely outstanding and we would love to get you back on the show. Right? Just to hear more of your experience, you know, more of your wisdom in this space. But we would love to hear your final thoughts on what narratives meant in your life and how we can use it in our day to day. Because I think it's important to have medical education meetings, programing that's based around narrative. But I also think it's important that we can integrate narrative into our day to day interactions with patients, allied health and even one another, because I think that binds us together. I think that's cohesion, as you talk about. But practically speaking, how can we integrate, how can we integrate this into our day to day practice lives or our leadership roles?

Dr. Alika Lafontaine: [00:39:59] Yeah so I'll maybe just touch on one thing, and that's the importance of narratives driving emotion. You know, why do we believe different stories is because we think we're going to feel different ways, right? And that was a lesson I learned from performing. You know, people didn't come to listen to you sing they didn't come to see you, they came because they thought they were going to get a feeling out of them showing up. And I would say in the moment that we're in right now, there's a lot of hopelessness that's going on. And the reason why people are drawing back from clinical practice, why they're leaving for other things, is because they think if I sit still and continue doing what I'm doing, this hopelessness will continue to build. Right? And so when we talk about the stories we tell ourselves, it's really important to find hope in the hopelessness and to ensure people act in a way that can actually generate hope again. You know, and so that's one part of of the point. The second part is that hopelessness, I think, transitions at some point into indifference. You know, you can see it with certain patient interactions that you had, you know, coming across folks who show up because they're going to die otherwise. But they really have no hope that the system is going to help them. Right? They come in very indifferent. You know, you're just going to be like every other physician, every other health provider that I've ever met who hasn't been able to actually help me get out of this hopelessness. And that is a much more difficult problem to confront. Indifference is many magnitudes worse than hopelessness, regardless of how bad it feels, right?

Dr. Kevin Mailo: [00:41:42] Yeah, that's a very powerful observation.

Dr. Alika Lafontaine: [00:41:44] Yeah, and so we have a moment right now where we can really focus on doing things that will generate hope. I mean, you look at what's going to happen with the budget later on this month. I do honestly feel that there are going to be some very significant changes in the way that we collect data. The fact that we're going to share depersonalized data between jurisdictions now. We haven't really done that except in huge emergencies like having a unique patient identifier across the country means you now can compare all databases, I mean there's all these different things. The regional license opening up on May the 1st in Atlantic Canada, you know, finally taking a measurable step towards having folks be able to register once for a license and be able to practice in multiple jurisdictions simultaneously. That could transform practice in a lot of different ways. Suddenly, you meet somebody at a conference and you know that you all share a regional license. You could set up a virtual team together the next day. You know, you wouldn't have to worry, how am I going to practice if you move from, you know, a place like New Brunswick to Nova Scotia for school, for example, you know, you could keep your family doc. Because now your family doc's licensed to work in Nova Scotia, they can follow you where you go. You know, there's all these like, really amazing changes that could happen. But we haven't done the greatest job in helping people understand the hope in those actions.

Dr. Kevin Mailo: [00:43:07] Right, Right. The emotion that sits there.

Dr. Alika Lafontaine: [00:43:10] Yeah, 100%. And so, I think if we can focus on being authentic, because I think false hope is almost worse than remaining hopeless, you know, but we can take people to places where things are very likely to actually change practice, you know, actually make things better. It's important that we all kind of lean in and do that right now because once we start to become indifferent and once indifferent starts to spread and entrench itself across the health care system, it's going to be even harder to change things.

Dr. Kevin Mailo: [00:43:44] Absolutely. Absolutely. All right. I think we should wrap it up. But this was outstanding. It was just great. And I really want to sincerely thank you for your time, Alika, because I know you're busy. And on behalf of the profession, and I know you get a lot of thanks, I just want to share another thanks for all you've done to advocate for the profession, but also, again, you know, to advocate for Indigenous voices within our health care system to start meaningful, meaningful change towards one of the most marginalized groups in our society. So, again, thank you. And, you know, we should have you on the show for sure at another point.

Dr. Alika Lafontaine: [00:44:23] All right. Thanks for having me.

Dr. Kevin Mailo: [00:44:29] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.

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Dr. Kevin Mailo welcomes Dr. Sarah Smith to the show to talk about the time investment of charting and how to set boundaries on how much work eats into your personal life and well-being. Dr. Smith is a practicing rural physician who does everything from family medicine to emergency, and she is also the Charting Coach whose program has helped hundreds of physicians. 

Sarah shares her personal story with Kevin and explains how her practice in Australia eventually became a burden due to all the paperwork, the undone charting. She says she loved the people but hated the paperwork burden. She struggled under the weekend-eating charting until she had a realization and really took stock of how she spent time in her day. That led to imagining how she could change her time usage to better suit her.  

In this episode, Kevin Mailo and Dr. Sarah Smith explore Sarah’s “a-ha moment”, how she coaches physicians to view their time and the work they take home, and why a mindset change and the phrase “you see the patient, you close the chart” becomes one of the keys to more efficient time usage. Sarah advocates for well-being in terms of physicians reclaiming their personal and family time by focusing on the ways in which they are in control of their own clinic time management.

About Dr. Sarah Smith

Dr. Sarah Smith is the Charting Coach for Physicians. She is a Rural Family Physician and Certified Life Coach through The Life Coach School. She helps physicians get their admin and paperwork done more efficiently to create time for the things they love. 

Dr. Smith has spent the last three years coaching hundreds of Physicians, over 1000 hours of coaching, in the specific area of “getting home with today's work done”.

Resources Discussed in this Episode:

• Save the Date for May 6-7, 2023 in Toronto
• Dr. Sarah Smith on LinkedIn
• ChartingCoach.ca

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Physician Empowerment: website | facebook | linkedin

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Transcript

Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.

Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast, and today I'm extremely excited to introduce to you - I say I'm excited every time - but I am very excited to introduce our listeners to Doctor Sarah Smith. And I'll say a couple of words about Sarah and her practice background, and then I'll let her talk and share her journey because it's really quite remarkable. Sarah is a rural family physician who kind of does it all - family based practice, palliative care, long term care, hospitalist, and emerg - she does it all as a rural physician. She is originally from Australia and immigrated to Canada about ten years ago and I assume came for the great weather and beaches. And today what Sarah is going to be sharing is strategies around charting and practice optimization because this is something we all face in practice, right? Whether you're a radiologist or you are a family doctor or a surgeon, you've got to chart what you're doing. And we don't get a lot of training around that. We get a lot of training around like the medicine and making proficient notes. But how do you be efficient about that? How do you communicate effectively? And that's what we're going to touch on today with Doctor Smith. And with that being said, Sarah, why don't you go and tell us a little bit about your personal and professional journey that led you to this point.

Dr. Sarah Smith: [00:01:54] Hi, and thank you so much for having me, Kevin. It's really, really fun to be here. So yes, I'm from Australia and I had been in full time family medicine in Australia, having finished up all of my hospital years that we do in Australia after graduation. And we then as a family decided we wanted to see something different, so we packed up, full time family practice, I'd just got to that fun point five years in where I understood the billing, the patients, my panel, everything was kind of like ticking along quite nicely except for the paperwork. And we'll come back to that. And then we decided, you know what? We really want to see something different now. So we packed up and went around Australia for a year and a half, which was super fun. So I highly recommend semi-retirement. I think that process of giving up full time family practice, the disappointing all your patients, the little grief journey that happens when you're leaving people behind because you've loved and looked after these people for a solid five years. But the lesson on the other side of that, that you are replaceable and that's a beautiful thing as a physician. I think that was a lesson I didn't expect to learn that early in my journey. And what it did is created less of that feeling trapped in family medicine and more of that ability to figure out, Oh, this, it can be different, it can look different. I can kind of reinvent myself and it's all going to be okay. So that was part of the exiting family medicine. So we then went around Australia, I locumed for that year and a half back in emergency departments, which was super fun in the middle of frickin nowhere in Australia. And then at the end of that journey we were just sitting around as a family wondering what to do next with ourselves, and Canada had some openings, so we came here for a year and we stayed. So back in full time family medicine. And then this paperwork problem reemerged.

Dr. Kevin Mailo: [00:04:05] So it followed you?

Dr. Sarah Smith: [00:04:06] It followed me.

Dr. Kevin Mailo: [00:04:07] One continent to another continent.

Dr. Sarah Smith: [00:04:09] Right, across continents. Totally different government system, billing system. Even the way we see patients in Canada, different from Australia. So in Australia it's one room, that's your office and your patient room. So you've got to exit one patient before you can get your next one in. So you're really limited in the number of patients you can see a day. Like it really puts a significant time delay in turning over appointments, versus in Canada I had an office, two consultation rooms, somebody to usher my patients in, tell them to get undressed and put gowns on, or anything of that nature. So it was a totally different practice and - boom. I'm back to this point in my family medicine day, where I don't know when I'm going to be home. Hours after the last patient left. I get a text from husband almost every day saying, When are you home? Because it's dinnertime. So I hurry up and pack up and head home knowing full well I'm not done, nowhere near done. After family time is done for the night, I'm back on the computer. Hours and hours every night. And my weekends were also disappearing in, I've got paperwork. Like this was a common thread that I was noticing. And throughout my career I'd asked every mentor, How do we do this? How do we do the paperwork? What do you do to overcome like the paperwork? It was just all consuming. My mind was constantly thinking about the work that wasn't done, and it was a huge burden. And so that was where I found myself. Unhappy.

Dr. Kevin Mailo: [00:05:48] You bet. And I think what you're sharing is the same frustrations that physicians coast to coast in this country face with, you know, what appears to be ever growing paperwork and EMRs have not necessarily helped this. And so before we dive into, you know some specifics around, you know, charting and workflow, talk to us - I mean, you touched on this - but talk to us in more depth about the why. Why is this so important in our lives? And I'll share a couple of my own thoughts on this. But why do we need to be doing better with our charting?

Dr. Sarah Smith: [00:06:23] Yeah. So my big a-ha, I was standing somewhere in my living room, in my house somewhere, and my kid's in grade ten at that point. He's older now and I just, and it's still emotional a little bit, of course I'm going to miss it. I'm going to miss his last two years of being at home. Because of the paperwork. And that for me was enough. In addition to that, when I'm looking after physicians, it's about, they're diluting their income. They're under-earning even if they're earning. You've earned the money in the room most of the time, like occasionally, if you're doing it same day and you're in that file a bit longer, you might get some time modifiers depending on which part of the country you're in. But for the most part, we have earned the money in the room. Now, if we listen to what doctors are saying, that every hour of time with my patients equals an hour of admin time, now we're diluting our income, right? If you actually work out your hourly rate at that point, significant difference.

Dr. Kevin Mailo: [00:07:33] Oh, massively, massively. Right? And this matters. I mean, it's actually something we teach at Physician Empowerment's finance classes, right? Is that we discuss the notion of hourly rate. And the hourly rate doesn't just include your clinical work, it includes your administrative time and charting time. Right? You know, and it's not about creating more space to see more patients. It's about doing better on the ones we've got so that we create more time for ourselves and for our families.

Dr. Sarah Smith: [00:08:06] Yeah. When I was in this moment, before I changed it, my days felt heavy, trapped, drowning, overwhelmed, I dreaded work. I was seeing as many people as I could fit in in a day, and that was too much. And then every single request that came in, like, now we want you to monitor, you know, whether they're a smoker or not. Now we want you to measure their height and weight once a year. Any other requests just felt like they were stripping me of anything I had left. It was, the ask was too much. And so it felt like I had no control over my clinical day whatsoever. It was already packed. Don't ask me to do anything.

Dr. Kevin Mailo: [00:08:52] It's a lack of control.

Dr. Sarah Smith: [00:08:53] I can not do it.

Dr. Kevin Mailo: [00:08:55] And that is tied to well-being across many, many industries and fields, is a sense of lack of control and disconnectedness. Please keep going. This is very good.

Dr. Sarah Smith: [00:09:07] Then I would take three forms home on the weekend. Right? At the end of the consultation they hand you a form, Oh, can you get this done? When you get a minute? My brain would say, There's an hour of my life gone. That was a sentence my brain had about this form. And it wasn't just an hour. If I took those three forms home for the weekend, I would tell my family, I can't go to that barbecue. We can't go to the lake. I have paperwork. I would spend all weekend cleaning my cupboards, washing down, you know, the kitchen was sparkling because I was procrastinating these forms. And then I'd go to work Monday morning having not done them. When I finally did them, I got 90 bucks, right? For three forms.

Dr. Kevin Mailo: [00:09:50] Right. What is that worth? What was that worth over your weekend?

Dr. Sarah Smith: [00:09:56] Right? If like the actual amount of money I got for those three forms, maybe maximum 500 bucks, but not worth a whole weekend of, I can't I've got paperwork. The mental energy attached to that, the disappointedness I had about myself not getting them done, even though I'd given up a whole weekend for it. So maddening, just maddening. And the fact that it had been there at the beginning. I took these two years off thinking I'm in a better place, get to my next workplace, new continent, same things happening. I'm like, What has gone wrong?

Dr. Kevin Mailo: [00:10:31] Absolutely true. Right? So this isn't just about money and our hourly rate. This is about, this isn't just about time management. This is much bigger. This is about our personal well-being. And our psychological well-being. We should all have healthy boundaries between our places of work and our homes, and the charting issue erodes that massively. Massively, right? And it's important to be able to set up boundaries, right? We talk about boundaries with our patients. We talk about boundaries with colleagues, but it's also boundaries with ourselves in terms of charting and paperwork. And it's not just about saying no to another useless meeting or saying no to another committee that you didn't really want to sit on, if I can be blunt. It's also about saying no to that impulse to do more paperwork, right. Or just, you know, putting too many patients in and not having enough space or time to chart properly.

Dr. Sarah Smith: [00:11:29] The other thing was when I would chart in the evening after everyone's gone to bed, or in the morning, you know, get up at four in the morning because I was too tired the night before.

Dr. Kevin Mailo: [00:11:40] Oh, goodness.

Dr. Sarah Smith: [00:11:40] Didn't think I was hurting anybody. It was only it was like, well, there's no one else awake, so it's not hurting anyone to do it then. And I heard this from a physician recently as well in my program that, you know, I wasn't hurting anyone when I was charting in the morning, but I realized I was hurting myself because I wasn't getting the sleep I needed, which meant the next day wasn't as efficient. My brain was already tired before I even turned up because I'd already been on the computer for three hours before work even started. So it is impacting our lives even when we're trying to hide it in the minor hours of the evenings or mornings. So.

Dr. Kevin Mailo: [00:12:19] Well, and even just, we're just not as joyful in our personal lives. I mean, how do you feel about going to the gym after getting up at four in the morning to chart? Well, how much mental energy do you have for your practice or yourself or your family life?

Dr. Sarah Smith: [00:12:33] Yeah, I hadn't exercised in years and I wasn't alone. When I'm talking to physicians who are in the pain of this right now, haven't exercised in years, haven't picked up a book in years, haven't sat on the couch and watched a movie with my family without thinking about work for years. I haven't had a weekend for years. This is not uncommon. Like literally all weekend, I've got no other hobbies anyway, I might as well just do my paperwork. It just becomes a familiar and comfortable cycle that if we're not aware of it and taking notice of it, it starts to just be there as a thing.

Dr. Kevin Mailo: [00:13:10] Absolutely. Absolutely. So, Sarah, take us through your process. What's your approach? So we know how important this is, not only about practicing better medicine, but about being happier, being more psychologically healthy. Talk to us about your process. Tell us how that works.

Dr. Sarah Smith: [00:13:31] So, all of us work in different environments, we have different EMRs, different staff, different patient appointment lengths, different things we're doing in our clinical day. So some of us will be family physicians, some of us will be other specialist types, but we all have to see patients, do the documentation, and then we have the rest of today's work. So we start separating it out into the patient protected time where we're seeing patients and closing charts. And then we have the rest of today's work, which, you know, for a number of years I didn't even notice that work as an actual math, right? So it was just stuff that happened to me during the day. My inboxes, my messages, my forms. There was no think to it, it was just other randomness about my day. It wasn't something I was ever paying attention to and I was never doing efficiently. So, for instance, when I was first noticing my clinical day - and I think that's where we start, we just notice first what's happening - we see patients, then we come out, we sit at our desk because maybe some intention of doing the work, right, of the documentation from that encounter and what happens, Oh, there's three patients waiting. Off I go, next patient, right? Or I sit down, I see that blinky thing in the corner that says I have things in my inbox, so I open it up, I look at the first one, I'm like, Well, I don't have time to do that right now. So I close it. But instead of doing the documentation, I go to the next thing on that work list. Oh, I don't have time for that either. So now we're doing work twice, right?

Dr. Kevin Mailo: [00:15:12] Wow, yes.

Dr. Sarah Smith: [00:15:12] And we're task switching, so we are draining our decision making.

Dr. Kevin Mailo: [00:15:19] Yeah. Absolutely.

Dr. Sarah Smith: [00:15:20] So we've come out of the room, we've spent two minutes effing around in our inbox or thinking about, Oh, I've got three patients waiting five minutes, ten minutes, forty-five minutes behind, and off we run to the next patient. So what are we doing now? We're taking that last encounter and we're packing it into our working memory. Now physicians are very, very amazing with our working memory, right? We can pack in a huge amount in there. And we've done it for so long that we just do it automatically. But you're in the next patient's room, you're listening to that story, you're wondering about the minutes behind you, and the things in your inbox that are kind of starting to collect. And then you're like, Oh yeah, I mustn't forget to do that referral that I said I would do for the patient number one. Oh, hang on, there's somebody in front of me talking. Wait a minute. Kind of rewind back into them. Kind of, Remind me again, what did you say? You kind of, so you're not even present in the room. Okay. So by the time we get anywhere close to the end of the morning, our brain is exhausted. We've been doing all of this stuff.

Dr. Kevin Mailo: [00:16:33] Absolutely. It feels like an emergency shift. The task switching, the carrying a whole bunch in your head simultaneously, without question.

Dr. Sarah Smith: [00:16:42] You get to lunch and you're like, okay, I'll get at least some of those charts done. So you, with all very good intention, jump into your charts. Or maybe you think, Oh no, the inbox is more important. So you jump into the inbox, whatever it is you decide to do, you kind of just do it the way you have always done it for a number of years, right? There was no teaching on this. It was just whatever we happened to think was most important or prioritized. Or maybe we just sit there for the first ten minutes of lunch thinking, well, where do I even start? There's so much to do. And even that level of, that was the energy you needed to start. And you're using it to figure out what do I do first? But it really doesn't matter what you do first because it all needs to be done, right? Then we hit the afternoon. Woof. Hyped. If we're lucky, we've had water and food. Some of us have run so far behind, we're running into the afternoon having not stopped at all. Our bladders get bigger, our working memory is working really hard right now. Multiple tabs open. Okay. It's exhausting. It's exhausting. So we teach you, you see a patient, you close the chart, you see the patient, you close the chart. That's our patient protected time. What is left? What's left is the rest of today's work. Now we need to figure out how much is that? What is that worth in time? If I was to sit down and with the time to say yes to that inbox, what's it going to take to empty out two days work? Not the backlog, not yesterday's charts, not like last week's labs. We're just thinking about what is the work of today. And actually starting to just be curious about that. So that's the starting blocks, is noticing, measuring, starting to be curious about how could I change this and do it differently.

Dr. Kevin Mailo: [00:18:41] Absolutely. Absolutely. So what approaches do you take in terms of like, a charting review. If you can take me through where to start on making things better with a client. What does that start with?

Dr. Sarah Smith: [00:18:59] Yeah, so we're trying to find your most simple solution to getting your charts done. And so you might type, you might dictate, you have a process that you're already familiar with. We want to optimize that. So we're not wanting you to change your EMR or learn a new system or buy a scribe. This is not how it works. This is about you in the environment that you work right now, right? So this is you with your EMR, your staff right now, the patients you have, and saying, if I wanted to see patients and close charts, now what? What already exists at the end of this consultation, how long does my charting take? What is in my note and why is it in there? You know you are the boss of your note. You know what needs to be in your note. We need to, obviously, what happened, what were the pertinent features that support the working diagnosis and the differential? What was the plan? What was the education given? What was needed for insurance, if you're in the US right, to be able to get some things approved. So whatever that looks like. Now we've got neurologists, rheumatologists, neuroophthalmologists, psychiatrists, who thought this was impossible, too. Family doctors think it's impossible. And they're doing it. Seeing patients and closing charts. So it's not impossible. And if there's any other message, it's that you can create impossible if you want to. But it is not like a tomorrow we're going to have, it's a if you want this, what do I want to work on first? What looks like low hanging fruit about this idea, right?

Dr. Kevin Mailo: [00:20:47] I love that.

Dr. Sarah Smith: [00:20:48] And stepping towards the very first step towards it and just not giving up. If we quit, we just get what we have right now. Which is disaster. Horrible. Don't like it. Unpleasant. I'm done with this. And if it's, I want something different, it's like any goal you've ever run towards, right? It's uncomfortable. It's different. It takes a lot of mental energy to do it differently, but it's figuring out what would make this easier for me. We come up with, we come up against a lot of objections, right?

Dr. Kevin Mailo: [00:21:23] How often do you see that there's just too much getting put down in the EMR? Like it's too verbose. Do you see that a lot or is that not a major issue?

Dr. Sarah Smith: [00:21:32] So the too much, too verbose, or it's got to be perfect. Absolutely part of this journey, right? Absolutely it's part of this journey and it's the noticing why you're doing that. So what is in your note and why? Right? And I often say, this is one of the little marks, who are you imagining is reading your note? Like, actually get a picture of that person. When you recognize who they are, and it may be someone from your past, so for me, it was a white haired white guy professor. Right? And he was a little frightening in my medical school. And he didn't like me at all. When I realized I thought it was him who was going to look over my shoulder at my notes, I'm like, Why would I let him decide to give up my evenings and weekends. Just one of the tricks of like, that different perspective. Is that, Oh, interesting.

Dr. Kevin Mailo: [00:22:34] Absolutely. Absolutely. What about the role of templates? Talk to us about that.

Dr. Sarah Smith: [00:22:41] Yeah, Anything that helps you. Like, so the template. So there are, you know, Facebook sites where people share templates and that, maybe that's not the right option for you. We want something that you're going to use without having to edit it too much. Same with your short phrases and other things you pull into the chart. If you pull them in and then edit them for the next three minutes, that's ridiculous. Stop it. Find something that works for you. Do I use templates? Not really. Like, I've got like a three in total that I use. I don't, that's not my style. But this is not about me. This is about you. What's going to make it more simple, easy, faster for you. That is what we're looking for. And that's what we're always looking for when we're talking to physicians is, I'm noticing, you know, what they're doing right now and how they could make some easy changes. That's what we're doing, we're just kind of taking a look at what's already happening and optimizing that.

Dr. Kevin Mailo: [00:23:43] Do you find that there's a difference between family physicians and, let's say, clinic based specialists or the issue is pretty much the same?

Dr. Sarah Smith: [00:23:52] So yes and no. So when we're looking at if consultant specialists, so somebody is going to be seeing this patient once, it's somewhat different than the family doctor who's seeing them over like that continuity. So there is differences in the content of what's required within that appointment and the who is receiving the information that's being gathered in that consultation. So there absolutely is different reasons for these consultations, different objectives at the end, but that's also important. So what is the objective? What is the question I'm being asked when I'm seeing this patient, could help you run this consultation more efficiently. So running the consultation has its own skill sets. And for instance, if a psychiatrist is being asked which medications might most help this patient, they're not necessarily being asked, have we got the diagnosis right? So it could actually change the objectives of how we're going to approach this consultation.

Dr. Kevin Mailo: [00:25:07] Got that. What about the laundry list of issues that comes up? I mean, I remember that from my family medicine training. You still see it in the emerg occasionally, especially with our geriatric patients. Right? We have to sit down and go, wow, there's a lot here, you know, a patient comes in with a family member or loved one. So talk to us about that. Is this a, is this a time management thing where you say, listen, these all are important issues should we reschedule so we can go through these with a little bit more time, you know? Or is there also an element of charting here? Talk to us about what this looks like.

Dr. Sarah Smith: [00:25:41] Yeah. So this is like a really broad topic and that's okay. Let's try and handle it from a few different places. So the patient comes in and says, you know, I've got back pain, I need my meds renewed, and, you know, by the way - it's usually when you put your hand on the doorknob to end the consultation - and by the way, right? Or here's my list. I haven't been able to get in with you for a while. So it's again part of this taking notice of our clinical day and what we always do. So if your next access visit is in a month, but physicians will often say yes to the ask in the room because they know it's a month away until they can get the next patient in, like to get them back in. Notice that. Notice that. Oh, I see the way I've designed my appointment schedule, it's fully booked for four weeks. That's not helping me because now I say yes to the list in the room because I've got nowhere to put them next week. Oh. Now what about our appointment list? So in Canada the really nice thing about physicians that I've noticed, Canada to US it's a little bit different, is the level of autonomy that we often have in Canada. Not all of us, but many of us. So that appointment list is set up that way because that's how everybody else has set it up. If we actually think about, well, what would help me? Oh, I could get them in next week. That would be helpful. Now what? How could we start to think about that? So just, it's taking a step back from the busy and saying, well, why am I making these decisions? Because they are the executive decision maker. You are the executive decision maker in your appointments. Number two, our patients never, ever, ever understand how long it takes to do back pain. How long it takes. How long it takes to renew scripts. No idea. Okay.

Dr. Kevin Mailo: [00:27:51] Yeah, the way I heard it when I was taught, actually when I was in Edson, I forgot to mention on the podcast, Edson is a very special place where you practice where you live, Sarah, because I spent nine months there during medical school, um, during my clerkship years. But I remember one of my preceptors saying exactly that - the patient comes into the encounter with one agenda and you have your own agenda, right? Like they want something for their back pain and you want to make sure that it doesn't need imaging, that there are no red flags there. Right? And of course, you know, treat it. But, you know, it's about reconciling those differing agendas.

Dr. Sarah Smith: [00:28:29] Yeah. And so it's not about I don't have time for this or I've got too many patients today or I, you know, it's nothing to do with it. Right? Patients are always self-centered. Of course they are. They don't care that you haven't peed today, that you haven't had lunch yet. They've got their idea of what they want, but it's up to us to guide them in what I can do for you well, right. So, I would like to have the opportunity to do a good job for this back pain. Right? So we're going to do the normal important things like check for red flags, hear a little bit of the problem, and then deflecting it to the next appointment is not about I don't have time today. It's about, I want to do a good job for this. Let's rebook that. So it's, is this a one problem per visit? No. You are still the boss. So it's about saying I am making the choice to say yes to this request or deny this request. I am deciding to say yes to this little old lady because I know she's traveled three hours and her daughter lives in B.C. and now is here in Edson with her. I'm going to say yes to spending that little bit more time here today at the cost of, of course I'm going to be running 20 minutes behind at the end of this, that's okay, I've decided to. Rather than, Oh, I can't believe they did this to me. Don't they understand I only have 15 minutes or 10 minutes? Don't they understand I only get paid $31, $38 for this? Like, whatever that internal frustration is that we're hearing, it changes when we start to be the decision maker, the one who is in control of this clinical encounter.

Dr. Kevin Mailo: [00:30:22] Absolutely.

Dr. Sarah Smith: [00:30:23] That's the change. That's the biggest change. So when somebody brings a list in. I'm totally fine. I'm not immediately going to that place of, of course they did, is what my brain said. Of course they brought a list.

Dr. Kevin Mailo: [00:30:37] It's that notion of acceptance.

Dr. Sarah Smith: [00:30:39] And it's totally fine because I know how to handle a list, a request, I know what I will say yes to, and I know when I'll say no. And even when the patient has a grumpy face, says something different than what I was expecting other than a loving comment, it's okay. I can hold space for me to be okay that I'm doing the best I can with what I'm given.

Dr. Kevin Mailo: [00:31:01] Good. I love that. So, Dr. Smith, Sarah, we actually have to wrap up. I can't believe it went by as quickly as it did. Absolutely loved it. And this is so important to physicians. You know, I just keep coming back to your personal story and what charting meant to you or disorganized charting meant in your own life. Right? And I think that's so powerful to share that, because I think we're all feeling feeling that, you know, regardless of practice, background, we struggle with it. I'm just going to leave a teaser out there for our listeners. But Doctor Smith also goes much broader than this and discusses practice optimization or what was your term for it, Sarah?

Dr. Sarah Smith: [00:31:44] Sustainable clinical medicine.

Dr. Kevin Mailo: [00:31:46] Love that, love that. And so we're going to get you back on the show later to hear more about this because obviously it's more than just what we're doing and charting. And so again, I sincerely want to thank you for your time today on the podcast, Sarah. Thank you so much. And if anybody is looking her up, she is the charting coach.

Dr. Sarah Smith: [00:32:05] Yeah, ChartingCoach.ca

Dr. Kevin Mailo: [00:32:07] The ChartingCoach.ca. Love it. Thank you so much.

Dr. Kevin Mailo: [00:32:12] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Kevin Mailo and Dr. Wing Lim welcome financial advisor Goran Ogar to the show to share some tax code insights that a lot of general accountants may not know. Goran specializes in complex tax strategies for professionals, the very wealthy, and corporate entities. His understanding of the Income Tax Act is second to none. 

Goran first explains why many accountants and lawyers don’t know all the ins and outs of the tax regulations. It’s a very complex thing to study in its entirety. He then explains how corporate taxation works upon a business owner’s death and how 60% of the assets will end up double taxes so only 40% remains to pass on. How can this be avoided?

In this episode, Kevin Mailo and Wing Lim, with guest Goran Ogar, discuss the strategies to be found within permanent life insurance, how to collateralize on the opportunity for loans on insurance investment, and why strategies are necessary for personal businesses earning over $200,000 per annum. As Wing says, this episode is like reading the table of contents of a book you are very interested in, so there will be more in depth insight from Goran in the future. Start here and keep listening.

About Goran Ogar

Goran Ogar is a financial strategist and advisor recognized by his colleagues for having a unique command of the most complex financial issues as it pertains to corporate tax and legal matters. He started his career in the financial industry in 2001 as an independent financial advisor, and has taught over 500 seminars and workshops on various financial topics. He approaches financial planning by first taking time to learn the specific values that his clients hold dear, then he identifies solutions to their challenges, and communicates a clear and concise course of action that is in alignment with those values.

In addition to the financial advisory career, his entrepreneurial endeavours gave him first hand experience in business. He developed and started businesses in the areas of real estate, recycling, oil and gas, and hospitality. His business activities ranged from startups and initial fundraising to public company mergers and acquisitions. 

Resources Discussed in this Episode:

• Save the Date for May 6-7, 2023 in Toronto
• Goran Ogar on LinkedIn
• Brilyant

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Physician Empowerment: website | facebook | linkedin

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Transcript

Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - That's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.

Kevin Mailo: [00:00:35] Hi everyone. I'm Kevin Mailo, one of the co-founders of Physician Empowerment. And tonight I'm joined by Wing, also one of the co-founders, and he is going to be interviewing an associate of ours, Mr. Goran Ogar. And I'm not going to introduce Goran. I'm going to let Wing do that, but I'm going to introduce the topic. And the topic is this: Aspects of the Canadian tax code that your accountant or lawyer may not be aware of. So a bit of a controversial topic and a very fascinating deep dive. And I'm really looking forward to this one because Goran has a ton of background in tax planning for high net worth individuals as well as businesses and start ups. So with that being said, I'm going to step back and I'm going to let you run the show here, Wing. Take us through this great topic.

Wing Lim: [00:01:26] Right on. Thank you. So I'm Wing. Dr. Wing Lim. I'm one of the co-founders of of Physician Empowerment. And some of you know me very well, some of you I may not know. Anyways, I'm absolutely excited to interview Goran tonight. Goran and I went back 20 some years ago. A past kind of crisscross, and then we're working on some really interesting stuff together. So yes, so the topic is highly controversial, but let me introduce why I would interview Goran? He's one of the most interesting guys I know and we say that our webinar and podcast, we want to interview interesting people and interesting topics. So Goran, of all, he came from Serbia and of all places that he chose to fly to, he chose the Frozen North called Edmonton 25 years ago and he actually became a preacher, went to school, become a preacher, and ended up in the financial world. But not just that. He did a bunch of start ups, different companies. He's a serial entrepreneur. I consider myself one of those too. And it's not open up serial companies, it's serial as a bunch. And he's taken some companies public that's in the oil and gas industry and others, and he's done restaurants and different things. Him and his wife both like they they cook so well, it's like MasterChef, and they fix a meal for me and my wife, it was absolutely amazing. And so Goran is not the type of financial advisor that goes around drumming up clients. He has a select suite of select high net worth clients, and some of them are in this professional space, but some are extremely wealthy. And he, I would call him specializing in complex tax strategies. He's been retained by various companies to do retirement planning, and two of which that is in our city, is University of Alberta and NAIT - North Alberta Institute of Technology. And these are, and they hire him just to help people retire. Right? So without further ado, Goran so tell tell us about your yourself, your journey, like it's really interesting path you crisscross.

Goran Ogar: [00:03:33] Yeah well I came back in mid-nineties to Edmonton to study theology of all things, and when I finished my undergrad studies I continued for the master's degree and had a really good friend who was a financial advisor. He showed me strategies that he was doing - in particular tax strategies that he was doing - for his clients. And I just fell in love with the process of strategizing, figuring out different things. And the bottom line for me was figuring out how to, and learning how to reduce the tax burden. And so that was about 21 years ago. And I decided at that time to join a company, Assante Wealth Management is the company I joined, and became a financial advisor. And one thing that was very interesting for me, because before getting into financial industry, I was a teacher at local college here and teaching was the only thing that I knew how to do at the time. So I prepared courses on financial planning and tax strategizing and approached large companies in Edmonton area. And the University of Alberta was one of them, NAIT was another, Sherritt International, Dow Chemical and dozen other companies. They hired me and I was doing their financial planning, educating their employees for probably about 12, 13 years or so. But in that period, getting to know and meeting lots of entrepreneurs, I myself decided to become an entrepreneur myself and in the process started several companies in oil and gas, in tire recycling, hospitality. That was probably the most painful experience, owning the restaurant. I wouldn't advise anybody, you know, unless you're so passionate, but hey, I did it and it was a fun experience. So, and lots of good stories to tell from that.

Wing Lim: [00:05:23] That's good. The good, the bad and ugly. And so, okay. So with that diverse background, of course you dealt with some really high net worth family offices and individuals, and there are stories that - I don't want to belabor everybody, but there are people worth double digit million - and then their tax advisers goofed. Right? And then as a result, they paid millions and millions of dollars in tax they shouldn't have. So for our level, regular human beings, doctors. So what? So what could possibly, the tax code, what could possibly our accountants and lawyers not know? Didn't they go to school?

Goran Ogar: [00:06:02] Well, they did. The challenge is that the Income Tax Act is about 3500 pages thick. And in order to reduce taxes, you need to know the rules. And to know all the rules is pretty difficult. You really need to have an income tax act as your bedtime read. And very few people do that and on top of income tax, there's income tax regulations as well. That's another 1500 pages. So when you start looking at the whole picture of how the taxes are regulated in Canada, there's lots of material to study. The challenge is, in particular for lawyers and for the accountants, is many of those things are not even being taught during their education as they're getting their certification degrees and being actually accepted to the bar, because other things are more interesting. And there is, there are other things that are more of a focus. So the taxation does ends up being a really specialized field because even every accountant you will come across a tax accountant. So there is a general account, there is a tax accountant and actual tax accountants, very few of them are out there. Most of them are, most of the accountants are general accountants, so they don't focus on strategizing and the strategies that would be applicable both to the individuals and the small businesses or any size business. So the taxation is really narrow field and there are way too few, if you will, specialists in that regard.

Wing Lim: [00:07:36] Right on. And so we, those of us who are married, said the vows till death do we part. It might hold true for marriages. It doesn't hold true for taxes. And sometimes till death do we start, right? And so. So maybe we should start there. So let's start with the end in mind. Right? So what happens when we pass on? We say work all our life, save the money, and then what does this tax man get if we just don't do capital planning?

Goran Ogar: [00:08:13] Yeah. The big challenge is in particular with people who own corporations and most of the physicians are corporate owners. You are a business owner, you run a business whether you feel that you are a business owner or not, you are. That's the bottom line. And essentially, when a person, business owner who's, let's say 100% or 50% business owner, when that person passes away, the corporation is deemed as disposing of all the assets. So the corporation gets taxed pretty much at the highest marginal tax rate when the owner passes away. So the corporation gets taxed at about 50% tax rate. Now, the next step is for the assets to pass to the estate. And as an inheritance, there is another layer of tax that comes on top of that that the estate is going to pay at the disposition of those assets. So unless there is a proper tax planning, there is double taxation at the corporate level and then at the personal level. And that tax could be easily north of 60% of the total assets that would go to the government.

Wing Lim: [00:09:24] So wait a minute, wait a minute. So you say, okay, so we work our butts off over the years. Let's say we save $1 million in assets passes to the next generation. So what really passes to the hands of our children is only 40%.

Goran Ogar: [00:09:39] Roughly 40%, if no planning was done. Right?

Wing Lim: [00:09:43] Wow. So what about what about these RSPs that everybody's racking up? I've known people rack up millions of dollars in RSP and then become whatever Lira. And what happens to those?

Goran Ogar: [00:09:54] Well, when the person passes away, if that's the last person, let's say in a couple, right? So all the assets are considered to be sold. So full withdrawal of the RSPs happens. And pretty much if there is $1 million in the RSPs that's considered in the terminal year, the year of death, that's considered as an income to the person that passed away. So at $1 million, that would be the highest tax rate depending on the province where you are, 2 or 3% up or down from 50% of the money would go to the government depending on the province. So 47, 48 to 53% in Canada goes to the government from the RSPs. Same with Lira, right? The only actually type of account, registered type of account, that would not be hit by that is TFSA, tax free savings account. But unfortunately, with the tax free savings account, there is very limited amount of money that could be invested in it.

Wing Lim: [00:10:56] That's so good that the government has to limit it.

Goran Ogar: [00:10:59] That's right.

Wing Lim: [00:11:00] Yeah. Now, the other thing, the government, is so good that the government have to limit it is insurance.

Goran Ogar: [00:11:06] That's right. Yeah. So there are three types of insurance, actually two categories. There is term insurance and there is permanent insurance. And permanent insurance could be as universal life and whole life. What's interesting is about five years ago, the government reduced the amount of money that could be placed inside the insurance. And when I say placed inside the insurance, permanent life insurance is very different from the term insurance. Term insurance is only insurance that has pure insurance cost in it, plus some administration fees and stuff like that. So it's kind of like people consider it as a cheap, the least expensive type of insurance. It's not, actually it's even more expensive When you look at the net cost of pure insurance, it's slightly more expensive than net cost of pure insurance inside the permanent policies. Now, with the permanent policies, that's universal life and whole life, there is the insurance component, but there is also the investment component. In the past, government used to allow a significant amount of money to go into the investment portion of the permanent policies. And the challenge for the government was that the investment inside the insurance is exempt from the taxation. So it behaves in a similar way like tax free savings account. And essentially a person could put a large amount of money to grow at your discretion. If it's universal life, you can invest however you want - mutual funds, stocks, index funds - whatever you want to have in your portfolio. And that money would grow on a tax free basis and at the time of passing, it would go to the estate on a tax free basis as well. But also a person could withdraw from there in the form of a collateral loan or a straight withdrawal. We can get into it a little bit later, but about five years ago, the government decided to reduce the amount of money that the person could invest inside the universal life policies simply because lots of people were put in a significantly large amounts of money into those life insurance policies and without paying any tax on them.

Wing Lim: [00:13:29] So that's that's actually the wealthy people secret weapon, right? They have so much inside this TFS on steroids which is insurance, permanent insurance, and jacking up just getting fatter and fatter. And at the end the government gets so little tax out of it, they have to limit because it's so good.

Goran Ogar: [00:13:49] That's right. There are certain strategies, we're not going to go into all the details because our time is limited from that perspective. But there are certain strategies that could be used with the, within those policies, and with the corporation where literally corporate money could be withdrawn outside of the corporation without triggering any tax.

Wing Lim: [00:14:10] Yeah. Now so we don't have time to go dive into that. But this is very interesting. So would you, so comparison number one, you have a bunch of assets portfolio. You know usually the regular Joe doctor goes to the regular Joe accountant and they say, okay, pay yourself T5, save a bunch of money in the corp and invest in the corp and build up the portfolio. And upon death, like you say, there's double taxation. There's like 60% gone to the tax man. So what happens if there is an insurance policy?

Goran Ogar: [00:14:41] So essentially how it works with insurance policy, let's say if it's corporate owned insurance policy, so there is no withdrawal of money outside of the corporation. If a person would set up insurance policy, they could dump in a large amount of money as an investment inside that policy. So that money would number one, it would grow tax sheltered. What it means is there would be no taxation. So again, similar to the RSPs or tax free savings account, as compared to regular investment inside the corporation, which would trigger passive income taxation. And at about three, four years ago, the government actually was addressing the passive income inside the corporations. And if your passive income is over $50,000 per year, you lose the benefit of the small business deduction, which means you're getting taxed as a large business. Even on the first portion of a half $1 million. With the life insurance, permanent life insurance policies - so universal life or whole life - you completely bypass the passive income taxation. Now, if the investment inside the policy grows and let's say if it stays there 34 years until a person passes away, the proceeds from the insurance are paid into the corporation, number one, on a tax free basis. So they hit the corporate account on a tax free basis. The corporation does not pay any money in tax and as a result, proceeds from the insurance create something that's called capital dividend account or short, abbreviated CDA. The capital dividend account is a notional account, so it's used only for the accounting purposes. But that account allows the funds from the corporation to be passed on to outside of the corporation on a tax free basis. So which means all the assets that are accumulated inside the corporation within that policy would pass to the heirs without triggering any tax at all. So even if it's corporate money.

Wing Lim: [00:16:54] Wow. So let's dial back a little bit. So same thing, right? So you work your buns off, have $1 million nest egg. Right? So you put it, uh, hide it inside a policy, permanent life policy, which is corporately owned by your place of work or whichever, so upon death is not just the insured amount - whatever 1, 2, 3 million - that goes to your offspring, but also the growth inside it is tax free compound over 30, whatever decades. And it goes down tax free.

Goran Ogar: [00:17:25] That's right. Yeah.

Wing Lim: [00:17:27] So then then so the comparison is we, my wife was a financial planner like 30 years ago, and at that time we read the book The Wealthy Barber, and said, okay, buy term life the cheapest to hold it personally, then you don't have to worry about pulling it out of the corp. Then the difference is a million, you only get 400 down to your kids or 300 versus a million. So for us to believe in that, we have to work 2 to 3 times harder to save a million to the next generation. That's absolutely crazy. But that's, everyday Joe, that's the advice that we got.

Goran Ogar: [00:18:02] Yeah, well, that's the challenge with the advice. That's the challenge with the taxation. Because even I had an opportunity to chat with an accountant, one of my client's accountants - this was about 4 or 5 weeks ago - and the conversation revolved about the taxation and certain aspects, and I mentioned a different accounting firm and certain strategy. I was going to send the documents that I received from that accounting firm, kind of saying that the strategy is okay and that that's what they recommend to the clients. His comment to me was, Well, I don't like what they're saying because they approve of capital gains stripping. I'm not going to go into that strategy. But it's a very unique strategy. It's called, in other words, a pipeline strategy for a corporate tax planning. He was upset because the other accounting firm utilizes that for their clients. Well, the other accounting firm is actually a large national firm. I'm not going to name that firm, but it's a large national firm that has a very good auditors and frankly, CRA does not come against them very often, if ever. So they're utilizing this strategy that the other accountant that did not approve. Why? Simply for the lack of understanding and knowledge of certain aspects of a tax code.

Wing Lim: [00:19:35] Right. Now, so yeah, this is very interesting. So let's move on. So do we have to, all these benefits just from one strategy you're talking about, do we have to wait till we die to benefit from.

Goran Ogar: [00:19:48] No you don't. No, because, so let's say with with the permanent policies, if they're a part of the corporation and if the funds are accumulated inside the corporation, you can either withdraw money from it. Now, it would be taxed if it's withdrawn outside the corporation. Another option is to use those funds and use it as a collateral asset for the loans, and pretty much every major bank in Canada will lend you money against a permanent life policy outside of the corporation for the corporate asset. So the way we structure it often is, let's say if there is retirement planning, so an individual, a business owner, would invest a large amount of money inside the insurance policy. When the time for the retirement comes, they would just have a series of loans outside of the corporation, which would be a tax free money to them. Let's say a series of 20 loans, 20 annual loans for the 20 years. So all the the money is not withdrawn. It's alone. The investment inside the permanent life policy continues to grow. And upon death the insurance policy pays the proceeds to the corporation, as I mentioned earlier, from the corporation it gets on a tax free basis to the heirs or to the estate outside. A portion is used to pay off those loans and the rest stays tax free with the family or with the heirs. So a person can simply use that, collateralized, use a loan as a tax free income in retirement against the assets inside the policy.

Wing Lim: [00:21:38] And in case this makes your head spin, don't worry about it. We'll have future sessions that dive into these strategies. Today is opening, by talking to Goran it's like going to a bookstore and find a very interesting book or novel and you open it and you just look at the table of contents and you're really attracted. So this is, today is one of those because there are so many interesting things. Now, let me recap it in layman's terms. My understanding is instead of going buying a cheapest term life insurance under your personal name and then pay yourself T5, the different advice that that we get here, or different brain wave, different wavelength, is actually put it inside, buy a permanent life policy inside your corporation and stuff as much as you can and build it up, build it up to be tax free. And not just that you collateralize it, right? So you borrow the money out and pay whatever prime rate or whatever. And then, but then now it's a loan under your personal name. So it's not under your corporation. It doesn't have to be in a corporation anymore. So you don't have to worry about this passive income thing. And then so you can invest. So then you have your nest egg inside a life policy that's growing, but you take it out, collateralize it, and you still, and you now you can invest again. So you got two, two piles growing. Is that true? Goran?

Goran Ogar: [00:22:59] Uh, sorry, could you repeat?

Wing Lim: [00:23:01] So your life policy is growing, right? Tax free. But you collateralize, so you borrow the money out.

Goran Ogar: [00:23:07] That's right.

Wing Lim: [00:23:08] Now you can go invest again. So. Have a second pile growing.

Goran Ogar: [00:23:12] Exactly. So what lots of people do is they would have a policy inside the corporation. They would borrow money outside the corporation and not spend that money, but actually use it for the investment purposes. So essentially, it's using a corporate money in the personal environment now, where the taxation is actually lower than inside the corporation, and that's additional benefit that could be used. So the interest in that regard becomes also tax deductible.

Wing Lim: [00:23:44] Right. And then a lot of struggling young physicians, right, we met young colleagues by the time they finish med school, they are $250 to $300,000 in debt. Right? And so they if they have this kind of policy and they do a collateral loan, and so they can pay off a little bit and still sock some money away. Right? Or can sock away for a nice retirement. So this now, this alone is amazing. What... give us another, what else would a regular physician, should should we do if we, now that we have this thinking cap on, what else would you advise? Like what other corporate restructuring strategies would you recommend?

Goran Ogar: [00:24:24] So depending on a personal situation, of course, and everybody's situation is different. But typically when I have my wish list for my clients, when I look at their situation, and that's restructuring the type of income that they draw out, I understand that people have to take out T4 income. But if you're taking T5 income, you can look at reduction of your CPP income to reduce so that you're not paying CPP, because many people are not going to use it. So for me, number one income strategy would be looking at the pipeline strategy. So I would advise many individuals, if you have income of, let's say, $200, $250,000 per year or more, utilizing pipeline strategy or capital gains stripping, would reduce your income by half, literally. Number two is setting up a permanent policy for estate planning, for retirement planning, or for immediate financing for other investments and stuff like that outside of the corporation or for a different corporation. Number three, I would say setting up a family trust, family trust and keeping the assets inside the family trust. Family trust for a reason, there are tax reasons, but also there is a control reason that will help you save money from creditors. If there are certain situations in life, there are many things that can happen that with a family trust, actually you can prevent negative consequences from happening.

Wing Lim: [00:25:59] Like a divorce of your kids.

Goran Ogar: [00:26:00] That's right. Exactly. Yeah. Yeah. Because with the family trust you can avoid even for your kids, you know, prenup agreements and stuff like that, which is often a tough conversation to have. If a person is a donor, if you like to donate money to charities, I would look at setting up a private foundation as well for those purposes, because with the private foundation, whatever you put into the private foundation, you get pretty much about 50% tax credit. But you have to spend only 3% of whatever is inside the private foundation for the charitable purposes in any given year. So those are kind of like four strategies that I would look at seriously considering setting up pretty much every business owner. Now, there are other strategies as well that could be applicable for various situations, but these four, I would say, are the core when it comes to tax savings for business owners.

Wing Lim: [00:26:56] Right on. Yeah. So somebody's already made a comment like we're drinking from a fire hose already, so 30 minutes just came and gone like that. So a couple of questions left from me. Why wouldn't more advisors tell us this?

Goran Ogar: [00:27:12] Well, I would say, number one, there is a lack of knowledge when it comes to these strategies, and I think that's the biggest issue. Number two, there is, from the accounting perspective, there is only accountants, there is always fear that you are too close to the line and that you shouldn't walk too close to the line. So I would say those two things - the lack of knowledge and fear of stepping over the boundaries - are probably the two most the biggest reasons why we don't hear about those strategies.

Wing Lim: [00:27:46] Fair enough. Fair enough. And that's why we're here to empower everyone, right? The empowerment process to empower you to ask smarter questions, write to your advisors. That's then the last question I have, if we have run of the mill advisors, we feel stuck. Do we fire them or what do we do? What are our choices and steps?

Goran Ogar: [00:28:06] I mean, that's difficult to say, you know, because I'm an advisor myself. Right? But the challenge is there are lots of good advisors out there, but there are few in comparison to the number of advisors that are there. So looking and finding a competent advisor who knows his stuff and who's willing to tackle the taxation and the estate planning and the strategies that are involved, who is willing to go extra step, if you will, with strategizing, I think would be probably the most important thing for an individual to do.

Wing Lim: [00:28:43] So what, at what time should one retain a tax lawyer? At a cost?

Goran Ogar: [00:28:50] Yeah, I would say for tax lawyer in particular with the income of $200,000 plus, I think a tax lawyer is a must because the cost for a tax lawyer at that point, percentage wise as a percentage in relation to the income, becomes justifiable.

Wing Lim: [00:29:08] Right. Yeah. Well, that's absolutely amazing. So I can share with people that, that I've learned tons and tons over the years. And when I tell people, when I meet with my accountant once a year is not ask my accountant, what do I do? Is I like do the Vulcan mind meld like Star Trek, but I suck him dry. I drive the two hour conversation and then I would pay the tax lawyer to give instruction to my accountant. Right. So that's, and inspired advisors like you, Goran, right are so, that is so rare. So rare. Well, so I want to thank you for this really, really valuable small lesson. And you definitely will be back many, many times. Let's open up the floor because we want to keep it lively a little bit. So, Kevin, maybe you can take control.

Kevin Mailo: [00:29:57] Yeah, I'll be happy to moderate. And I'll add that Goran is going to be joining us for a portion of our conference May 6th and 7th. So we got those comments, you know, from some of our webinar guests say it feels like drinking from the from the fire hose, listening to Goran talk, I couldn't agree more. And I'm right in that category myself. So if you're feeling overwhelmed or there was a lot here, this is going to be up on the podcast, so you can always listen to it again. But more importantly, just reach out to us, connect with us. Goran is going to be at the conference to answer these questions and explain these concepts in more depth. Because there is a lot here. And like Wing said, we're just glancing at the chapters of a very big book here. But if we do this properly, this can mean hundreds of thousands of dollars over the course of our careers. Right? And we sit there chasing returns on the public markets or other investments. And we're not, we're not really paying attention to the single biggest line item in our lives, which is personal and corporate taxation. So it's worthwhile doing what Wing does. Learn some of this stuff better than your accountant so that your tax lawyer can send instructions over. But that takes time and I'd encourage everybody to come and join us May 6th and 7th for a bit of a deep dive in some of these topics. So with that being said, if anyone has questions, go ahead and ask them or reach out to us via email or connect with us on the website.

Kevin Mailo: [00:31:19]  All right. We got one question. We got one question. From one of our master class participants. Thanks, Goran. Is the investment in whole life insurance going to be managed like mutual funds? You sort of touched on this earlier. Do you want to explain that a little bit more?

Goran Ogar: [00:31:34] I did, and I do, yeah. So there are two types of permanent insurance. There is universal life and there is whole life. With the universal life, you manage the portfolio just like your mutual funds portfolio. So you have probably 500 choices, with most of the companies you have 500 choices of the investments. You manage them like a mutual fund. With the whole life in particular, the company gives guarantees. So the insurance companies, they manage that portfolio for you and the income is fixed. So there is no fluctuation like in mutual funds. So they're not phased, but whatever is happening with the market. So the income is fixed on the whole life.

Wing Lim: [00:32:21] Which is amazing already.

Kevin Mailo: [00:32:25] Wow. Are whole life premiums like a corporate rate expense? I'm hoping I'm getting that right.

Wing Lim: [00:32:32] Is it a corporate expense?

Kevin Mailo: [00:32:35] Yeah.

Goran Ogar: [00:32:35] No, it's not. There is a very narrow reason when a life insurance could be a corporate expense. That is, if the bank, let's say if you're borrowing money from a bank, if they require that the principals of the corporation be insured, life insured, only then the premiums end up being corporate expense.

Wing Lim: [00:33:00] So you mean when we buy a life policy, like a whole life policy, for example, inside a corporation is a personal expense not a corporate expense?

Goran Ogar: [00:33:08] No, it's not considered. So it's after tax dollar to the corporation.

Wing Lim: [00:33:14] Okay. But it's still inside a corporation.

Goran Ogar: [00:33:17] It's inside the corporation, that's inside.

Wing Lim: [00:33:19] Inside PC not personal.

Goran Ogar: [00:33:20] Inside PC. It's not personal. That's right. Right.

Speaker5: [00:33:25] Hi. Thanks. Sorry, I can't come online. I can't show my face.

Kevin Mailo: [00:33:31] All right, go for it. Go for it.

Speaker5: [00:33:32] That was very, um, my head is still spinning. So lots of good stuff, right? So I just wanted to be sure that it's like, after you do your tax year and you have money left over, you pay taxes on it. So whatever you do with that, you can buy life insurance with that, just like you would do an investment in your corporation. So it doesn't have to be from the personal side.

Goran Ogar: [00:34:03] Yeah,it's not from personal side. So if it's corporate owned, exactly how you explain. So after you pay corporate tax, then you use those funds to invest money inside the permanent insurance.

Speaker5: [00:34:15] Okay. Thank you very much.

Goran Ogar: [00:34:17] Very welcome. I see the question, what about term life insurance? Same thing with the term life insurance. Only if the lender requires that there is life insurance on the principals, then the term life insurance could be deductible. Otherwise it's not. To the corporation.

Wing Lim: [00:34:43] There's another question. There's somebody raising hand, but there's a question ahead of that. Who would you recommend, like term life insurance versus whole life insurance?

Goran Ogar: [00:34:52] Okay. So where I would recommend the term insurance is, for example, there is, let's say, a startup company and there is a buy sell agreement between the partners and they're planning to build the company and sell it maybe in 5 to 10 years. So where there is an exit strategy that close, then I would say go for the term insurance rather than the permanent insurance for the reason of it's less money to be put in because more money is required for the corporation maybe to run. In that case, I would say term insurance because there is no other plan in a tax planning that's involved. Now, if the desire is to do additional tax planning, then I would look at the strategies with the permanent insurance. Does that answer the question?

Wing Lim: [00:35:45] So in my mind, just my 2 cents worth, we all have cell phones, right? And I would say that the cheap term life is this is a phone you can call somebody. But now people use more than just phone, right? Your whole life is managed. Right? So whole life or permanent life policies is not just a term, but a bunch of other stuff. You can use a lot more.

Goran Ogar: [00:36:05] That's right. Now, what's very important to remember, the premiums for the whole life appear to be more expensive than the term insurance and I carefully use appear to be more expensive. The cost of insurance is actually pretty much the same. Term insurance ends up being even a little bit more expensive, about 5% more expensive, than a whole life insurance because the rest of the money, whatever is the difference in the premiums, so whole life being a higher than the term insurance in terms of premiums, the spread that's here is actually what's going toward your investment as a cash value eventually that could be used for the retirement or as a collateral what we discussed earlier. And so term only appears to be cheaper. But in reality they're more or less the same cost.

Kevin Mailo: [00:37:02] You mentioned a number of strategies like capital gains stripping, whole life, family trust. Is this one after the other depending on net worth? At what net worth would these be applicable? So how do you deploy these? How do you put these together? Or do we need to sit down with someone like you, Goran, who says now's the time to do a trust, now's the time to do capital gains stripping, all that. How do we deploy all these strategies? Right?

Goran Ogar: [00:37:29] I wouldn't say there is - how would I say - there is a rule at the net worth thresholds when you start applying these strategies. With the capital gains stripping, I would say income over $200 to $250,000. That's when you start with the capital gains stripping. With the whole life, you can start at about $150 to $200 or more. With the family trust, I would start looking probably at about $350,000 income. And then with the foundation, the foundation would come after that. So there are certain stages where a person would apply one strategy and then when they hit another threshold in income, then apply another strategy. Et cetera. And beside these four strategies, there are other strategies as well that depend on the net worth of the individual. There is always a potential for the offshore tax planning and stuff like that. So yes, to answer that, it depends on the net worth which strategies would be applied, at what stage in life. Does that answer the question?

Kevin Mailo: [00:38:42] I think it's great.

Speaker5: [00:38:43] Yes. Thank you.

Goran Ogar: [00:38:44] You're welcome.

Speaker6: [00:38:46] Sorry. I'm not sure if we got you.

Goran Ogar: [00:38:49] Now we can hear you.

Speaker6: [00:38:50] Oh, really? I've been typing for the last two minutes of my question there, so.

Kevin Mailo: [00:38:55] No, no, no. Go, fire!

Speaker6: [00:38:57] Okay. Thanks a lot. Like, you've been, like, really enlightening and helpful on really making the tie between the strategy and how it's used in corporations, because I did read about this, especially in the States, and I've asked locally and tend to only get like deer in the headlight looks from advisors. So it really sounds like you've known how to put this thing to use. It's a bit of like a personal scenario kind of question, but one way, well, there's really two questions. One way I saw potentially using this strategy is in 4 or 5 years we wanted to maybe do something like building a house. I understand there's a bit of like a build up to this, the whole life insurance before it starts paying its own premiums. I'd just be curious to see if you've ever used it this way so that essentially those loans can be taken out, taken out personally to do something like to pay for like a house build or a mortgage or something like that.

Goran Ogar: [00:39:59] That's right, it could be. Yeah. So there is a strategy that we called immediate financing arrangement where you can set up a whole life policy and you can literally collateralize that immediately and get 100% of the premiums outside of the corporation as a personal loan immediately, pretty much. So whatever the amount of money is that you would need, structure the premiums for the whole life to be in that range and then you can borrow it outside of the corporation personally right away.

Speaker6: [00:40:36] Wow. Okay. That sounds pretty powerful. And the second piece was like, is it ever too late to implement like working towards like a whole life? Let's say somebody had collected or done the RSP route for many years. Is there a way to to move things around or how would that work?

Goran Ogar: [00:40:59] Yes, there is. Yes. Now, on the personal side, so this would be outside of the corporation, you see. As long as the person is comfortable using loans, what I've done in the past is I would set up an investment loan and I would pay the interest from the RRSPs. You see, because investor loan for the investment purpose, the interest that you pay on it is tax deductible. The income that you withdraw from the RSPs is taxable. So essentially you would be using RSP money to pay for the interest on a non RSP loan so they would neutralize each other from the tax perspective. That way you could freeze the RSP growth and slowly start transferring money into the non RSP vehicle with significantly better taxation than the RSPs down the road. So.

Speaker6: [00:41:57] Okay. I think I'll have to like draw a chart to make that make sense to me. But I think I got what you're saying.

Goran Ogar: [00:42:02] So again, you have RSP, you have a loan, and let's say RSP is, I'll just use round number for for the sake of illustration, the RSPs are $100,000. The loan is $100,000. Let's say the interest is 5%, which is $5,000 per year. You withdraw from the RRSPs $5,000 per year, which would trigger tax on the $5,000 per year. But the moment you pay the interest, the tax is neutralized because the interest on the loan for the investment purposes is tax deductible, you see. So you're feeding the loan, if you will, with the RSP money without triggering any tax.

Kevin Mailo: [00:42:44] Wow. Wow. Absolutely. Wow. Goran.

Speaker6: [00:42:52] Yeah, it's cool.

Goran Ogar: [00:42:54] Does it make sense? Does it make sense now the way I explained?

Kevin Mailo: [00:42:57] Yeah. Wow.

Wing Lim: [00:43:01] Well, there's so much now to do.

Kevin Mailo: [00:43:04] We got another question. Let's go. All right. We'll we'll find some way to cover all this later. Okay. About whole life insurance, as you mentioned, a few years ago the law changed. And this participant wrote in, I purchased one policy prior to that change in the law. But what was the change? Can you explain the change in whole life?

Goran Ogar: [00:43:25] Yeah. So number one caveat. If you bought it before the change, your policy is grandfathered. So the old rules applied, which means what's in insurance industry called MTAR Room. So it's an acronym. But essentially what that is, it's the amount of money that you can invest inside whole life policy for the cash. So the government saw that that amount was being, let's call it abused, from their perspective or overly used. So they decided to reduce the amount of money that could be invested on an exempt basis inside the whole life policies. So that reduction was probably to the tune of about 30% that they cut it down. So back in 2016, you could put significantly more money as an investment portion inside the policy as you can right now. But there are ways to work around that as well. So there are not straightforward as it used to be before, but there are ways to increase that investment portion. So to answer your question, if you purchased yours prior to the changes, nothing would change to you. For people who did not buy it at that time but bought it in 2017 or later, the amount of money that they can invest inside the policy is significantly reduced then to your policy.

Wing Lim: [00:44:59] All right, this is awesome. Now, so I'm aware of the time as well. Now, there was a comment earlier in the chat and that is, oh, this sounds so expensive. So can you go on all these strategies? What kind of cost and is it cost benefit ratio? How do you balance that?

Goran Ogar: [00:45:17] Yeah, the reason I mentioned some of those thresholds is that proportionally to the income, so whatever strategy you implement in proportion to your income, it would be significantly cheaper to implement those strategies. Even if you need to pay a tax lawyer let's say $10,000 to set up one of those strategies for you, $10,000 in that strategy would probably save you $50, $60 or $100,000 in income tax. So it may sound expensive just to write a cheque, let's say, to a lawyer, but when you look at the tax that you would save, it ends up being actually more beneficial to pay a significantly smaller amount to the lawyer than to the government.

Wing Lim: [00:46:08] So from personal experience, okay, so if you don't know anybody, you have no discount pipeline could cost you 35 K, but it saves you if you do $1 million pipeline suck out of your corp, you can save $375,000. So in that savings is 300 K so, right? I've done it twice. So there's always a cost and then a good advisor would help you work that through. Right. So if you only have so little pool, for example, you pull 50 K out, it's really not worth it. Right.

Goran Ogar: [00:46:39] That's right. Yeah.

Wing Lim: [00:46:40] Yeah. So. All right, good. Now, so this is, this is awesome. So now, so I don't want to drown everybody because this is already a whole lot of information. And I think the whole point is to expand your brain, right? I think our brain is like, what do you call it? The airbag driving. Once you decompress it, you need to shove it back and you can't. Right? So my brain, that happens multiple times. And so hopefully tonight that creates this decompression in your brain. This is a good place to wrap up.

Kevin Mailo: [00:47:10] Yeah, I think that ought to cover it. And clearly, clearly we've got to get Goran back on for another webinar, for a podcast episode, because this was probably our longest by far and away because it was so good. We loved it. Wonderful. And I'm going to wrap up here before my busy six year old starts taking up all my time and and space. But again, Goran, we sincerely want to thank you for coming on today. It was absolutely outstanding and we're looking forward to having you at our national conference, uh, this May 6th and 7th.

Goran Ogar: [00:47:46] Yeah. Looking forward.

Wing Lim: [00:47:48] Thank you, Goran. Really appreciate your time and your wisdom.

Goran Ogar: [00:47:50] Thank you, guys. Yeah.

Wing Lim: [00:47:51] Thank you, everyone, for attending. Good to see you all.

Kevin Mailo: [00:47:54] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo at PhysEmpowerment.ca. Thank you again for listening. Bye.

Dr. Kevin Mailo and Dr. Wing Lim welcome Brennan Carson, CFA Head - Solution Wealth Portfolio Manager, to the podcast to talk about market mindsets and mentalities. Brennan’s goal is to always build diversified portfolios that deliver consistent returns for his clients and he discusses how that works in the markets with Wing and Kevin. 

Brennan addresses the change between 2022 and what is forecast for 2023 and how interest rates drive much of what happens in financial markets. He differentiates between the public and private markets, how much greater the wealth in the private market space is, and discusses how many different aspects of market investments are available. It isn’t just what stocks are publicly traded, and Brennan has advice on themes for portfolios and what to look for in terms of stability. 

In this episode, Kevin Mailo and Wing Lim discuss with guest Brennan Carson the benefit of index funds, why a focused concentrated portfolio is advisable, and how Brennan and his team approach new clients. Brennan shares how the discovery document is vital to client understanding and details how he approaches each client individually based on their needs. This episode highlights how having the right investment quarterback to manage a team of specialists enhances wealth plans overall. 

About Brennan Carson

Brennan Carson has spent almost 20 years in the financial industry preparing for the unique opportunity to provide wealth management service and advice to clients with the simple goal of doing it right. His team calls themselves Solution Wealth Management (a division of eQuaTe Asset Management Inc.).

Over the last two decades, Brennan has had the good fortune to work hands-on with individual clients, investment advisors, and institutional investors. Each experience gave him more insight and knowledge on how to help turn financial goals into reality. Now he applies this experience to offer his clients a comprehensive approach to wealth management.

His investment objective is to build diversified portfolios for his clients that deliver stable and consistent returns and lower volatility. This approach generates more consistent long-term performance and fewer worries. His team’s investment platform provides access to five unique asset classes, each with its own return & risk benefit: stocks, private equity, real estate, income funds, and real return portfolios. 

Resources Discussed in this Episode:

• Save the Date for May 6-7, 2023 in Toronto
• Brennan Carson on LinkedIn
• Solution Wealth Management

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Physician Empowerment: website | facebook | linkedin

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Transcript

Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.

Kevin Mailo: [00:00:34] Hi, everyone. We are so glad to have you out tonight. I'm Kevin Mailo, one of the co-founders of Physician Empowerment and it's Wing and I tonight on a Friday evening here in December as Christmas approaches, but Wing and I on the webinar and it's been a while since we've both been together here. Now I'm going to just say that for those of us  on the webinar who are attending, it was supposed to be Dr. Dimitre Ranev, who teaches alongside us at Physician Empowerment, who was supposed to be talking about market mindsets. Because of a scheduling issue, he's not able to make it. But we are very, very excited to have portfolio manager Brennan Carson speaking with us tonight about market mindsets and Wing is going to be conducting the interview. So why don't I let you go, Wing, and I'll just step back.

Wing Lim: [00:01:21] Sure. So good to see you guys and some of you know me. I hope we have met. Anyways, so we're co-host, co-founders of Physician Empowerment. And so market mindsets, so of course, Dimitre would have had a unique twist based on his personal experience. And when there was a conflicting time scheduling conflict, I thought, who would we want to interview for market mindsets? How about somebody who does it on a full time basis, right? In this world of - and I'm going to introduce Brennan in a minute - but in this world of DIY, everybody want a nickel and dime and DIY themselves to suns like wealth land.

Kevin Mailo: [00:02:02] Oh yeah.

Wing Lim: [00:02:03] So sunset and everything is going to be fine until they do some crypto and hit a few colleges.

Kevin Mailo: [00:02:10] So they have a 2022.

Wing Lim: [00:02:13] Yeah, exactly. So there's a lot of market corrections and it's not for the faint of heart. And I happen to follow a lot of economists and a lot of people in the know, and this is not an easy path. That's why in a master class, which I'm putting in a plug in, we talk about all these jungles where the jungles - that the DRAT - the risk jungle, which is what we're going to talk about next Wednesday. Get navigating the risk jungle, there's the asset jungle, there's the tax jungle and asset jungle. So I would like quickly pass the mic to Brennan, and we're going to actually go back and forth and the three of us is going to have a really informal chat about market mentalities. But Brennan is a full time portfolio manager who actually picks and chooses stocks and other than stocks, bonds and other public and actually private assets. And he's the mandate to do that for his clients and he has a unique practice that he doesn't sell a specific fund to you and he's trying to create a tailor made thing called bespoke kind of practice, which is what we would like at Physician Empowerment and empowerment office. So I come to know Brennan and I really, really come to respect him for what he does and what he believes in. And so let's start with, Brennan, maybe you can say hello to everybody. Where are you from and what's your family like?

Brennan Carson: [00:03:36] Thanks, Wing. Thanks, Kevin. Yeah, it's great, it's great to do this, absolutely. I think in your comment about sort of what's happened in 2022, it's a great opportunity to really talk about those risk elements and those, that sort of that investment trajectory. I am based outside of Toronto, but I have to tell you, when I redid my business card about three months ago, I took my address off my business card because I have clients in every prairie and B.C. Province out west, and I've got clients throughout Ontario, so I kind of feel like I don't really have a home office. My office is really wherever my clients are. So it's actually kind of that's the fun. You talk about what I do for fun, my fun part of the job is that I get to see a lot of Canada all the time, and I get a chance to see clients and travel to different cities around Canada and really talk about what's going on. And I think it's also what makes it interesting is that when you are in, when I'm in Saskatchewan and everybody's talking about farming, when I'm in Alberta and everybody's talking about oil and gas, when I'm in B.C. and everybody's talking about immigration and sort of the metropolitan-ization of that area, it's different conversations. So that's the fun part of my job. So yeah, I'm here outside of Toronto and I have three young adult children.

Wing Lim: [00:04:57] Same here. Yeah, right on. So you deal with a lot of professionals, I'm sure you deal with physicians. So there's a lot of mentalities out there that we can just, you know, just dibble dabble and then we'll be wealthy. And of course, now this is  really testing the hypothesis, right? So can you give us kind of a gut feel that the market has, where the market has been and where the market is going to go? Of course, nobody has the crystal ball. But can you give us a kind of a lowdown grade eight level synopsis?

Brennan Carson: [00:05:32] Well, I'll tell you this. If you think back, if we all go back in our heads, go back 12 months, the biggest factor that was driving markets - all markets, public markets, private markets, assets, fixed income - were low interest rates. We were really leveraging everything: people's personal debt, corporate debt, government debt, asset valuations, cost of capital, was all inextricably linked to low rates. One of the most valuable education sessions I ever did was a two week hedge fund course in New York City in 2006 / 2007. And, you know, say what you will about hedge funds, it's kind of this, it's sort of been whitewashed, the concept of a hedge fund. Some people think of it as the risky guys. I think of it as hedging away risk in certain investment classes. That's the way it should be done properly. But ultimately, a really good hedge fund understands the driving risk behind an investment. And so if we go back and think about personal residential real estate, if we think about the fixed income market, we think about technology stocks, which are classified as long duration, which is I got revenue now, but really I'm banking on that company being worth more down the road. Everything was connected to low interest rates. So when you get a situation of a whole bunch of printed money, and the velocity of money - which is a key metric for the economy - so when the the velocity of money slows down, the volume of money goes up. Everything is tied to low interest rates. So the greatest risk management tool that we applied to client portfolios a year ago was to say, all right, interest rates are going up. We don't know whether this is going to be a meteoric rise or a slow and steady rise, although I think we all could have realized that they held rates too low, too long. How do we mitigate our exposure to low interest rates changing into more of a normalization of interest rates? So really, you think of everything that's happened in 2022. Stocks are down, I mean, the US market's down 16, 17, 18%. Canadian Bond Index, which was supposed to be a hedge against equity risk, is down 9, 10% and everybody's house in Canada is down somewhere between 5 and 15%. It's all linked to one thing. And so that really is the theme going into 2023, which is how are we going to now adjust to where rates are? How is it going to affect different businesses? How is it going to affect different assets?

Wing Lim: [00:08:31] Mm hmm. Well, that's really a good recap. So based on the interest rate, of course, we just went up to overnight rate of 4.7% now, more like to what it was normal. But for every everyday Joe Schmo mom and pop with some portfolio in the public markets, so how is that going to impact everybody's performance, stocks versus bonds, fixed income versus all that?

Brennan Carson: [00:08:58] Well, let's just talk about, let's talk about stocks in general. And I don't necessarily even want to talk about stocks per se. Let's talk about operating businesses, because as a colleague of mine wrote a great paper and it was posted on LinkedIn a couple of weeks ago, he said the market is not the public stock market. The market is operating businesses, it's the economy. So whether you're investing in a private business, a startup, a publicly traded company, if you're investing in the economy, you're investing in operating businesses, things that generate GDP. So when I think about 2023 and this sort of adjustment to higher interest rates and I think about how it's going to affect operating companies, I think let's think about some of the inputs into net earnings, profit margins of an operating company. So cost of capital. All right, so if I'm doing a balance sheet analysis on a company, I got to think, all right, what kind of debt are they carrying on that? What interest coverage do they have? Do they have cash flow to meet their debt? Is their debt structured as short term floating or long term fixed? So even how they build their balance sheet and how they manage their liabilities. That's going to be a factor when we start thinking about those that would have an ability to adjust to higher rates better than others. Think about wage inflation. It isn't just inflation like the goods cost more, which of course is related to trade, it's related to a lot of other issues. Think about wage inflation, and I'm just going to pick on UPS or Starbucks. UPS and Starbucks are both facing significant rebirth of a unionization push, safety of employment wages. Well, all of a sudden, if you now your human resource input into your PNL now goes up 25 or 30% because you have wage inflation, it dynamically changes your ability to have profits at the bottom line. I was talking with actually with a client today and, you know, runs an operating business, manufacturing, pretty blue collar, you know, 40 people, not a big operation. And he says, my wage expense just went up 25 to 30%. So all of a sudden, if your margins were 35, they're now 5. Right? That, I mean, that's your biggest input cost in a lot of these operating companies and I'm not even beginning to touch the input cost due to trade issues and the sort of decentralization of of manufacturing and labor and trade, but just wage inflation. So when I look at 2023. I think there's going to be a pretty good split between winners and losers. So, you know, if you think about the concept of owning an index fund, you know, I own the S&P 500. I own 500 operating businesses in the SNP in the US. 500 biggest, most well established public companies. So the index itself, it may go up 5, 8, 10% next year. I certainly don't think we're in for the most dramatic rebound to a bull market in the history. I don't sort of see that in the cards. What I see is there are going to be 200 of those companies that can pass inflation through to their customers, that can manage their margins, they can manage their cost of capital, their debt. They can continue to generate free cash flow, which is the bee's knees of running an operating company, and they'll be just fine. And then there will be 200 on the other side that don't. So next year, in my mind, it's, I really believe this is a year of quality over quantity. Find those that are driving free cash flow, paying dividends, maintaining margins. I'm going to stick with those businesses for the next 2 or 3 years, all day, every day.

Wing Lim: [00:13:11] Right on. So even this, when you talk about input cost of, let's say, wage and all that, it applies to medical business. A lot of clinics in Alberta are actually folding and doctors are quitting in a record number because everything's going up, the wages ceiling and actually crashing down. And so it's not just Alberta phenomenon, right, it applies to everybody. So it's going into 2023, I agree. Some will make it, a lot won't. So for a lot of people who want to pick and choose, would it be if people have no time, I just want to pick an index fund, would that be? What would be your advice for those stocks?

Brennan Carson: [00:13:48] Look, I mean, people choose an index fund for two reasons. One, it's very accessible, low cost. I can literally pick an index on my phone and be done with it in about 5 seconds. So very accessible, very easy, very inexpensive. Number two, the statistics are not going to lie. 80 to 90% of actively managed US equity portfolios, mutual funds or pooled funds of any kind tend to underperform over a cycle of the market three, four or five years. So if I want my odds of at least matching the index and making it easy on myself, I'm going to buy an ETF. So really, there's two ways to generate Alpha, the concept of outperforming an index, in my mind. This is this is 23 years of being an analyst and being a portfolio manager. Number one, you run a more focused portfolio. One of the reasons mathematically, and I won't get into the math, although, you know, my colleagues and I all come from calculus and physics backgrounds, so we love this kind of stuff. I mean, literally, you know, on a Friday night pulling out an Excel spreadsheet. I know that sounds weird, but that sounds fun to us. If you do the math of running a 80 to 100 stock equity portfolio, just by the math of the amount of stocks that you're trying to trade, that you're trying to follow and the amount you're putting into each individual stock, just in it's, just in its mathematical composition, very hard to outperform an index just by that math alone. So I've always believed if you want to generate outperformance, you have a focused portfolio. So for me, that's, you know, 20 to 35 stocks. Number two, you should have a specific style to that portfolio. And this is generally what I find the weakness in a Do It Yourselfer, is I own some oil and gas, I own some blue chip, I own some utilities, I own some speculative, I own some tech. What's the style of that portfolio? I get it, there's some diversification, you're in different industries. You've got sort of different profile of kind of companies that you're buying. But you're just going to end up in the middle. You know, if you add five different vertices together, you end up in the middle. So in my mind, a focus portfolio with a specific style. And in my mind, that style going through the next couple of years is more of a value dividend quality than it is betting on technology and more speculative long duration companies. You know, everybody rushed in to cloud storage because, well, we all need the cloud. Okay, well, we don't need 32 companies with cloud services. Some of those aren't going to survive. You know, you talk about businesses that aren't going to survive. It's just too many players. I'm not even getting into the 3000 people offering crypto. Right? It becomes a crowded space where really maybe there wasn't room for any to begin with. So that to me, that to me is both a philosophy, regardless of what market condition we're in, right? Focused concentrated portfolio with a very specific style. That's the way to generate outperformance if you are going to choose something other than buying the index. But as I said, my view of the index is we'll probably have a decently positive return in 2023. But you're going to be weighed down by the fact that half the stocks you own have deteriorating profit margins. And so I would prefer, in a market like, that to cut out the stuff where I know - and again, we have we're more of a data focused firm, I track profit margins. I can, at a snap of a finger, I can look at the profit margins of 2500 US stocks - I'm not going to bother with those next year. Why bother? I don't need to own those. If I can choose to not own them, I'm not going to own them.

Wing Lim: [00:18:07] That's a great perspective. So, Kevin, you have a question?

Kevin Mailo: [00:18:09] Yeah. Yeah. So I can tell you already, Brennan, I definitely feel like we're just going to keep asking you tons and tons of questions and which what I'm really getting at is we got to get you back on for another webinar or a podcast episode for sure, because we're loving it. And I know those of us out there who are listening to this are, like, going to be all ears on this sort of perspective when it comes to the market. So I want to shift a little bit. So Physician Empowerment is more than just money. It's about building better lives for our physician clients, right? And that's also behind why we founded the Empowerment Office Corp as well, is to build better lives for physicians. And a lot of physicians, I think, struggle with micromanaging. And they work 70, 80 hours in a workweek and then they step in and try to manage their portfolio. And I see it done poorly in a lot of cases. I've got colleagues, we've got physician clients who who've lost. And so can you give us some insight into your client base? And why they might choose you besides just the numbers, right? Because, again, one of the things that we talk about in Physician Empowerment is learning to delegate. Not abdicate, as Wing says, but learning to delegate to quality professionals who, it's not just about making money it's also about building a better life. Right? Because as the market slides or goes through its ups and downs, you know, do you really want to be watching your phone go off at 11:00 at night, worried about your portfolio, your ability to retire, that sort of thing? So do you want to just provide some insights into your clients and why they go with a portfolio manager? And share as much as you as you feel comfortable in terms of net worth or geographic spread or background, whether they're business owners or professionals or whatever. I would personally love to hear a little bit more about who chooses a high level portfolio manager such as yourself.

Brennan Carson: [00:20:06] All right. So as you're asking that multifaceted question...

Kevin Mailo: [00:20:08] Yes, I just keep going, which is why we're going to have to get you back on.

Brennan Carson: [00:20:11] I quickly jotted down five points. So I will address those five points. Number one. The most important tool we have when we work with clients is the discovery document. There's no close second to the importance of a discovery document. So just to give you some perspective, I have clients that charge me with the responsibility of just finding them specific investment solutions, public or private market. I have some people call me up, Brennan, I'm looking for this. Can you get me into that? Yes. And that's another point, which is access. But we can circle around back to that. And I've got clients who say, Brennan, you're literally my family's CFO. I want you to talk about tax, estate planning, insurance, financial planning, risks, intergenerational wealth issues, even holistic wealth concepts, charitable giving. And we really run the gamut all the way through. But that starts with that discovery document. And to your point, Kevin, and this is what I've always appreciated about the platform that you and Wing are building, which is it is so much more than just, Hey, let's make a dollar on a dollar.

Kevin Mailo: [00:21:25] Oh, without question. Without question.

Brennan Carson: [00:21:27] So the beautiful thing about a properly constructed discovery process is you really invariably unearth the strengths, the weaknesses and the risks that exist within an individual sort of wealth profile. Sometimes it's emotional risk, sometimes it's financial risk. You have family issues, you have succession issues, you have health issues. So that, to me is, you know, that is the sort of the gold standard of establishing a strong roadmap. And that to me is, again, that's, the discovery document is the input. The roadmap is the outcome. And that document allows you to establish a much deeper and stronger relationship with that - I'll call it a wealth quarterback - than anything else. So this isn't about, Hey, my performance is great, or Hey, I've got a really nice marketing campaign. In fact, the research is compelling. People do not fire an adviser for performance. It is the fourth ranked reason why people fire or hire an adviser. Trust, communication and transparency are one, two and three. So that should always be the most important inputs into the equation of working with someone who you really want to both empower, to use your word and to engage and trust into that relationship of someone that, yes, you can collaborate with that person. I do have some clients who say, Brennan, here's my dollar, invest it. Tell me in a year how I'm doing. And they're very hands off and that's fine. But I don't let my clients get off easy. It's not just, Hey, Brennan, trust, you know, I trust you. Go with that dollar. I get into situations where I'm meeting with a couple. One person has been primarily responsible for the finances. I want both partners of that couple to be involved in that discovery process and to know who I am and what I'm doing and why I'm doing it. I don't want to have, as I have in the past, that conversation with a widowed spouse who does not know where to start. Who doesn't know where the will is, who doesn't know anything about finance, doesn't know how the bills are being paid. That's not really a great partnership.

Kevin Mailo: [00:23:57] Yeah, sorry to interrupt, but yeah, that's exactly what we say at Physician Empowerment, wealth creation is a team sport. And we've got our annual national conference coming up in May, and we really encourage the non physician spouse to come. And understand physician finance at the same level as the doctor in the household. So I just, I just wanted to tell you, I'm loving what you're saying. Keep going. Keep going.

Brennan Carson: [00:24:19] So the second part of that, so discovery document really building a strong plan and a roadmap. And I think that's something that that makes people sleep better at night. I mean, that's, at the end of the day, the emotional risk often trumps the financial risk. And frankly, if you're a high income earner, that should be as important as the financial objective. It's the emotional, which is I sleep better knowing that somebody is taking care of my tax, somebody is taking care of my insurance needs, somebody taking care of my family. Really in sort of a broad context, someone's really working with me on that. Then the other part of it is really looking at wealth, Kevin. It's, look, nobody - very few, I won't say nobody - very few people get wealthy picking stocks, you know, like, well, Warren Buffett is worth whatever, gazillion dollars. Warren Buffett invests in businesses that are well-run that he's going to hold for a long time. There's no flipping stocks. Right? So just about everybody, if you've built wealth, you've owned great assets, you own great real estate, you own a great business. So wealth is really, I think it becomes, I think we get so inundated with fund performance and stock news. As I said, the private equity market in this world is ten times the size of the public market.

Kevin Mailo: [00:25:44] Yeah, I know. I know. And people don't realize that, right?

Brennan Carson: [00:25:48] There's close to - it depends on the day - but, you know, 70 or $80 trillion in the public market. And there is ten times that, the value of the operating businesses that don't trade on the market.

Kevin Mailo: [00:26:02] Yeah, they don't have an IPO or a real estate project or whatever. Absolutely. Absolutely. This is going to be another, I'm just, there's going to be another thing we're going to be talking about at the conference is trying to open positions up to a much bigger world that goes beyond public markets.

Brennan Carson: [00:26:18] Yeah. So we get it, we get fooled into this, Literally, my wealth is dictated by how the TSX and the S&P 500 do. That's, I mean, there's just, you know, I can say this because I'm a portfolio manager and I don't sell equity funds for a living. You know, it's just, that's just not the way wealth is managed. And so the byproduct of that discovery document is understanding all the elements of wealth. And one little tiny sliver of it is maybe an exposure that you have to the public markets. But again, your real estate, your health, your insurance, all those other elements all plug into that. And so that is so important. And that's, again, a big part of the practice. So I manage, I manage about 60 families, high net worth families myself. Probably the average client is 2 to 2 and a half million. And with a lot of those, it is far more than just, hey, manage my money. It is so much more about building all of this. So that's, I know I said five, five points. We're kind of two or three into it. So the other one really, then, again through that discovery document, is the risk component. We've touched on that a little bit already. You know, I have a client who's a general contractor. He runs an extremely good business. You know, as you probably all imagine, it's been a great environment. People have stayed home. They want their houses renovated. And I looked at him and I said, you know what your greatest risk is? I said, it's not whether I make you 5% or 8% or 2%. It's your health.

Kevin Mailo: [00:28:00] Yeah, you are your business.

Brennan Carson: [00:28:02] If you can't use your hands and you're not on site, all of your goodwill equity is gone. You're, you know, that's it.

Kevin Mailo: [00:28:10] Physicians are no different. Physicians are no different. You are your most important investment. It's something we teach. Absolutely. Absolutely.

Brennan Carson: [00:28:18] So take care of that and take care of that isn't just making sure you have a safe work environment or that you get good rest, your site is good, all those kind of things. But it's also all right, do you have insurance to cover what happens if something happens to you? So all of those elements and I think, you know, you talk about the fact that why people do or don't work with an advisor. I think they work with an advisor who realizes that A, the best interest is the best interest of the client. That's really what's driving decision making. And B, that they care about something beyond whether you're going to buy whatever fund you want to stick in front of them. I'm really, I'm proud that my team is built as an independent. And this is not to throw shade on on the banks or the big mutual fund companies. But it's really important to maintain that independent, objective viewpoint in order to effectively address your client needs.

Wing Lim: [00:29:21] So two points I want to respond to Brennan's comments. Number one, it's no different than medicine. People like to Google, consult Dr. Google, and piecemeal their health. Right. We're in primary care, we understand that, how important it is to have that family physician. Right? So having that trusted figure that is your quarterback, you're using finance term, trying to piece everything together. Second thing is, that's what we started Empowerment Office corp, is that we believe in this whole process - we call it the roadmap process - and we help people break down all the facet of that for each aspect of it to customize it for everyone. So this is awesome. Now, sorry, I have a hard stop, so I'll leave and Kevin would continue. All right.

Brennan Carson: [00:30:06] All right. Thanks, Wing.

Wing Lim: [00:30:08] Thank you, guys.

Kevin Mailo: [00:30:09] All right, so Wing's going to sign off, but I absolutely love this topic because you're getting on all the right points, Brennan, in terms of looking holistically at our lives. One of the things that I often reflect on is that real wealth is peace of mind. And I think that, at least for some people, portfolio management offers that in addition to all the other things we outsource in our lives, whether it's property management, clinic management, great lawyers or accountants, people who manage us, who are the people you work with to build wealth for your clients?

Brennan Carson: [00:30:41] You mean in terms of the, kind of the--

Kevin Mailo: [00:30:44] Yeah. Explain it, right, or explain your process, if you will, if you have time to just go into it, because there are going to be a lot of physicians listening to this whom this is going to be very new for. Right. It's just, you know, how do you sit down... because they have their own network. Maybe they have an accountant or a tax lawyer. They have insurance policies already. Who do you work with? How do you coordinate? Do you do a lot of tax planning?

Brennan Carson: [00:31:08] So in terms of sort of that broader wealth concept, Kevin, in terms of kind of putting that team together, I had a great mentor in this space who was a wealth manager for a number of, you know, wealthy families, and they said, you know, don't try to push someone on someone. You know, in other words, Oh, I've got an estate lawyer, you have to work with them, you know, fire whoever you've been working with. So first of all, you do have to have a quarterback. Doesn't have to be me, but there has to be someone that is that central resource to access and have the ability to coordinate the team and the documents and the roadmap. So that's important. You have to have that. And obviously that's a huge part of what you guys are trying to do in terms of really focusing that broader concept of bringing that together. But my approach has always been, I may be the hub, but the spokes are specialists, people who are really good at what they do. And I say that in the wealth space and I say that in the investment space. I may have 23 years of managing equities and some alternatives, but if I'm looking for a private debt portfolio, a mortgage portfolio, an international long shore hedge fund, I don't do that. But I can bring my clients those professionals who are laser focused in that particular solution. So I think of myself on a wealth management point of view as a generalist. I'm an investment specialist, but I'm a wealth generalist. So I can uncover tax deficiencies, I can understand, I can uncover insurance shortcomings, talk about generational wealth issues. In my first life, I actually worked in the not for profit sector. So I, I actually have a background in charitable giving and charitable planning as well. And I still do quite a bit of that work as a volunteer and a board member now. So again, it's if someone comes to the table and they say, look, I've had a, I've had a tax accountant working with me for 20 years, I trust them. They're an important part of my planning. That's great. That's great. So let's not get into an arguing match about who's right or who's wrong about things. Let's set down at the table. I think you want your team to be open minded that we're better together than we are all trying to yap in our client's ear about what they should do. That's really ultimately ends up being the worst of all situations. Well my accountant says I should take out an insurance policy, my investment guy says I shouldn't. You know, my neighbor, my golf buddy, says that I should like, No.

Kevin Mailo: [00:33:54] Oh, it's a mess. I mean, it's not it's not going to work for somebody's health either. You know what I mean?

Brennan Carson: [00:34:00] Yeah, well, I'm sure. Look, I'm not in your business, but I'm sure the notion of Googling what's wrong with my sore right eye or my...

Kevin Mailo: [00:34:07] I am deciding whether to take out my colon or not.

Brennan Carson: [00:34:12] Yeah, I just heard that we should all be putting Head and Shoulders on our face to cure acne the other day. So, yeah, you know, like--

Kevin Mailo: [00:34:19] You know what I mean? It's not useful if it's 100 different answers.

Brennan Carson: [00:34:23] Right. So, absolutely. The only thing I really stress in that situation, I used to survey my clients about who their professionals were, not to really, not to really judge one or the other, but the greatest partners we work with in that well space, whether they're a tax person, a financial management person, insurance person, estate lawyer, is are they proactive and strategic? I don't need someone to file my taxes. I don't need someone who files my medical professional corp papers. I need someone that says, Okay, Dr. Jones - sorry, I always use that example.

Kevin Mailo: [00:35:04] No, that's fine.

Brennan Carson: [00:35:04] I love Indiana Jones. Dr. Jones, okay, what's your tax advisor telling you? Are they are they telling you to do a strip or are they telling you to do a freeze or are they telling you to add your kids in? Are they suggesting you do, you know, an IFA to create an insurance solution to lever more money, you know, money coming out of the corp? And look, I see this a lot. I see - and in fact, I had breakfast with a a medical doctor who's a client of mine this morning - and she, like so many physicians, get to that stage in her career, she's in her mid-late fifties, where almost all of her investable assets are in tax deferred vehicles. They're in her PC and they're in her RSP. And so when I do a wealth analysis, they say, Oh, by the way, you owe the government $1,000,000. Don't pretend that you have 3 million because you don't. The government owns a million of that 3 million sitting in your tax deferred vehicles. So this is a bit of a circuitous way to answer your question, Kevin, but you want to meet the team. You want to make sure the team wants to work together and can work together. And you want to have members of that team that aren't just going to just kind of rinse and repeat. They are going to bring solutions to the table. So, and I think that's that conversation. And if there's a sub out and a sub in, again, I don't have a hidden agenda to push any professional or any strategy onto anybody. But if my clients are going to be well taken care of, I want them to be working with great people who care as passionately about them and their and their future as I do.

Kevin Mailo: [00:36:47] Absolutely. Listen, I can't believe we've come up on nearly 40 minutes. We should probably wrap up and move to the question portion.

Brennan Carson: [00:36:57] I'm going to add one more thing, Kevin.

Kevin Mailo: [00:36:59] Go, go, go, go. No, no, I love it. Go.

Brennan Carson: [00:37:00] I'm going to add one more thing.

Kevin Mailo: [00:37:01] I'm loving it all. Go.

Brennan Carson: [00:37:02] You talk about - sorry, part of your question was why would you work with a professional portfolio manager? Why would you - so besides discovery, risk analysis, proactive, strategic, all that things - when it comes to not just investments, but this is certainly more in the investment space than it is in sort of the other wealth space, is access. If I go to Wealthsimple, I cannot buy a private debt portfolio. I cannot get a private real estate portfolio. I can't get private equity. So if we're all trying to aspire to, I mean, you think about CPP or Ontario teachers, some of the best managed pension funds in the world, aren't we really all aspiring to have this portfolio that just keeps making 7 and a half or 8% every year with very little volatility? Well, that portfolio looks very different than I can get on my do it yourself platform. So I put, when I launched, when I left and I built my own independent practice four years ago, the first thing I wrote in my notebook - and I am a note taker exceptional - is the democratization of diversification. Let's break down the barriers of who has access to some of these really incredible portfolios that add value, both in return and in risk management to clients.

Kevin Mailo: [00:38:35] I love that. I love that. Brennan, I just want to thank you for coming on like you did tonight, especially on such short notice. This was just amazing, right? I mean, these are the insights that people need to hear. I certainly needed to hear this. And it was eye opening for me just hearing about how the private markets are ten times larger than the public ones. And yet everybody's following what the public markets are doing. So I want to thank you, Brennan, for being here tonight and for those of you that have questions, by all means, reach out to us and we're definitely going to be getting Brennan back on to the show. So with that being said, we're going to wrap up and step into a couple of questions because we do have some people here who joined the live webinar.

Kevin Mailo: [00:39:19] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.

Dr. Kevin Mailo welcomes physician and beyond MD podcast host Dr. Yatin Chadha to Physician Empowerment to talk about finance for physicians. Yatin Chada’s podcast is well-known and he has interviewed a wide and notable range of physicians and finance industry professionals since beyond MD launched in 2020.

Kevin Mailo shares the news that Yatin Chadha’s podcast reached the Top 50 of finance podcasts on the Apple Canadian Business podcast. He asks Yatin about some of his more memorable episodes and Yatin shares several, including one with Kevin himself, and other episodes featuring Jamie Golombek and Joe Bakish. He highlights what he learned from each of them. 

In this episode, Kevin Mailo and guest Yatin Chadha discuss the finance industry through the lens of topics Yatin has explored with his podcast guests. They talk about how to build financial security, real estate as a great investment, diversifying portfolios, generating passive income, and dividend stocks. Kevin and Yatin break down what is important for physicians to consider when pondering their financial futures.

About Dr. Yatin Chadha

Dr. Yatin Chadha, MD is a Diagnostic Radiology Specialist in San Diego, CA and has over 13 years of experience in the medical field. He graduated from UNIVERSITY OF BRITISH COLUMBIA / FACULTY OF EDUCATION in 2010.

Dr. Chadha launched the beyond MD podcast in 2020, which focuses on financial literacy. The content is provided by subject experts, but is steered by him to ensure relevance to healthcare professionals in Canada. There is a frequent focus on professional corporations.

He believes that stress related to personal finance can lead to physician burnout. Dr. Chadha’s mission is to change this. He has learned a lot along the way and wants others to be more prepared than he was. His aim is to help other healthcare professionals navigate personal finance such that this area becomes enjoyable, rewarding, and eventually automatic such that physicians are able to dedicate more time to the things that matter most to them.

Resources Discussed in this Episode:

• Save the Date for May 6-7, 2023 in Toronto
• Dr. Yatin Chadha on LinkedIn
• “beyond MD” podcast 
• “Real Estate Investing - a Physician’s perspective” beyond MD episode with Kevin Mailo
• “RRSPs for incorporated small business owners with Tim Cestnick” beyond MD episode
• “Holding Companies with Ali Spinner” beyond MD episode
• “Corporate investments - optimization and taxation with Jamie Golombek” beyond MD episode
• “Alternative Investments with Joe Bakish” beyond MD episode

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Physician Empowerment: website | facebook | linkedin

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Transcript

Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca, that's PHYS empowerment.ca, to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.

Kevin Mailo: [00:00:35] Hi, everyone. It's Kevin Mailo here, one of the co-hosts of the Physician Empowerment Podcast. And today I am joined by the one and only truly amazing Dr. Yatin Chadha. And for those of you that haven't heard Yatin speak or listen to his podcast, you can find him online at the Beyond MD podcast. And it's truly amazing. And Yatin, you had a big milestone. I'm going to talk about you for a couple of minutes and then I'll let you talk about yourself. But let me do some bragging for you. But you broke the top, you broke the top 50 finance podcast. That's not medical podcasts. You broke the top 50. And was it...?

Yatin Chadha: [00:01:12] You know, yeah, it was the, I think it was the Apple Canadian Business podcast. But Kevin, I can tell you what, you're so kind to mention that, but it gave me, it gave me newfound respect, though, for the people who just continue at this and are actually able to stay there. Because I tell you what, I do rely a lot of my guests for the content. Now I am producing a few more solo episodes, but it is really hard once you get there, it's really hard to stay there.

Kevin Mailo: [00:01:42] Yeah, trust me, I've done it for years, not just this podcast, but obviously the other one as well. Yeah, there is a lot there.

Yatin Chadha: [00:01:49] Yeah. Yeah. It just takes, and I have a lot of respect for people who have been doing this for years and like with anything in life, it's a journey, not a marathon, right? Just takes a lot of time and effort.

Kevin Mailo: [00:02:00] Make sure, make sure you're doing what you love, right? I think that rule applies to all of us in our lives. Like, if we're not loving it, why are we doing it? Life's got to be more than just a trudge. It truly does, you know? So, you know, you got this incredible podcast. Do you have guests now coming to you? Like, are you still having to source guests or are you big enough now where everybody sort of says, Oh, can I be on the show?

Yatin Chadha: [00:02:25] It's definitely getting to that now. And I can tell you, I think this was around episode seven or eight - I'm trying to think, episode seven - it was Tim Cestnick who agreed to come on, and I can tell you at that point in the early days, I remember that specific episode. Kevin, I was scrambling to find a guest because I told myself, I have to put something out there every four weeks, stay consistent, and then thank goodness Tim Cestnik messaged me back the same day and he was just like, Yeah, I'd love to come on. And I was just like, Thank you. Because without him I would have been struggling. But now times have changed. I mean, now I've probably recorded episodes to, all the way out through January, February, and a lot of requests, a lot of requests now to come on. But it's a mix, right? Because for me, my goal is to find who I think are going to be the right people to come on and present information in an articulate way and hopefully less biased way. So it's a bit of a mix, but certainly a lot of demand from guests now.

Kevin Mailo: [00:03:23] And where do you see your audience now? I mean, we talk about this being Canadian physicians, but I can see you being so much bigger than that. Do you have some sense of your audience beyond Canadian physicians? I know lots of us talk about you and hold you in enormous esteem, but I have a feeling this is now expanded beyond that.

Yatin Chadha: [00:03:43] Well, thank you. That's very kind of you. Canadian physicians are certainly the top audience, other health care professionals, so dentists, pharmacists, I do get messages from time to time. But then there are a lot of people in the in the finance industry as well, because one goal that I've had is I want to be touching on topics that are not only relevant or maybe are a little bit beyond what people may be talking to from day to day, like tax free savings accounts and RRSPs. I'm trying to just take it one level further - and not, this is not to say that more complicated is sexy or better, but I think there are a lot of things that we need to be better versed in and more aware of. And so that's my goal. And I think because of that focus, it naturally gravitates to people in the financial industry as well. I think they find the content interesting. So I do have a lot of people reaching out from from that part as well.

Kevin Mailo: [00:04:38] You know, one of the central teachings that we do at Physician Empowerment is talking about the notion of your why. Right? And getting down to what motivates you to build financial security and create wealth. The other side to this is learning to ask your own questions. Like, you know, we sit there, you know, always talking about looking for the answers, but how do you know what answer you need if you don't even know the question to be asking? And these are questions of, questions of ourselves, of our lives, of our loved ones, but even within our careers. And then taking that further is, you know, sitting down with an insurance specialist, you know, a tax lawyer, sitting down with an investment advisor, looking at the markets, you don't even know what questions to be asking. Like, you know, I struggled with that with my accountant in the early years of my practice, like just not knowing enough about the Canadian tax system at a corporate or personal level in order to ask educated questions of my accountant. Do you know what I mean?

Yatin Chadha: [00:05:37] 100%.

Kevin Mailo: [00:05:38] You know, it's up to us, I think, with sophisticated tax or financial picture, to have enough base knowledge in order to step into these conversations with trained professionals, our consultants, if you want to call them that, and ask them relevant questions. Right? Because if it's poor data in, it's going to be poor data out, is been my own personal experience.

Yatin Chadha: [00:06:02] Yeah, and I think with that summary, Kevin, I think you have encapsulated the main goal of the podcast, and that is to make people feel comfortable enough on a broad range of topics so that they feel comfortable asking the right questions. And, and the truth is, I've always had in the back of my mind that maybe we should have more of this material in our medical training. But then after thinking about that again, I think with the information people have to learn now in medical school and residency, it is really hard to incorporate it. And so I do think the onus is on us as a community to continue to talk openly about these topics and hopefully motivate our colleagues to just be avid learners and really curious about this content. And I think that's the right step forward.

Kevin Mailo: [00:06:45] And the other big, big side to this is practice management, right? I mean, we started teaching practice management at Physician Empowerment because we realized like nobody was getting educated on this stuff. And again, like, you know, going back to your point, like rightly so, in a sense, like there's already so much medicine to learn in that 5 to 10 years of training that that someone goes through like to learn their craft. Do we really, honestly have time to be taking deep dives into finance and practice management and tax planning and all these sorts of things? But I think it speaks to the need for lifelong learning in these areas, and...

Yatin Chadha: [00:07:25] Absolutely.

Kevin Mailo: [00:07:26] ... realizing that our finances affect our practice, our finances affect our personal well-being. Right? And so having a handle on those, not a perfect handle, but a good approach and a solid financial base, allows us to practice our best medicine, allows us to live our best personal lives, which I think is so important for Canadian physicians. In my opinion, that's what we deserve across the profession. I see doctors constantly working extra hours to serve their patients and serve the community, but we should be able to do that knowing that our financial futures are secure.

Yatin Chadha: [00:08:01] Yeah, I totally agree.

Kevin Mailo: [00:08:02] So talk to us about some of your memorable moments along the Beyond MD podcast journey. What was it like in the early days? What is it like now and how long have you been at it now? Is it two years now, Yatin?

Yatin Chadha: [00:08:15] Yeah. So it started September 2020. So just over two years now.

Kevin Mailo: [00:08:19] Wow, it went by so quickly I felt like we talked for the first time yesterday, but it's been two years that we've been talking because I was on one of your earliest episodes, right?

Yatin Chadha: [00:08:28] Yeah. Yeah. Kevin, so you were on my season one finale. We did an introduction to real estate, and I know you wanted to pick my brain on some of the most popular episodes ever. So in fact, your episode, that was episode number 16, that that is one that did help the podcast jump to the next level. So thank you for that because that was a great--

Kevin Mailo: [00:08:50] -- Oh, lumbar puncture night --

Yatin Chadha: [00:08:51] -- talking about real estate--

Kevin Mailo: [00:08:51] -- if anybody wants to know that one, you can just listen to Yatin's podcast. Lumbar puncture night. That was a lot of fun.

Yatin Chadha: [00:08:58] Yeah. Yeah. So, your your episode is quite memorable. And I have to say, it wouldn't have been possible without my first guest, Ali Spinner, who was an accountant at Crowe Soberman. She's based in Toronto, and she helped me produce two incredible episodes, one on basics of corporations and the other one on holding companies. Her episode on holding companies, I mean, up until recently, that was the most popular episode in terms of like the one week and one month metrics. And then and then early on, just to have a name like Jamie Golombek.

Kevin Mailo: [00:09:28] Oh, wow. I know. I remember when I saw that, I was like, Wow, Jamie Golombek went on the show.

Yatin Chadha: [00:09:33] To have Jamie Golombek on the show, that was huge because I was literally, you know, I had a few downloads up until that point. And then that week when I released his episode, it was like every two days I was getting, I was hitting new milestones. Just because he was on, he was blasting it around. And so I'm very, very grateful to that, to him for doing that.

Kevin Mailo: [00:09:53] Wow. Isn't that awesome? Isn't that absolutely awesome? And then what sort of things have you learned along the way? Right? Like, what have you learned about the finance industry that Canadian physicians who are listening to today's episode should hear about? Because I certainly have found this process to be eye opening through Physician Empowerment because we engage with, we get a lot of outreach from the finance industry, and by and large keep them at arm's length. But tell us what have you learned about the finance industry?

Yatin Chadha: [00:10:23] Yeah, I think some of the notions that our community had about the finance industry in terms of maybe doctors at times due to our income and our relative lack of knowledge in this area, we become a bit of a target. I will say that there are people out there who do get very interested in seeing a product based on finance. So the podcast that's being put out by a physician. And so I will get a lot of people reaching out and, and you know what? Now that I'm becoming more comfortable with the content, I think I do know the questions to ask, and I do know when to maybe challenge somebody on a point. And so yes, I think that that notion that people have, for sure, it's correct and you have to, I think that's point one is that's all the more reason to be well versed in this material so that you know the right questions to ask and you know how to protect yourself and make sure you're getting the right product and served in the right way. So that's one thing I've learned. The other thing, though, is I've learned how much there is to learn about about finance. When I first started, the talk was really just about investing in a TFSA, investing in an RRSP, maybe buying an ETF. But when we look at what's happened, Kevin, especially since February, it's really just been kind of all downhill this year in the markets, right?

Kevin Mailo: [00:11:43] Yeah, that was eye opening.

Yatin Chadha: [00:11:45] Yeah, it's just been, it's been crazy. And you look at the history, you know, most bear markets are, are fairly long, but I think we're kind of hitting the average length of what historically most bear markets have been, and you know just to to endure something like this. It's also taught me, well if you have the right knowledge base, you can invest in different instruments and different ways such that those investments will not totally correlate and move the same direction as the stock market, right? So this is a notion that I had no idea about, but it's the concept of uncorrelated returns. And that's why--

Kevin Mailo: [00:12:21] -- I like that. Wow, goodness--

Yatin Chadha: [00:12:23] --I think I encourage everybody to read about this a little bit. And so just for people who may not be as familiar with the concept, it's if two types of investments have a correlation of one, that means they generally tend to move in the same direction at the same time and often by a similar magnitude. But you want to make sure that, I think most people would feel comfortable if their portfolios were truly diversified. And so you want to be investing in things that are not always correlated with stocks. And traditionally, that's why a mix of stocks and bonds has worked well. But this year, with inflation, the stock bond 60/40 mix has not worked well at all. It's just been brutal for bonds. So I think that's why it begs the question, do you go beyond that? And I think it's at least worth learning beyond that. And so one of my more recent episodes, I hosted a very knowledgeable, savvy financial planner. His name is Joe Bakish, and he talked about alternative assets. And so I know this is an area that some people may see. They may raise an eyebrow and be like, well, there's a lot of costs. But I always tell people, at least learn about it and then you kind of know.

Kevin Mailo: [00:13:33] Oh be aware.

Yatin Chadha: [00:13:34] Yeah. Be aware.

Kevin Mailo: [00:13:35] Be aware. You've got nothing to lose by being aware of a different opportunity or different asset class.

Yatin Chadha: [00:13:41] Yeah. And one thing I'll say is I never like to give advice because to each their own. Personal finance is personal. And, but now what I've started to do is small parts of my portfolio, now that I've been investing for 4 to 5 years, small parts, I am starting to incorporate some of these alternatives that are truly uncorrelated from the markets. And this can be more an offline discussion if people want to reach out. I never give advice. I'm not certified, I'm not a planner, but I encourage people to learn and enjoy learning.

Kevin Mailo: [00:14:11] Yeah, yeah. At Physician Empowerment, we call it CBE, continuous business education, right? Like knowing what money does in our lives and the different ways that we can use it. One thing that we always kind of harp on at our finance events - and we've got another finance conference coming up May 6 and 7, 2023 in Toronto, of course you're invited, Yatin.

Yatin Chadha: [00:14:36] I'll be there.

Kevin Mailo: [00:14:37] Yeah, I know. It means a lot when you come out.

Yatin Chadha: [00:14:40] I wouldn't miss it.

Kevin Mailo: [00:14:41] But one of the challenges that we try to encourage people to face is the notion of an income based retirement. Right? Because in my opinion, real wealth is income coming in regardless of whether you are going into work, regardless of whether you're picking up that call, that clinic, you know, doing those ORs, is money coming in through passive investments or near passive investments, right? Because nothing, you know, it's very, like unless you've got a trust fund that's churning out money, like most of the time, you're going to have to at least learn to manage your managers, whether that's a property manager or a portfolio manager. But talk to us about an income based, a truly income based existence where we are not dependent on hours worked and ideally one in which we retire and our net worth continues to climb because the income not only handles our day to day expenses, but continues to grow in value or continue to grow our asset column in value. Do you want to talk to us about what that means or what your reflections are on that?

Yatin Chadha: [00:15:47] It's such a wonderful question, Kevin, and so I'm happy to talk about my perspective on this. And first off, I think we'll hear a lot of stats out there. But I think generally speaking, most people who end up in a very good financial position in life and people have different definitions for that, whether it's a millionaire - but now when the cost of living is getting so expensive to have $1,000,000 at point X may not mean that much - but generally speaking, people who do well have multiple sources of income, and those sources of income are not necessarily tied to their day to day grind. So I was reflecting on this, and I'm a radiologist day to day. And one thing I realized was, well, wow, I have a lot of income tied to radiology. It may not all be tied to the hospital, but it's tied to extra clinic shifts that I'm doing and locums that I'm doing. And you and I have talked about this. This is a very, you know, the tendency of a lot of physicians to just start doing these extra shifts. But what I notice is that if--

Kevin Mailo: [00:16:51] -- it's easy and we know it right, and you go, Well, exactly how am I going to make that kind of money? Well, just exactly a shift. But but that's not a recipe for health and wellbeing and it's not sustainable--

Yatin Chadha: [00:17:03] -- exactly. That's my point. I realized that if I was doing this same thing all day, every day wasn't necessarily making me happy inside. And in fact, I had a few people reach out to me. These were friends who were listening to the podcast and they said, Yatin, why, some of us are asking, why are you doing this? Because you could just go and read radiology cases all day and ramp up your income. I was like, Yeah, I could do that. But deep down that would be almost stalling my personal development. That would be, that would be, in a way stalling my ability to network and and meet with people. And at the end of the day, I want, you know, and I'm not saying I'm going to monetize the podcast, but at the end of the day, you know, I want to grow and--

Kevin Mailo: [00:17:49] -- you're doing something you love--

Yatin Chadha: [00:17:50] -- exactly, but I think--

Kevin Mailo: [00:17:54] -- keep going. Keep going.

Yatin Chadha: [00:17:56] No, no, no, no, no, no, no. I keep interrupting you there. But I was going to say, I think most successful people have sources of income that are truly diversified coming from different areas. So that's one of the reasons that I started to get into real estate, for example, in the last several years. So starting in 2020, up until now, each year I have invested in one property and now, now as I'm learning more about real estate and I'm learning about the different ways you generate income in real estate, I can say that each year I think the investment that I made is probably a more sound investment. And my most recent one was in fact a triplex in my hometown of Kingston because I wanted to make sure that the next property that I acquire results in some positive cash flow each month.

Kevin Mailo: [00:18:42] I love it.

Yatin Chadha: [00:18:42] And so, and so this is my goal. So the reason I'm doing real estate and first of all, listeners don't have to invest in real estate because I can tell you - and as you know, Kevin, you know more than me about this - but when you're starting early on in real estate, it certainly is a bit more active until you have your team on the ground and you understand the processes, then it can become truly more passive. But I'm still in that kind of more active phase. But what I want is that I want, let's say, a handful of rental properties so that by the time I am, let's say, 60, you know, most of that stuff is paid off. And then it's just, it's cash flow every month, it's gravy every month. And I don't have to work for that. Right? You're providing a necessary need for society, you're providing shelter. And that's something that at the end of the day, that would make me feel good, and I won't have to be grinding to earn that money. So that's why I'm investing in real estate. I want a certain number of dollars each month that are just flowing in at a certain point in time.

Kevin Mailo: [00:19:40] I couldn't agree more. Just on the real estate point. I mean, when we talk about an income based existence, very few things beat real estate, right? I mean, if you have a big stock portfolio or a whole bunch of bonds or whatever, you're going to have to liquidate that at a certain rate in order to fund your lifestyle and hope that the market continues to grow. But, you know, this year was a nice reminder that the markets don't always grow. So how much do you want to liquidate? But again, what's powerful about real estate, there's different ways to own it, but what's powerful about real estate is I've been through one, two, I think three cycles now, three downturns in Alberta's real estate market. But the money just keeps coming in. The income just keeps coming in, it's like, as long as I'm not under pressure to sell in a down market, real estate allows me to enjoy an income, you know. And that's what's so powerful. So, you know, people ask, does real estate mean that much to you? I say, Yes, real estate transformed my life. I used to worry about my future. I used to worry about money. And now I don't. Not that real estate is perfect. Not that it's all the answers, but it's a big part of my own financial picture because it's that very powerful income based existence that is so hard to get elsewhere. I mean, I know people that have made money in crypto and then watch them lose it all this year when crypto crashed, you know, and it's something about owning a hard asset. Yeah, I know. I know somebody who who got a little bit woken up with the crypto crash. Right? And all it took was rising interest rates. Do you know what I mean? And so there's all these swings, but real estate, again, it's not perfect, but it holds on nicely.

Yatin Chadha: [00:21:19] Absolutely. And I can tell you that when I acquired this latest property, I felt almost like a small weight was being lifted off my shoulders because I knew that my future became slightly better. And I actually bought the property when my wife was out of town. I told her I was serious about it. She didn't know I was going to buy it. She kind of freaked out. But we're all good.

Kevin Mailo: [00:21:37] You know what? That's okay. Sometimes you just have to jump on things. But, you know...

Yatin Chadha: [00:21:42] 100%, 100%, you keep keep going.

Kevin Mailo: [00:21:44] You converted your hard, hard working labor. You doing call, you doing extra clinics, you're doing those locums, you converted that labor into a lifetime of income through that triplex. Do you know what I mean? And you do that a few more times over the course of your career, and then you replaced your clinical income. And I know doctors who do it all the time and don't have to own the doors directly. You can invest in private equity. There are different ways to get involved in the real estate markets without having to manage your own doors, because I think that's a big downside for a lot of people that are in this space or thinking about this space, is like, am I going to be getting calls in the middle of the night for, yeah.

Yatin Chadha: [00:22:28] Well, Kevin, I'll speak to that. Absolutely. I will speak to that quickly. And I can tell you the one thing that I've learned over the last few years, and this is also from talking to you, is that how we spend our time is critical.

Kevin Mailo: [00:22:39] Oh, yeah.

Yatin Chadha: [00:22:40] And we have to be spending our time that is in line with how we want to live our our life and in touch with our core values. And so for me, I don't want to be getting calls in the middle of the night. So for this triplex, what I've done is I have this week, in fact, Thursday I'm handing the keys over to a property manager and that's incorporated into the the expenses of the property. And so the other thing that I'll kind of just say your comment about private equity, so, and I won't mention specific companies or what I invest in, but I did do my first private equity investment this year as well. And that was--

Kevin Mailo: [00:23:11] -- so did I. And it was amazing.

Yatin Chadha: [00:23:13] Good for you. Good for you. You know what? And I know that the two reasons I did it was it's a passive way of investing in real estate development. And then the other way, the other reason is, it's often, not always, but it can be uncorrelated from the market. So I wanted to just kind of diversify things and I wanted it to be totally passive. And so I did that. And so more for an offline discussion, people can obviously reach out to me. I won't mention specifics here, but yeah, just to comment on private equity there. And the other thing is, Kevin, in terms of having different sources of income over time, I have, I have become more interested in things like dividend stocks. You know, Canada is very rich with dividend stocks. And I know that Dimitre did a wonderful presentation at the Physician Empowerment Conference, so he did a great presentation. And the thing is, like, I know emergency physicians, I'm about to interview one in a month or so who basically reached his definition of financial independence. And a core component of his strategy was investing in dividend stocks that continue to raise their dividends year after year after year. There are so many in Canada. And when you look at this last downturn, Kevin, you kind of look at what's happened to stocks, what's happened to bonds, what's happened to crypto, the asset class among these more liquid asset classes that has actually fared the best, are dividend stocks. And so I think having that as a chunk of my portfolio, personally, it gives me an added layer of confidence and to get those dividends either monthly or quarterly, it just, it feels good when you see that.

Kevin Mailo: [00:24:49] I couldn't agree more.

Yatin Chadha: [00:24:51] I'm a fan. I'm a fan, it's not for everybody, but.

Kevin Mailo: [00:24:53] A big part of this is how well are you sleeping at night? I mean, you alluded to that earlier. And I consider that to actually be an investment criteria. Wing calls it the pillow test, you put your head on the pillow at night, are you sleeping better or sleeping worse? Because if you're sleeping worse, don't invest in it. Right? You know, if it's Tesla stock or whatever, don't invest in it. You know what I mean? Like so, you know, find things that are going to bring you peace of mind because that's one of the reasons to have money is to simply be happier and less stressed out about your day to day. Right? So if you're investing in a certain dividend paying stock allows you to feel better and go to bed at night feeling a little more secure in your future, then go and do it.

Yatin Chadha: [00:25:32] Yeah, it does for me. And there's a lot of wisdom coming from Wing. I mean, he's lived, he's lived a very experienced life, one with varied experiences. And so there's a lot of wisdom there.

Kevin Mailo: [00:25:43] Yeah, I respect it a lot, you know, and it's, it's about just getting to that point where you don't have to stress about your future and then at some point you don't have to stress about your monthly bills. That's the dream. It's hard to get there, requires a lot of discipline, a lot of savings and a lot of retained corporate earnings. But I know that Canadian physicians have tons of opportunities in front of them. You know, even though I just want to send a message of hope because I think a lot of Canadians that I've talked, Canadian doctors that I've talked to coast to coast, and I don't know about you Yatin, are really struggling. Right? I mean, inflation's going through the roof, cost of living, interest rates. But then it's our overhead is going up. And yeah, codes aren't keeping up. I mean, in Alberta, we just I think we just voted to ratify our agreement. But it's not, it's not going to keep up with inflation, you know, and so physicians feel squeezed and they start saying, well, now I'm going to work more hours. But there are actually strategies so that we are not working more hours to catch up or keep up. There are ways that we can utilize advance tax planning, learn to invest and really learn to grow without feeling pressure to simply pick up more hours, because I think most of us are probably tapped out.

Yatin Chadha: [00:27:00] You know, 100%. I'm going to comment on a few things there and interrupt me at any time.

Kevin Mailo: [00:27:05] No, no. Go, go.

Yatin Chadha: [00:27:06] We talked about kind of an income based existence. So we touched on dividends. We've touched on real estate. And for me, I'll talk about my experience. But for me, it's still kind of early stages for the podcast. And right now I'm beginning to have some conversations about, well, what's kind of the next step? But what I want to relay to the listeners here is, sometimes don't think that the path you are on is going to be your only path or the final path. You have to be very open minded and open to new experiences. And so I can tell you, when I decided to start the podcast, it was April 2020, that entire month, not by choice, because our volumes really slowed down, I was only able to work four days that month and I don't do well in that kind of setting, Kevin, and so I just thought to myself, there's got to be some other way for me to bring something useful to the world. And so I told my wife, Sima, I said, Hey, I'm getting more and more interested in finance. I mean, I drive my accountant crazy with all these questions. I'm always talking to you about it at home. But I told her, I think that there's a way to create something so that I'm bringing on subject experts and that through this maybe we can kind of enhance the financial literacy of the medical community. I think it'd be really worth trying. And so I didn't even do any research, Kevin, I did a quick Google search on, financial podcasts for physicians. I saw nothing and I was like, okay, good enough for me.

Kevin Mailo: [00:28:28] There you go.

Yatin Chadha: [00:28:29] I'm going to start it. Just do it. Pull the trigger. And to be honest, even though I'm not making anything off it right now, Kevin, just because I took a chance, because I made a decision in the moment and I acted on it, the pod is one of my, I guess it's one of my proudest accomplishments today.

Kevin Mailo: [00:28:46] Well, I'll tell you, I treat my companies like children. Like my companies are like babies to me. So you can just call it a baby. I don't know how your real kids are going to feel about that, but.

Yatin Chadha: [00:28:56] Yeah, yeah. No, I honestly, it's one of my proudest accomplishments to date today for those reasons.

Kevin Mailo: [00:29:01] You should be proud, it's incredible.

Yatin Chadha: [00:29:02] Thank you, Kevin. But you know what? And the real message I want to get across to people is that sometimes in life, whether you're thinking about starting a podcast, whether you're thinking about starting a business or you have an idea, just sometimes you have to act, sometimes you have to take a little bit of risk, and sometimes you have to just kind of throw that Hail Mary and hope for the best. And if you make a mistake, you'll be better for it in the long run.

Kevin Mailo: [00:29:27] And don't be hard on yourself for mistakes. I've made many mistakes in my financial life. Don't be hard on yourself. Accept it is a cost of learning.

Yatin Chadha: [00:29:35] 100%. I mean, make sure that you're sleeping well at night, but you have to take chances sometimes. And honestly, part of the reason that I continue to do the pod, it takes up a lot of my time right now. I mean, I'm not really making much off it at all. But, you know, at the end of the day, my kids see me do this and they ask me questions about it. And there's a lot of messages and lessons I want to teach my kids. And one of those is, Boys, I want you to pursue things that you're passionate about in life. I want you to learn how to work hard in life. And I hope that the things they see in our household, I hope that those lessons will be passed on to them and that they'll be better for it. You know, it's a multi layered process, Kevin. There's so much to this, and I think it's taken me a long time to realize this, but I think the pod has shown me where one of my key interests lie, is just in online education and there's so many ways to do it. And so that's the path that I want to kind of keep pushing towards. And it may not become apparent to you right away what your path is, but if you stick with it, if you do things with full intent and with passion, you will discover that path. So that's what I want to articulate for the listeners.

Kevin Mailo: [00:30:44] I absolutely love that. And you know what? With that, I can't believe we blew through over 30 minutes. We should probably wrap up, but I loved it. As you can tell, we could probably just keep talking and talking and talking, you and I, because every time we do this, we just go and go. But it was truly incredible. And Yatin, like, you just, you're so gifted in this space, you really just got to keep going and I know you will, and I know you're going to continue to succeed. And again, for our listeners, if you haven't listened to Yatin's podcast, I really encourage you to do so. It's the Beyond MD podcast and it's all over the Internet tubes. And so with that, I'm going to start wrapping up, say a final word, and then we'll get to some questions in our webinar here.

Yatin Chadha: [00:31:22] Yeah, Kevin, thank you for that. And the one thing I will also say is that the fact that you and your team have been at these webinars have been at these conferences year and year over and over again, it speaks to your passion and I've had many conversations with you offline, and in fact I've learned so much from you. One of the topics being real estate. You really lit a fire under me when it came to real estate. So I have to thank you for that. And honestly, you've, you know how to encourage people to pursue the areas that are most tied to their skill sets.

Kevin Mailo: [00:31:55] Find their why, find their why.

Yatin Chadha: [00:31:56] I know, I know people are going to get listen to you on many podcasts, but you're a great host, you're great at what you do, and I hope you and your team keep it up.

Kevin Mailo: [00:32:03] Yeah, you know what? We're going to keep working. And like I said, we've got the conference coming up this May 6 and 7, 2023. And it is going to be wonderful. That's something, I'm not the best at everything, but I'm very confident in what we do at our conferences, in our ability to transform physician's lives. And you've been there Yatin, you know.

Yatin Chadha: [00:32:20] Yeah, I'll be there next year too, as a guest. But I look forward to it.

Kevin Mailo: [00:32:24] Very much looking forward to having you there. So we're going to wrap it up because like I said, we can keep going and going. Thank you again Yatin for being on the show.

Yatin Chadha: [00:32:30] Thank you for this, Kevin. Oh, pleasure. Anytime.

Kevin Mailo: [00:32:32] Thank you. Bye.

Kevin Mailo: [00:32:33] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal wellbeing, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Wing Lim, co-founder of Physician Empowerment, turns the tables and interviews Dr. Kevin Mailo for a change. Kevin talks about real estate investment for physicians and shares insights and advice from his own personal real estate journey.

With a family history of investing or buying in real estate, Kevin acknowledges that he came to real estate naturally. He sees real estate as a very powerful wealth creation tools and he names three main reasons for that: appreciation, positive cash flow generation, and mortgage paydown. Kevin gets into detail with Wing about how each of those three work. 

In this episode, Dr. Wing Lim and Dr. Kevin Mailo discuss how an incorporated physician can start in real estate investing, why Kevin feels real estate gives him more peace of mind than stocks or other portfolios, how to start if someone is not incorporated, and why eventually it’s advisable to bring experts in to help with property management. They shed light on real estate as a powerful tool for physicians to use to their benefit.

About Dr. Wing Lim

Apart from his clinical & teaching roles, Wing has extensive experience in Practice Management and Business Development. 

He is passionate about sharing his extensive knowledge & experience (both clinical & business) with others in various settings, from his clinic mentoring younger colleagues, to churches, senior groups, ethnic functions, radio broadcasts, retreats, seminars, and national conferences.

About Dr. Kevin Mailo
Kevin is an emergency physician based out of Edmonton, Alberta. He is known for his highly engaging teaching style that breaks down complex topics into memorable experiences. 

Kevin cares deeply about the long-term wellness of the medical profession and wants to see physicians and their families succeed personally and financially.

Resources Discussed in this Episode:

• Save the Date for May 6-7, 2023 in Toronto
• Robert Kiyosaki
• “The Growth Mindset with Dr. Wing Lim” episode on beyond MD with Dr. Yatin Chadha
• “How Finance Relates to Personal Wellness with Dr. Kevin Mailo” episode on beyond MD with Dr. Yatin Chadha

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Isn’t it enough to have a personal CPA & a regular lawyer for annual tax & corporate returns? What does a Tax Lawyer offer & when would we need one? Come & learn from a “fire side” chat between Wing & Jason the Tax Lawyer on February 2nd at 6pm.

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Physician Empowerment: website | facebook | linkedin

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Transcript

Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you are listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment.ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.

Dr. Wing Lim: [00:00:34] Well, welcome everyone. So good to have a few people show up on Wednesday evening. Alberta time 6, I guess it's 8 p.m. in Ontario. And so yeah, so I'm really delighted to have this webinar and so we hold this on a regular basis once a month. And so we're going to talk about real estate for incorporated physicians. All right. So this is not for the faint of heart, I guess, and I'm very delighted to welcome everyone and actually I'll be turned the table around. Usually I got interviewed by Kevin, but I'm going to interview Kevin. So I'm Wing. I'm Wing Lim, one of the co-founders of Physician Empowerment. And so I'm turning the table around to interview Kevin about this, this interesting topic. So of course, people have different backgrounds and people invest in different things, and there's a wide spectrum across all of four asset classes. And so let's start off by saying that why real estate, right? There are people who do nothing but index funds and people do nothing but mutual funds, some do stocks, bonds, some do exclusively crypto, bless their heart right now. And then there are also people, even within real estate, they flip and there are a lot of things they do. So let's just have a bird's eye view over why real estate compared to other asset classes. So, Kevin, what's your take?

Dr. Kevin Mailo: [00:02:03] Yeah, let me talk a little bit about my my story about real estate and why it came to me and fairly naturally. But I come from a family where, for a few generations, has always been somebody on either my mom's side or my dad's side who has invested and bought in real estate. And I saw a lot of wealth created in real estate. So real estate started with me at a very early age. I kind of got into it by accident. Initially, having bought our first property as our personal residence years ago in medical school, and eventually didn't get rid of the place but rented it out. And so that was years and years ago that I started. And since then it's been a really, really great journey. But real estate, it's a very powerful, very, very powerful wealth creation tool for a number of reasons. The classic three are the following benefits of real estate. Number one is appreciation. So if you look historically across all different types of real estate in buoyant markets in North America, right? So I'm not going to talk about other parts of the world that are depopulating or aging or, you know, stagnant economies like the Rust Belt in United States or things like that, where real estate can be stagnant or drop. What I'm really referring to is a buoyant market and it doesn't have to be red hot like the GTA or the Lower Mainland in Vancouver. But real estate appreciates. That's the first pillar of why I love real estate and why I invest in it. Number two is real estate, if done properly, generates positive cash flow. So if you were in a buy and hold model where - and it depends on the ownership structure and we'll get into this in a little bit - but if you're in a buy and hold model and there is a tenant, whether it's a commercial tenant, whether you own your own clinic, whether you have residential tenants, ideally you're generating positive cash flow every month, which is income that comes into either your your own pocket personally or corporately. And then lastly, this is the most powerful of the three, is mortgage paydown, right? So when you acquire that property in year one and this is a very simple example, when you acquire that property in year one, you're using a down payment of 20% or less, typically on residential real estate. And then you flash forward to year 26 when the when the property is paid off and the mortgage is cleared. That property has appreciated in value three times, maybe four times what you paid for, but what you didn't you didn't pay with all of your own money. You used a loan from the bank, use the mortgage to acquire 80% of that property in year one.

Dr. Kevin Mailo: [00:04:52] So somebody else, the whole 25 years that you held the property, paid that mortgage, and that is your tenant, whether it's a commercial tenant or practice colleagues or a residential tenant. And this is incredibly powerful and we've got our conference coming up, so for anybody that's listening to this or joining us on the webinar tonight, our conference is coming up May 6th and 7th in Toronto. We do it every year. It's an outstanding event where we talk about wealth creation for Canadian physicians, and we're going to be focusing on real estate this year because we keep getting more and more interest. But we're going to break this down in a lot more detail in May, but just put that in the back of your head that the wealth creation through real estate very passively is this mortgage pay down and appreciation. And it's stunning what the annualized returns are on that on very, very basic entry level real estate investing. Right? Like you don't need to be out there as some aggressive high level investor who's buying up, you know, shiny office towers. You can make a lot of money in real estate in lower class properties for sure. So Wing, do you want to take us to the next question, then? Sorry, you can tell I just keep going and going because I love it.

Dr. Wing Lim: [00:06:04] Yeah, you're right. Yeah. So, there are advantages of the real estate. So while there are advantage of others, how does that compare to stocks, bonds, all those others?

Dr. Kevin Mailo: [00:06:17] Yeah. I mean, you know, we teach at our events, we talk about investing in the markets. And for those of you that have listened to our speaker, Dimitri, he's phenomenal, right? Dimitri has been very active in the stock markets, very active in crypto. And I always say there are many, many ways to make to create wealth as a position. We have many advantages and many opportunities. It's really about finding what works for us. One of the things I love about real estate is, number one, to allude to my point earlier, is you get access to credit for it, right? So you can't walk into the bank and say, Listen, I'm really good at buying stocks and bonds. I'm really good at investing in crypto. Give me a mortgage for $1,000,000 and watch me grow it at 15% annualized return. The banks are just going to laugh you out the door, right? They don't do that. But if you say I found a property, I want to acquire it, I need a mortgage, the bank goes Sure, right? Because the banks inherently recognize the stability and the long term growth that real estate offers. They do not offer the same for the markets, and I think we're in a great year to prove that point. And not that you can't make money in a down market, there are going to be many people that make a lot of money in a down stock market, but it's tricky. Real estate for me at least, I love because it's relatively simple. You put your money in as that down payment. You put a tenant in and over the course of years that mortgage is rapidly paid down. The property accrues in value and you get cash flow.

Dr. Kevin Mailo: [00:07:50] And what I'm really getting at is peace of mind. One of the central things we teach at Physician Empowerment is that when it comes to investing, your investment portfolio, your strategy should reflect your life. So we have stressful jobs, we work long hours. So I really don't want to be up at night wondering what the markets are doing, wondering what crypto is doing. I wonder if my Tesla stock is sinking, not that I own no Tesla stock, not one bit of it. But just to give you a sense of like what's going on in the markets and appreciating that that can take a mental toll, whereas real estate, there's a lot more stability there, right? Like, you know it's trending upward. You know that every month, even in a down market, those mortgages are getting paid down. And so it offers a lot of peace of mind. And again, at the conference, I'll show you the math on this, where you can sit down and say, well, if I invest X amount in real estate and if it grows at a certain very conservative rate, then I'm going to be worth millions of dollars in 20 years time. And it's as simple as that, right? So it really brings a lot of peace of mind. So that's personally why I love real estate is and it's a very tangible asset, right? It's not an electronic signal on the internet like crypto. You can drive, I can go look at the properties I've invested in or the properties I own directly. So I hope that kind of answers the questions. I mean, there's a lot here, Wing.

Dr. Wing Lim: [00:09:15] Yeah, so maybe let's go one step further, right? Because the topic is for INC positions. So does it matter whether we INC, let's talk about INC and let's talk about those that are not INC.

Dr. Kevin Mailo: [00:09:30] Yeah. So yeah, real estate as an INC position there are a few advantages and one of the big ones is you can retain earnings within your professional corporation. You pay corporate tax on that right, like we all do. But then you have that extra $100,000, let's say sitting in your professional corporation, you can then transfer to a holding corporation and invest in real estate. And whether that's direct ownership or a limited partnership or syndicated deal or something like along those lines is it's a very flexible, relatively easy thing to do. Setting up a holding corporation is very straightforward. Your accountant and any average kind of lawyer can easily set one up and then it can be funded with shareholder loans from your professional corporation. So in that regards, there's a huge tax advantage, at least to start out with when you're acquiring real estate because you're not forced to take the money out of the corporation. Because in Ontario, as an example, the top marginal tax rate I believe is 53.53%. So if you had that extra $100,000 retained in your corporation and you wanted to take it out and buy a rental property, let's say, well, you're going to be paying that, most of that is probably going to be in the top marginal tax bracket, which is going to leave you with only 43,000. 47,000, pardon me, I'm very bad at math, especially public math, 47,000 ish to invest. Right? Whereas if you held that corporately, you'd be probably sitting closer to 90,000. So that's a big spread. So you can see, like if you're trying to build that portfolio, it can grow quite rapidly using retained corporate earnings. And again, we're going to be diving into this a lot more at our conference.

Dr. Wing Lim: [00:11:13] Yeah, exactly. So, yes. So I like the big gurus, like the Robert Kiyosaki of the world saying that I love real estate because I borrow the money for free. Everything I leverage. And he brags about owing $1,000,000,000 in debt, leveraging, getting higher on other people's money.

Dr. Kevin Mailo: [00:11:33] I put some caution there. I put some caution there because there are risks to that, to overleveraging in real estate. And, you know, the truth is and again, we can show you this at June just as a side dig, but in some cases, you can actually create an infinite return for yourself on real estate by using totally other people's money. I again, I caution because there is there is some risk associated with that and we can explain what that looks like. Can I step back and just talk about personal real estate personally, because I own a little bit personally and that was also an interesting journey. So, you know, converting one of my personal homes that I previously lived in into a rental property because I couldn't sell it in a down market with rising interest rates. So I kept it. And that was kind of an interesting journey and it works out all right in terms of the same things apply. You have annual appreciation, you have mortgage paydown. But the issue is, is that whatever cash flow you're making, whatever profit you're making on that place, you're paying top marginal income tax rates. So that's one of the, that's one of the big ones that I struggle with, is that whatever money you're going to make off of your personal holdings, you're paying, you're probably going to be paying at the top marginal income tax rate. So that's a bit of a struggle. And then the other downside is, is whatever you own personally is because it's not your personal residence, you don't get the capital gains exemption. So if you go to sell the property and let's say a gain 500,000 in value over the 20 years that you owned it, you're going to pay capital gains on that. So again, it's sort of, it's not that great. And then there are some questions as to whether you're exposed to more liability. But this is all direct ownership of real estate when you probably want to get to other types of real estate investing.

Dr. Wing Lim: [00:13:30] Yeah, but maybe we just pause. So what about those who are not incorporated? They don't have a PC. What do they do? Should they give up?

Dr. Kevin Mailo: [00:13:40] No, no, no. There are many ways to invest. I mean, you can run it as a proprietorship. Absolutely. Again, I would recommend very robust insurance on that and definitely sit down and talk with your accountant and talk to your lawyer before doing anything in real estate in general, but especially, you know, as operating as a proprietorship. But you can still invest in real estate deals, you know, as an individual. So most physicians are what we call an accredited investor, which allows them to step into private equity deals in real estate that the average person can't access. And you want to just explain what an accredited investor is for a minute, Wing?

Dr. Wing Lim: [00:14:16] Sure. Accredited Investor, well, there's a very technical definition, but basically, from what I can gather as a layman, is you need to own $1,000,000 worth of free property, have $5 million of cash, sorry $1 million cash, $5 million of of properties, in everything you hold liquid and illiquid, but also for most people is $200,000 a year of income for the last two years. Well, $300,000 a year of income counnting the spouse. So most physicians qualify.

Dr. Kevin Mailo: [00:14:48] Yeah. Yeah. So again, there are ways to invest personally as well, even if you are not incorporated. But again, sorry continue Wing.

Dr. Wing Lim: [00:14:59] So we step into it already, so we're ahead of ourselves. So yeah. So then what are the different ways to own real estate?

Dr. Kevin Mailo: [00:15:06] Yeah. Yeah. So let me talk about my journey a little bit and why I'm changing growing maturity as as a real estate investor. And for anybody that follows Yatin Chadha's podcast, I was on there talking about my own real estate adventures and lumbar puncture night, which was pretty memorable. People still mention that when I bump into them and I won't go through that war story again. But the bottom line is I started out investing real estate, buying doors. Right? And that's sort of the the colloquial term we use for acquiring small single family dwellings, whether it's an individual condo unit or apartment unit or an individual home or a duplex or fourplex. But what I'm getting at is something small scale that I own myself as an incorporated position, and then go and effectively manage it myself. And even with a property manager, it ends up being work. It's always work, right? And I think this is one of the things that turns people off of real estate, right? And so I bought enough doors that I got to a point where I had quite a few doors, if I can be honest with you, that was keeping me really busy, you know, in terms of phone calls about some small issue, big issues, vacancies, paperwork, bookkeeping, accounting, there was a lot there that added up. And, you know, I've got property management on most of my doors and it's excellent. But in the end, somebody's still going to phone you about things, even if it's not you in the middle of the night dealing with that broken toilet, which after a while when you realize, like if I keep going down this journey and keep just buying more doors, I'm just going to get busier and busier until I bought myself another job, right? And I'm busy enough with emergency medicine and raising my kids that I really don't want to take away from my personal time. And to go back to echo that point earlier, this is about building a better life, right? Whatever we invest in, whether it's the markets, crypto - crypto, right, this is not the year - you know, whatever it is, it should be buying us peace of mind, right? So there comes this kind of tipping point, and every physician's different, I mean, some people, you know, I'm sure there are physicians out there with like 50 doors and love it. Right? I'm nowhere close to that and already feel busy enough with what I've got, you know, realizing that as somebody who is initially very hands on, like, you know, I go paint walls with my kids because I want to teach them a little bit about the business. You know, I can swap out appliances like nobody's business. You know, maybe it's all that practice on central lines and airway equipment. It just gives me handy skills, you know, swapping out appliances. I don't mind it, but I realize that as time consuming as I get busier, I'm going to struggle with this. And even if you have to find a contractor for a lot of this, it becomes difficult. So now this year for the first time is I finally stepped into private equity, right? I realized that I didn't want to keep scaling up, getting more and more doors, more and more mortgages and more and more phone calls. Even if I am making money and loving that part of it, there comes this kind of tipping point where, as a busy physician, I say to myself, you know, how much of my time, even personal time can I deploy here? And so that's where I stepped into private equity. And that's where I really think most physicians are going to be happiest, right? Because I come from a background where I grew up enough around this stuff to understand it. I'm pretty handy. But at some point, if you're busy, you may just be, as a physician, you may be much more interested in private equity. And so physicians make a lot of money in this space when it's done properly. And what private equity is, is you're not on the hook for mortgages or personal guarantees in many cases, what you're really doing is you're lending money into a project where somebody else carries the credit risk and somebody else is in charge of developing the property and managing the property. And I did that for the first time this year, and I'm very excited and very happy about that, that new phase in my real estate journey as I mature from being kind of the hustler that's doing it all myself to now stepping away and investing at a higher level with people who are professionals in this space, right? People who are experts, because that's what we do in practice, right? When we're in over our head, it's time to consult. The same sort of thing goes in our financial journey, whether that's finding an excellent portfolio manager, whether that's finding a great accountant, whether that's finding a great tax lawyer or somebody to help us with insurance or again, property management or deals, at some point we have to let go. And that's one of the things I struggled with as a physician was that instinct, that impulse to micromanage. But as you can step away from that, you could make a lot of money and be happier and enjoy more peace of mind, which I think that's the the triple win there. So keep going.

Dr. Wing Lim: [00:19:53] So. Yeah. So there are different things you talk about: actively managing, change your own toilet all the way to private equity, you're totally hands off. So for those of us who are brand new at this, how does a busy physician start?

Dr. Kevin Mailo: [00:20:10] Yeah, I mean, this is always the thing. And so we talked about this earlier in this month's small group. So we lead a master class and Wing actually took us through a great one called Navigating the Asset Jungle. And one of the key pieces of wisdom that I'm going to say before you even get started is actually start. Right? I encounter physicians all the time who talk year after year about investing in real estate and never pull the trigger. Some of whom I followed for years. I have physicians that say, I'm going to get into the market, right, whether it's the public markets, stocks and bonds year after year, and you find out that they have six, even seven figures worth of cash stacked in their professional corporation because they are too scared to finally step out and put it someplace. And knowing that your cash is dropping. In our current inflationary environment by 10% a year. So if you have $800,000 in cash stacked up in your professional corp and you're too scared to invest it in real estate or the markets or whatever, you just lost 80,000 this year in purchasing power. Right? So the first piece of wisdom in this space is having the courage to actually do it, right?

Dr. Kevin Mailo: [00:21:24] So saying to yourself, I'm never going to know everything, but at some point I have to step out there and do that. And you know what? That's not that different than our clinical careers, right? I mean, I remember my first few weeks in practice being like, Oh my goodness, there is a lot here, but it's on me because I'm now an independent physician. And we have to carry that same mindset of being able to step out knowing that we don't have all of the answers, knowing that there's always going to be some risk. So the first piece of wisdom is do something, number one. The next piece is realize that you cannot fully eliminate risk, and that goes across any asset, be it crypto, the markets, real estate, whatever you want to buy, there is no zero risk here. So be willing to accept some risk in real estate. Create that wealth mindset which is optimistic, informed ability to manage risk. Right? We're not talking about blind gambling and we're not talking about blind trust of the professionals you're working with. We're talking about understanding risk and being able to accept and put a little bit of money on the line. The next big one--

Dr. Wing Lim: [00:22:28]  -- Sorry, let me interject to plug in. So the masterclass that we're doing next month, December, we're going to do the risk jungle, navigating risk jungle. 

Dr. Kevin Mailo: [00:22:39]  Good, good, good, good. That one took me years to learn, and I'm still learning it for anybody that's on this webinar. Drop us a line. Email us because we would love to have you join us just to drop in and see what a single, what a single webinar or masterclass with Wing looks like because they're outstanding. But yeah, we're going to talk about risk. So let me move to the next thing here in what I recommend as first steps, and this is start reading, start learning about real estate so that you understand how it works, so you understand the terminology and you can begin to talk the language a little bit. And again, you don't have to be the expert here. You don't have to be the most knowledgeable person in the room. But just having some awareness goes a long way. The other thing that I anchored to, through the good times and the bad with real estate, is those three truths - cash flow, why would we call them 3 truths, 3 powers of real estate - cash flow, appreciation and mortgage paydown. The reason why is because there are ups and downs in real estate. I've been through Alberta's real estate market with some downs over the years and you have to just open up those numbers and go, Well, I'm not gaining through appreciation this year, but I'm still making cash flow and my mortgages are still getting paid down, right? Because when you get to those core realizations about real estate, it allows you to hold the road, right? You know, when people with the stock market plummeting like it is, we'll say Historically the stock market goes up, I'll ride out this rough patch, even though it's an eye watering loss in a given year, which is why I have very little in the public markets. And I have no answer for crypto. None whatsoever. Don't. How about that? Sorry to be so blunt. Yeah, crypto keeps coming up, but it's just, this is the month that went under. So anyhow, just going on about educating yourself in risk, educating yourself in the basic terminology of real estate, and having a commitment to say, Okay, I'm not going to freak out here, I am going to put some money into a project and you can start small, right? You don't have, do not go throw a million bucks into a deal. Right? As your first deal. Like, don't do that. There's no rush. There's always new real estate deals coming up, always new opportunities coming up. So go cautiously, go slowly, and get comfortable with what you're doing. And then once you see those returns coming in, you can start saying, Okay, now I get it. I'm okay with this. And you can gradually put more and more in and that's how I did it. And 15 years on, I couldn't be happier.

Dr. Wing Lim: [00:25:16] Right. Cool. So maybe Kevin can share with us some pitfalls and lessons learned that you wish knew earlier.

Dr. Kevin Mailo: [00:25:25] Absolutely. Yeah. So, number one, I wish I hadn't worried so much. I spent so many years investing in real estate over the years, and I worried. It's kind of like raising kids. You know, you sit there and you worry about them day to day, and then you look back and you're like, What did I worry about? They're actually all right. And so number one is, I wish I hadn't worried so much over the last ten years when I've really been much more active in real estate. I wish I had scaled up sooner and gone into private equity sooner. I spent far too many years in my life managing my own doors and chasing smaller returns because I wanted to be able to micromanage it. And I wish I had stepped into private equity five years ago and gotten involved in bigger projects. The other big one is don't overleverage, really don't overleverage. The banks are going to give you a lot of money if you go out and ask for it. But that doesn't mean you take all of it because you're on the hook for that. And in the end, like real estate is, like, you make a lot of money leveraging. I'm not saying not to, but I'm just saying to be mindful that in the end you've signed personal guarantees on all of those mortgages. And so don't overdo it. Go cautiously. Go slowly. And build within your risk tolerance. Right? But don't be scared. Like I got, there are physicians out there that have $2 million worth of personal mortgage and it's on them to show up every month with a with a mortgage payment. Whereas if you had $2 million in rental properties, somebody else is coming up with those mortgage payments every month. And whatever you have to subsidize, if it's a slow patch or a slow month, it's a tax write off, right? So it's a huge, huge advantage to being in debt corporately with rental properties versus personally. And so I would say compare those two. What does $1,000,000 in mortgage, personal mortgage debt look like versus $1,000,000 in rental property debt, and realize that personal mortgage debt is far riskier than rental property debt. And then the other big one that I would encourage people to do is not get too caught up in faddish returns or all the glitz and glamor because there's a lot out there. Right? As an accredited investor, you're going to have a lot of people potentially approaching you, looking to invest with you, but you have to be mindful who you invest with and when you can speak to that because you've had more experience in private equity as a real estate developer. Right? But there's a lot of caution, right? The people in the finance and real estate industries do not hold the same fiduciary responsibilities that we hold towards our patients. So don't go into it with rose colored glasses. Be very aware of who you're working with and who you're investing alongside. I would say it is very important if you're looking at going into private equity.

Dr. Wing Lim: [00:28:19] Right on. So those are really good pieces of gem that you offer, Kevin. So while we're going to wrap up, so we intentionally don't want to make this a long, drawn out thing, because if you want to do more technicality, come join our master class. We'll do the deep dive. We're doing a whole year's worth of, well building strategies and real estate, and June would be a big, big event in Toronto face to face. And we're going to have a lot of fun and we're going to plan for some some nice trips down the road. This is a further down the road project.

Dr. Kevin Mailo: [00:28:50] Yeah, Yeah, exactly. Lots of great, lots of great opportunities to come together. But yeah, we're going to be talking about this in a lot more depth in May in Toronto at our national conference. So again, that's May 6th and 7th. We're going to be covering this. We are just in the process of moving to new email. So this is my personal email that I just send out to our webinar participants. But reach me personally if you have questions or you want to learn more because this is, there are a lot of great opportunities in real estate, and in my opinion, every physician should be invested in real estate, not all of it, right? Like you can be diversified if you want, but I'd say every physician should be looking at real estate because there are just so many advantages as an incorporated professional to invest in this space and so much return to be had and peace of mind. Like I said, real estate's been such a positive thing in my life.

Dr. Wing Lim: [00:29:38] Yeah. All right. Good. Super. So thank you. I want to thank Kevin for sharing your wisdom. And thanks. I want to thank everybody for joining.

Dr. Kevin Mailo: [00:29:47] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.

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Dr. Kevin Mailo welcomes Dr. Bradley Block, otolaryngologist and host of the podcast ‘Physician’s Guide to Doctoring’ to the show for a discussion on using humour and setting boundaries in private practice. Dr. Block has a wealth of insight that he happily shares.

Dr. Block shares a rule he received from Scott Dikkers, founder of The Onion, on not punching down in using humour. The role of humour is to “comfort the afflicted and afflict the comfortable” and he shares examples of what that looks like in practice as a physician. Humour is a great way to increase rapport with patients and get them into a more relaxed state.

In this episode, Kevin Mailo and guest Brad Block talk about humour and how best to use it with patients, the flip side of how to carefully deliver bad news, why body language and non-verbal cues matter when interacting with patients, and how to draw important boundaries in private practice. While the instinct is to give everything to patients, a firm boundary for yourself and your self-care is vital to maintaining positive engagement with patients. This episode is both entertaining and enlightening.

About Dr. Bradley Block:

Bradley Block, MD, is a private practice otolaryngologist on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and creator of the Physician’s Guide to Doctoring Podcast.

He realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help him improve at doctor-patient communication, but there was none, so he created Physician’s Guide to Doctoring! The topics quickly expanded to “everything we should have been learning while we were memorizing Kreb’s Cycle,” and it is now a practical guide for practicing physicians, physicians-in-training and all allied health professionals. He is available as a keynote speaker on improving the patient experience, doctor-patient communication, and running office-hours efficiently.

Brad, or Dr. Block as his parents call him, went to med school at SUNY Buffalo and graduated with research honors. He then went on to his ENT residency at Georgetown. He enjoys spending time with his family, surfing (yes, there is surfing on Long Island), skiing (there is no skiing on Long Island), smoking meat, exercising, and finding any excuse to quote an 80s movie. “I’m not saying I’d build a summer home here, but the trees are actually quite lovely.”

Resources Discussed in this Episode:

• Scott Dikkers, The Onion

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Physician Empowerment: website | facebook | linkedin

Bradley Block, MD - Private Practice Otolaryngologist / ‘Physician’s Guide to Doctoring’ Host: website | podcast | linkedin

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Transcript

Dr. Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca - that's P H Y S Empowerment dot ca - To learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode.

Dr. Kevin Mailo: [00:00:34] Hi, I'm Dr. Kevin Mailo, the co founder and co host of the Physician Empowerment Podcast. And today I am very excited to be joined by Dr. Bradley Block, community based ENT physician down in New York and the founder of the Physicians Guide to Doctoring. And Brad, why don't you tell us a little bit about your practice background and what you're going to talk about today.

Dr. Bradley Block: [00:00:58] So I'm a general ENT and not realizing that going into general practice, private practice ENT would be mostly office hours. So, you know, in residency we're doing like four days a week in the operating room, half a day, maybe a full day of office hours, you know, and then lecture and the rest. In private practice, general ENT, we spend maybe four and a half days a week in the office and then another half day in the operating room, maybe a little more in the O.R. than that for some, but very, very office hours. And we see a lot of patients. And so what we're going to be talking about today is how I make sure that the patient experience is as positive as possible. Right? And so the reason that I founded my podcast, The Physician's Guide to Doctoring, is I noticed that there were a lot of experts out there that were helping people interact with other human beings, right? The interactions between salespeople and their customers, the interactions between people trying to date successfully or leaders and executives. But there weren't, there were these people with that expertise, but they weren't really focused on physicians. So I thought, you know what? I would love to hear what they had to say about specifically the physician-patient interaction. How do I get an audience with them? Well, start a podcast and then I can give them a call. And the physicians got to doctor and kind of sprouted from that because it became, really answers any questions that physicians might have that help us be better at physicianing. You know, it is either going to be the Physician's Guide to Doctoring or the Doctor's Guide to Physicianing. So better physicianing, whether it's in the office or interacting with our staff or being better community members, community leaders, public health issues, anything, anything that could help us be better doctors that we're not typically taught in our training.

Dr. Kevin Mailo: [00:02:55] Perfect. I love that. It is so true. I mean, this is the thing that we talk about at length here on the podcast. But in reality, during those training years, med school residency and those early practice years, we don't get a lot of training on that, right? And then the realities, as you alluded to, Brad, of going into practice and realizing that you don't have an hour for every single patient, right? So your patients need to feel valued, they need to feel heard, they need to feel that their concerns are important. And yet at the same time, you are running a practice where things have to move along, right? Because there are financial considerations to this. You know, you have to, you are a limited resource as a physician. We all are. And so how do we serve our community? How do we serve our patients as a whole? By being efficient, yet at the same time maintain that human connection, which I think is so, so important. So take us through. Take us through your approach. What have you learned? Maybe even share some failures or struggles. Tell us a little bit of wisdom, Brad.

Dr. Bradley Block: [00:03:58] So one of my favorite guests was Scott Dikkers, who founded The Onion. And I had him on on How to Be Funny. And he wrote a book called How to Be Funny, How to Be Funnier, and the finale to the trilogy, How to Be Funniest. And so he had a great rule for physicians and really for anybody, essentially don't punch down. But what it comes down to is the role of humor is to comfort the afflicted and afflict the comfortable. And so when you're deciding whether or not you want to make a joke, because if you joke around with your patients in the office, that is a great way to connect with them further, right? It's a great way to establish more rapport, to establish trust. People learn better when they're in a more relaxed state. And so you're going to decrease that cortisol that's coursing through their blood vessels when they're in the visit. So it helps them retain what you've what you're talking to them about and understand better. So there's a lot of roles for humor in the in the exam room. And so you always have to make sure you're using it to afflict the comfortable and comfort the afflicted. And so the afflicted in this case is your patient, right? And so you never want to make fun of the patient at all by any means. And then so who can you make fun of? Really, anyone. As long as you're punching up. Like you can make fun of the disease, you can make fun of the electronic medical record, you can make fun of yourself, although you have to be careful because you don't want to use humor that makes you look less competent at what you're doing. So you don't want to look like you're using like slapstick humor to look like you're bumbling. You can make fun of the institution. So there are lots of things that you can make fun of. And you said, look, one of my failures. So how do you recover from a failed joke? That's easy. You can use the same joke every time because even though it's the same thing to you, each encounter is a different patient. So you could always say, Oh, all right, I got it. That wasn't funny. I'll stick to doctoring. I won't, I won't make my foray into stand up anytime soon. So, you know, it's a quick and easy way to recover from a joke, but just identify that you made a bad joke because that can really sour the relationship.

Dr. Kevin Mailo: [00:06:09] Excellent. Talk to us about not using humor. Talk to us about bad news.

Dr. Bradley Block: [00:06:16] Bad news. Okay. So. So a great way... so you have to have a system when you're breaking bad news. You can't go in there without having a plan, just like when you're doing a surgery. You have a plan going into the operating room, right? If you're doing a procedure. When you're breaking bad news, you need to think first about how you're going to break the bad news. And a lot of times what you can do is you go through the steps with the patient of what's gotten you to this point. And what that helps them do is that helps kind of soften the blow as you're getting the bad news, as they're getting the bad news, because they can tell what's going on. So do you remember you came to me with that bump on your neck, right? And we weren't sure what it was. You'd already treated it with antibiotics. It wasn't going down. And so we decided to image it with an ultrasound. And that ultrasound, it really didn't come back with anything specific. So we decided to do a needle biopsy. Right? And what were we, you know, we were worried about that needle biopsy with was the possibility of cancer. Well, we got the results back, and unfortunately, that is the result, that it was cancer. And it's always important to use those words. Right? You don't want to say tumor, you don't want to say mass, you don't want to say malignancy, like use the C-word. Use the, you want to be frank about it. So you can kind of ease them into it that way. And once they have the news, you have to give them a chance to process it, right? So just let them, give them some time to sit with it. You can even give them some time to talk to someone. Would you like to call a family member right now? Would you like to... Listen, you have as much time as you need. Call one of your family members. Talk to them about it. I'll be back in a few minutes. And when you guys come up with some questions, we'll go over them. And then another thing they're going to need is they're going to need a clear delineation of next steps. And oftentimes, we don't have all of the steps, but they need to know what's happening next and it needs to be given to them with a good amount of confidence. Now we're talking about confidence. This is where we get into non-verbal communication. And so non-verbal communication can really be broken down into two different types, right? You want to convey interest and authority.

Dr. Bradley Block: [00:08:45] So when you're conveying interest, that's more like facial expressions and body language. I really love the term body language, but helps people to understand what's being said. So you convey interest, you know, keep eye contact, make sure you're actually emoting with your face. Right? Some of us get kind of stone faced, so you're emoting with your face and then the cadence and the volume of your voice can convey that authority. So when you're conveying that information, you want to convey it with that authority. So you're giving the bad news. You're emoting with the patient, right? And you are demonstrating that you have authority over what's going on with them. Like you're demonstrating your expertise. So. And then you need, that's when you come up with the plan. You don't want to go too many steps ahead as much as they will want you to. But what you do is you give them a clear follow up. So the next step, we're going to order this imaging. In m field, it would probably be okay, we're going to get a CAT scan to the head and neck with contrast, we're going to get a PET scan, and then you're going to follow up with me two weeks later. I want you to write down all of the questions that come up. I'm not going to have many answers now, but I'll answer what I can. But as you're processing this, you're going to come up with a lot of questions. Make sure you write them down, because each visit is going to be a lot more information than the last one. You might forget the questions that you have, so make sure you write them down and make sure you come with somebody. You don't want to come by yourself to these visits because of the volume and the complexity of the information that you're going to be getting. The reason I'm using cancer is the example just because in my field, that's usually what ends up being the bad news, and it's common in other fields as well. So those are a few bits of advice for how you break the bad news and how you kind of walk them through what's going to be happening next because they're going to feel like they've been cast out into space with no gravitational pull to bring them back and they don't know what's going, what side's up and what's down. So you give them some touch points to hold on to, and then you go from there.

Dr. Kevin Mailo: [00:11:01] So, many of our listeners are family physicians in private practice. And again, one of the big things that we feel is that time pressure and one of the commonest things - you probably don't get it as much as the specialist, but we get it all the time in family medicine - is that And what about this? And what about this? Right? And as patients struggle to access primary care, they often will come in with a laundry list of complaints or issues that they want worked out in that 50 minute appointment. And I completely sympathize with those patients. I do the same thing when I go see my own family doctor. So what do you do when you're having one of those days and you are running behind and not like 5 minutes, you're an hour behind because maybe it was a couple of difficult conversations around cancer. Maybe there's a whole bunch of loose ends. Maybe something blew up at the hospital or the O.R. and you're late getting into clinic, whatever. How do you navigate that data? How do you keep your composure? How do you make your patients feel valued? How do you speak to them honestly about what's going on, when, you know, for many patients, it's not easy, right? People got child care to coordinate. They got careers. You know, some people take a bus to get to the other side of town and see you. Tell me what that looks like.

Dr. Bradley Block: [00:12:13] So as an otolaryngologist, this happens as well.

Dr. Kevin Mailo: [00:12:15] Okay.

Dr. Bradley Block: [00:12:16] You know, I've got a patient that comes in with an active nosebleed and they also want to talk about their CPAP machine. Oh, and also they've been having some dizziness lately, probably because they've lost a bunch of blood from the nosebleed. But, you know, they assume that it's something from their inner ear. Everyone assumes it's coming from the inner ear. I can't tell you how many people I see when it's like, Oh, yeah, it's my earwax that's causing my dizziness. Okay, so just for the audience, earwax doesn't cause dizziness, okay? It's a skin issue. Can cause  hearing loss. But okay, so it's important to create boundaries. Now, I recognize that you said some of these patients are coming, they took three busses to get there, but you still have to create those boundaries. And I've gotten better at it as I've gotten along in my practice. Like I used to have patients, like they come in and they can't hear anything. Why? Because they have bilateral middle ear effusions. I could do a myringotomy at the time, but like you said, I've already got four patients waiting. So you know what? That procedure is going to have to wait. They're going to have to reschedule, make an appointment, and we can do bilateral myringotomy, maybe with tubes, we'll see. So I've gotten, I've gotten better about that. But yeah, that happens to me. I would make, when they come in, right, if they come in with that list at the get go, give them the choice of what they want to talk about. Okay. You get to pick two things and I get to pick one thing, but we're only going to talk about three things today. Or vice versa. I get to pick one. I get to pick two. You get to pick one. So whatever you feel comfortable doing as the physician. But they don't get an infinite list of things to discuss. And if you're already out the door and they say, Oh, wait a second, I also want to talk about this, Great, I'd love to talk to you about that. Unfortunately, we've run out of time. I do have three other patients waiting. We've covered a lot today. We talked about X, we talked about Y, we talked about Z. But we don't have time to talk about that too. So just schedule your follow up. It sounds like an issue that you should probably discuss within 3 to 4 weeks or whatever timeline you decide. But it's important to draw those boundaries. And as physicians, we're not trained to. We're trained to give up everything. Stay late, like miss your kid's birthday. I got a patient they wanted to be squeezed in today. It was my kid's birthday today, right? I'm already in the, you know, I'm already getting home late enough.

Dr. Kevin Mailo: [00:14:29] Exactly.

Dr. Bradley Block: [00:14:30] Like, no, no. Like, you can see one of my partners, or I can see you within the next couple of days. But no, I'm sorry. I just. So you have to get better at drawing boundaries. And you do that by keeping the patients to just a couple of issues.

Dr. Kevin Mailo: [00:14:44] You know, one of the things that I found helpful in the emergency department in my own practice is very often I'll take, I'll sit down with patients and I'm later then I said I would because inevitably I get called away to an emergency, something more urgent in the department, I get interrupted to deal with a result or something like that. I come back, I sit down with my patient, I apologize that I'm late, but I say this is important for me that I give you time and it's important for you that you get time. So now I've created time for you because I'm now towards the end of my shift. Let's say if it's something serious or complex, like a geriatric patient, there are a whole bunch of issues. I want to sit down and make sure that I am not rushing that. And as you alluded to earlier, Brad, that body language is everything. I make every effort to sit at eye level or lower than my patients and be near with them and never look like I'm in a rush when the department is busy. I really try to create that space in that time. And that's even about setting boundaries with other patients or residents or whoever wants your time. Right? And just saying, I have to go in here for a couple of minutes and sit down and talk to a patient, really convey or go over the issues. So I think that thing about boundaries is so important. And in terms of our self care, we do a better job when we're  caring for ourselves, right? If you were running late today for your child's birthday, seeing that patient, I mean, how good is that patient interaction going to be? Right? Because there's probably going to be some degree of frustration or angst or worry that carries in your voice as you interact with your patient versus any other day, Brad, when you could have sat down and created that space for them. So I think it was such a powerful observation that you made in terms of setting those boundaries.

Dr. Bradley Block: [00:16:30] Yeah, the non-verbal cues, they can pick up on that, they can pick up when they know that you're rushed. But it's also important that you convey those non-verbal cues. So sometimes, as I said earlier, we're a little stone faced, myself in particular, and they have trouble reading that we're interested. So it's, you can't fake it, but you can make sure that you're conveying it. And that helps those visits to actually go, those other visits to go faster. And when they feel like they're being heard, they feel like they're being understood, that you're more likely to move through the visit faster than if they're getting frustrated because they don't feel like they have your full attention. And that's often why they need to repeat themselves over and over. Another reason why they end up repeating themselves is because there's something that they're not saying that you need to get them to say. And sometimes it's important to really pull that out of them. And like, and I find it a good way to do that is say, What's bothering you about this? Like, right, people come to see me with with globus, right? They feel like they've got something stuck in ther, there's nothing actually stuck in their throat. What are you, what bothers you about this? Do you, do you think you might have cancer?

Dr. Kevin Mailo: [00:17:41] Right?

Dr. Bradley Block: [00:17:42] Yes, I do. Well I'm going to do this exam. And by putting this camera down your throat, I'm going to be able to see whether or not there's cancer. And if I can't see anything like it's extraordinarily unlikely that there's anything there. Right? So getting them to verbalize what's bothering them about their particular symptom can often get you over that hump where it seems like you're just going in circles, you're saying the same thing, they're saying the same thing. So a good question like that can move things along nicely and then everyone leaves the visit feeling more satisfied.

Dr. Kevin Mailo: [00:18:12] Yeah. Boy, I love that. So, Brad, this was absolutely outstanding. I don't want, I mean, I think we can go on and on and on. But give us give us your wisdom. Give us your insights. We have a lot of young listeners who are here. And I think even for for those of us that have been practiced for years, this is the one part of the job that we continue to evolve on. I continue to be humbled throughout my career by the things that patients have shared with me that were unexpected, that if I just took time and listened, I really came to appreciate the patient's perspective. So share share that wisdom with us, share your insights on how we can keep that humanity in medicine that's so important not only for our patients, but for ourselves as well. Because medicine is not a business. Medicine is not a technical skill or a set of knowledge. It really is a human, a human career.

Dr. Bradley Block: [00:19:05] Really, it goes back to what you said, right, about making sure you're taking care of yourself. Because if you are hating life, you're going to resent your patients for it, right? If you're burning out, you're going to resent your patients, and that's going to put up those boundaries, it's going to take away from their care. And it's not their fault that you've made these decisions or the system has put these these things upon you so that you can't take care of yourself. So you really, it's really important for that self care. And it's not just lip service, right? Like we've all been in that, I've been in that place where I've resented, I've resented it, I've resented the patients because I've burned myself out. And that's where the boundaries come in, wherever you decide to put them, wherever you decide it works for you that you can really enjoy. And I'm in that place again. I'm in that place again where I'm really enjoying what I'm doing. I mean, I do plan on retiring at some point. I'm not going to do this for, I'm not going to, you know, I'm not going to be those people that's like, oh, it's my passion. I enjoy it, right? But I definitely enjoy it. It's, I'm not in that bad place anymore because I figured out how to make those boundaries. So self care boundaries, all that, all that stuff, wellness stuff that we say, it really does make sense. It's just every person has a different way they need to go about doing it. You got to figure out what works for you and that might evolve as you practice. But yeah, you've got to look out for number one first.

Dr. Kevin Mailo: [00:20:33] Well, I absolutely love that. So again, for our listeners, I'd encourage you to track down Brad's podcast, The Physician's Guide to Doctoring, and he has got so much great material, so many great episodes with amazing guest speakers. So I'm very honored to have had you today, Brad, joining us on the Physician Empowerment Podcast. And for anyone listening, if you want to be a guest, we're always looking to hear from members of our profession and hear their perspectives and hear what they've got to share. So again, thank you, Brad. Absolutely loved it.

Dr. Bradley Block: [00:21:06] Thank you, Kevin. It's been a lot of fun.

Dr. Kevin Mailo: [00:21:09] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.

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